Placenta Previa Patients Research Articles

Maternal Outcome of Cases of Placenta Previa with and without Morbidly Adherent Placenta at King Abdul-Aziz University Hospital, Saudi Arabia

Introduction: Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent placenta. This morbidly adherent placenta constitutes a serious and possibly a life threatening complication. An efficient team capable for managing possible complicated situations will be able to reduce mortality and morbidity. Objectives: The aim of our study was to evaluate maternal outcome in cases of Placenta Previa with and without morbidly adherent placenta. Methods: Analysis of all pregnancies complicated by antepartum hemorrhage during the period from January 2013 to September 2017 at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA) was done. Cases of Placenta Previa with gestational age > 28 weeks were included. They were classified into 2 groups; Group (A) included Placenta Previa cases without morbidly adherent placenta and Group (B) included cases with morbidly adherent placenta. Maternal outcomes were recorded. Results: Placenta Previa was the leading cause of antepartum hemorrhage constituting 76.8%, out of them 52% were unbooked. Morbidly adherent placenta constituted 13.5% of total Placenta Previa cases and was diagnosed prenatally in only 1 case. Morbidity rate in placenta previa patients with adherent placenta (Group B) was higher than in placenta previa without adherent placenta (Group A). We considered the occurrence of intrapartum hypovolemic shock, Intensive care unit admission, surgical complications and peripartum hysterectomy as parameters for morbidity. P value for hypovolemic shock was insignificant (P = 0.580), significant for Intensive care unit admission (P = 0.008), significant for surgical complications (P = 0.009) and significant for peripartum hysterectomy<span

Bakri balloon placement effectively treats uterine atony and placenta previa

ABSTRACTThe aim of this study was to explore the success rates of Bakri balloon placement in patients with placenta previa and uterine atony. In addition, we compared bilateral internal iliac artery ligation (B-IIAL) and Bakri balloon placement in terms of their ability to inhibit haemorrhage in postpartum placenta previa patients. The hospital reports filed annually from 2010 to 2015 were reviewed. In total, 54 patients were evaluated: 42 patients with placenta previa and uterine atony were treated with Bakri balloons, and 12 placenta previa patients with postpartum haemorrhage underwent B-IIAL when medical treatment failed. The results showed that the success rates of Bakri balloon placement rate in placenta previa and uterine atony patients were 71.4% and 89.2%, respectively. The comparative analysis of placenta previa patients treated via Bakri balloon placement and B-IIAL showed that the requirements for packed red blood cell and fresh frozen plasma, pre- and post-partum haemoglobin levels, pre- and post-partum platelet counts, and hospitalization times differed significantly between the two groups (all p < 0.05). Bakri balloon tamponade could be considered an effective treatment for placenta previa and uterine atony. The technique is minimally invasive and can serve as a second-line treatment for patients with postpartum haemorrhage when medical procedures fail.

Intraoperative Hemorrhage in a Dangerous Placenta Previa Patient-A Case Report

Dangerous placenta previa refers to somebody has a history of cesarean section while this pregnancy was placenta previa with the placenta attached to the original scar. The placenta can be adhered to the surface of the uterus, invasion into myometrium or completely penetrate the muscle and tissues in these placenta previa patients. It happens in these persons like older maternal ages (over 35 years), the frequency of pregnancy, history of previous cesarean section and so on [1-6]. Placenta implantation is a kind of serious complications of placenta which is mainly caused by placental villi penetrating into the myometrium. Now we would talk about our treatment of a dangerous placenta previa patient with intraoperative hemorrhage which could provide a reference in this kind of case.

Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy

Morbidly adherent placenta (MAP) is a growing concern currently and is still a diagnostic challenge for obstetricians. As emergency hysterectomy due to unscheduled delivery in MAP carries significant risks, we aimed to evaluate whether first and second trimester serum analytes may be used in the prediction of MAP requiring hysterectomy. A retrospective chart review of all identified cases of placenta previa totalis with and without MAP was performed. A total of 316 pregnant women diagnosed as placenta previa totalis were identified and included in the analysis. Cases were examined in three groups (Group 1: 204 nonadherent placenta previa patients; Group 2: 61 MAP patients managed with endouterine hemostatic square sutures and/or Bakri balloon tamponade; and Group 3: 51 patients with MAP requiring hysterectomy). Among all first and second trimester screening analytes only maternal serum alphafetoprotein (MS-AFP) levels were significantly higher in patients with MAP requiring hysterectomy (p < 0.001). According to the Receiver Operating Characteristic (ROC) analysis performed for the predictive value of MS-AFP levels, the area under the curve (AUC) was 0.742 [95% confidence interval (CI): 0.505–0.979]. The best MS-AFP cut-off value was 1.25 multiple of the median (MoM) with 85.94% sensitivity and 71.43% specificity (p = 0.036). The best predictors which affect the increased risk of hysterectomy, was further evaluated by multivariate logistic regression analyses. Only elevated maternal serum alphafetoprotein (MS-AFP) was found to be an independent predictor of MAP requiring hysterectomy [odds ratio (OR) = 25.329, 95% confidence interval (CI):1.487–43.143, p = 0.025]. In conclusion, increased second trimester MS-AFP levels independently predict morbidly adherent placenta requiring hysterectomy among women with placenta previa totalis.

A Rho-associated kinase inhibitor, Y-27632, improves cytotrophoblast culture efficiency by enhancing adhesion and differentiation

TNF-related apoptosis-inducing ligand receptor-2 (TRAIL-R2) is produced both by decidual and trophoblast cells during pregnancy and known to participate in apoptosis. In this study, we aimed to determine and to compare maternal serum and placental TRAIL-R2 levels in patients with placenta accreta, non-adherent placenta previa and in healthy pregnancies. We also aimed to analyze the association of placenta accreta with the occurrence of previous C-sections.A total of 82 pregnant women were enrolled in this case–control study (27 placenta accreta patients, 26 non-adherent placenta previa patients and 29 age-, and BMI-matched healthy, uncomplicated pregnant controls). TRAIL-R2 levels were studied in both maternal serum and placental tissue homogenates. Determining the best predictor(s) which discriminate placenta accreta was analyzed by multiple logistic regression analyses. Adjusted odds ratios and 95% confidence intervals were also calculated.Both placental and serum TRAIL-R2 levels were significantly lower in placenta accreta group (median 34.82 pg/mg and 19.85 pg/mL, respectively) when compared with both non-adherent placenta previa (median 39.24 pg/mg and 25.99 pg/mL, respectively) and the control groups (median 41.62 pg/mg and 25.87 pg/mL, respectively) (p < 0.05). Placental TRAIL-R2 levels and previous cesarean section were found to be significantly associated with placenta accreta (OR: 0.934 95% CI 0.883–0.987, p = 0.016 and OR:7.725 95% CI: 2.717–21.965, p < 0.001, respectively). Placental and serum TRAIL-R2 levels were positively correlated.Decreased levels of placental TRAIL-R2 and previous history of cesarean section were found to be significantly associated with placenta accreta, suggesting a possible role of apoptosis in abnormal trophoblast invasion.

Risk factors of peripartum hysterectomy in placenta previa: a retrospective study of 3 840 cases

To investigate the risk factors of peripartum hysterectomy in placenta previa through retrospective study of 3 840 placenta previa cases. The clinical data of 3 840 patients with placenta previa who delivered in West China Second University Hospital between Jan 2005 and June 2014 were analyzed retrospectively. The relationship of certain factors and peripartum hysterectomy was analyzed, including maternal age, residence place, parity, prior curettage, prior cesarean section, twin or multiple pregnancy, antenatal vaginal bleeding, type of placenta previa, suspected placenta accreta, antenatal level of hemoglobin and gestational age at delivery. The prevalence of placenta previa was 4.84%(3 840/79 304)in West China Second University Hospital during the study period, and the incidence of preipartum hysterectomy in patients with placenta previa was 2.76%(106/3 840). One-factor analysis demonstrated that residence place, parity, times of prior curettage, prior cesarean section, prenatal vaginal bleeding, anterior placenta, type of placenta previa, placenta accreta, antenatal anemia and gestational age at delivery were potential risk factors for peripartum hysterectomy(P<0.01). Variables with P<0.1 in one-factor analysis were introduced to multi-factor logistic regression analysis, which suggested that one prior cesarean section(OR=12.9,95% CI:6.3-26.3), two or more prior cesarean sections(OR=14.4, 95%CI:3.9-53.2), anterior placenta(OR=4.8, 95%CI:2.1-10.7), complete placenta previa(OR=5.9, 95%CI: 1.8-42.5), placenta accreta(OR=11.2, 95%CI:6.8-18.6), antenatal hemoglobin<100 g/L(OR=1.7, 95%CI: 1.0-2.8)and delivery before 34 gestational weeks(OR=3.2, 95%CI: 1.6-6.3)were independent risk factors of peripartum hysterectomy in patients with placenta previa(P<0.05). Prior cesarean section, anterior placenta, complete placenta previa, placenta accreta, antenatal anemia and delivery before 34 gestational weeks are high risk factors of peripartum hysterectomy in placenta previa patients. Perinatal care and risk evaluation before cesarean section are important to improve perinatal outcomes and reduce peripartum hysterectomy.

A retrospective analysis on the pernicious placenta previa from 2008 to 2014

To investigate the incidence changes, clinical characteristics and pregnant outcomes of pernicious placenta previa. A retrospective cohort analysis on 316 cases with placenta previa in the Peking University First Hospital from January 2008 to December 2014. The research group were 60 cases with the patients of placenta previa with the history of cesarean section, and the control group were placenta previa without the history of cesarean section. Compared with the incidence, intraoperative blood loss, the pregnancy outcomes and so on. (1) The average incidence rate of placenta previa during the past 7 years was 10.96 ‰ (316/28 837). And the cases of pernicious placenta previa was 60 (2.08‰, 60/28 837), the incidence of pernicious placenta previa was rising from 2008 to 2014 (0.91‰-3.08‰). (2) There were 145 cases of placenta privia had been translation from other hospitals in the past 7 years. The referral rate of pregnant women with placenta previa was 45.9% (145/316), and the referral rate of pernicious placenta previa (63.3%, 38/60) was significantly higher than that of non-pernicious placenta previa group (41.8%, 107/256; χ(2)=9.080, P=0.003). Referral the outcomes of these patients were good, and no maternal death occurred. (3) The placenta in the research group were mainly adhered in the front wall of the uterine, and the incidence was 38.5% (15/39), higher than that in the group of non-pernicious placenta previa (12.1%, 21/174; χ(2)=57.636, P<0.01). The incidence rate of complicated placenta increased in research group was 53.3% (32/60), higher than that in the group of non-pernicious placenta previa, compared with the control group, there was significant difference (15.6%, 40/256; χ(2)= 39.041, P<0.01). (4) The incidence of blood loss was more than 1 000 ml, blood transfusion rate, the rate of hysterectomy and the rate of asphyxia of newborn in the research group were respectively 41.7% (25/60), 38.3% (23/60), 8.3% (5/60), 15.0% (9/60), and the incidence of the group of non-pernicious placenta previa were respectively 4.7% (12/256), 12.9% (33/256), 1.2% (3/256), 8.6% (22/256), compared those in other two groups, there were not significant difference (P<0.05). The incidence rate of placenta previa increased year by year, patients with placenta previa has a history of cesarean section often combined with placenta in anterior wall of the uterus, and often with poor pregnancy outcomes. Hierarchical referral system is an effective means to reduce the mortality of the pernicious placenta previa.

Decreased placental and maternal serum TRAIL-R2 levels are associated with placenta accreta

ObjectivesTNF-related apoptosis-inducing ligand receptor-2 (TRAIL-R2) is produced both by decidual and trophoblast cells during pregnancy and known to participate in apoptosis. In this study, we aimed to determine and to compare maternal serum and placental TRAIL-R2 levels in patients with placenta accreta, non-adherent placenta previa and in healthy pregnancies. We also aimed to analyze the association of placenta accreta with the occurrence of previous C-sections. Study designA total of 82 pregnant women were enrolled in this case–control study (27 placenta accreta patients, 26 non-adherent placenta previa patients and 29 age-, and BMI-matched healthy, uncomplicated pregnant controls). TRAIL-R2 levels were studied in both maternal serum and placental tissue homogenates. Determining the best predictor(s) which discriminate placenta accreta was analyzed by multiple logistic regression analyses. Adjusted odds ratios and 95% confidence intervals were also calculated. ResultsBoth placental and serum TRAIL-R2 levels were significantly lower in placenta accreta group (median 34.82 pg/mg and 19.85 pg/mL, respectively) when compared with both non-adherent placenta previa (median 39.24 pg/mg and 25.99 pg/mL, respectively) and the control groups (median 41.62 pg/mg and 25.87 pg/mL, respectively) (p < 0.05). Placental TRAIL-R2 levels and previous cesarean section were found to be significantly associated with placenta accreta (OR: 0.934 95% CI 0.883–0.987, p = 0.016 and OR:7.725 95% CI: 2.717–21.965, p < 0.001, respectively). Placental and serum TRAIL-R2 levels were positively correlated. ConclusionDecreased levels of placental TRAIL-R2 and previous history of cesarean section were found to be significantly associated with placenta accreta, suggesting a possible role of apoptosis in abnormal trophoblast invasion.

A Study On Maternal And Neonatal Outcomes In Placenta Previa In A Tertiary Level Hospital In India

Background: Placenta previa should be suspected in any woman beyond 20 weeks of gestation who presents with painless vaginal bleeding. Rapid and significant loss of intravascular volume can lead to hemodynamic instability, decreased tissue perfusion, cellular hypoxia, organ damage, and death. The aim of this study was to describe the clinical outcomes in placenta previa patients. Methods: We enrolled patients presenting to our emergency ward or outpatient clinic with diagnosis of placenta previa from October 1, 2013 till September 30, 2015. Detailed maternal history and demographic profile was obtained for all included patients. Results of all ordered laboratory and ultrasound examination were noted for all included patients. Results: 44 patients satisfied our inclusion and exclusion criteria during the study period. With 3.8 as the mean parity and 35.7 years as the mean age at delivery, 13 had previous vaginal deliveries, 14 had lower section cesarean sections and 10 had a history of abortions. 8 patients had type I placenta previas, 12 type II, 9 type III and 10 type IV placenta previa. Estimated blood loss was approxiamtely 811.7 mL. 2 mothers had to admitted to the intensive care unit after delivery and 14 were admitted to the maternal indoor unit. Mean post-operative hospital stay was 4.2 days. During the study period there were 27 live births, 7 neonatal deaths, 8 were still births. There were 12 babies who were admitted in the neonatal intensive care unit. Mean birth weight of the neonates was 3.8 kgs. There were 13 neonates with an APGAR score of less than 7. Conclusion: Placenta previa increases the risk of antepartum intrapartum and postpartum hemorrhage. In this article we have described our experience of maternal and neonatal outcomes in patients presenting with placenta previa at a tertiary level hospital in Aurangabad

Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients.

PurposeThe aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation.MethodsWe reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL.ResultsSixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20–1200 mL) in the balloon failure group and 60 mL (5–500 mL) in the balloon success group (p<0.01).ConclusionIntrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.

OC20.06: Usefulness of uterine artery Doppler velocimetry in diagnosing placenta accreta in placenta previa patients

<scp>OC</scp>20.06: Usefulness of uterine artery Doppler velocimetry in diagnosing placenta accreta in placenta previa patients

Clinical Analysis of Placenta Previa Complicated with Previous Caesarean Section

To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. The clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period. There was no difference in the mean age (28.9±3.6 vs.28.1±4.5 years) and the average gravidity (2.35±1.48 vs.2.21±1.53) between RCS group and FCS group (all P>0.05).The RCS group had more preterm births (24.1% vs.13.2%), complete placenta previa (55.2% vs.4.9%), placenta accreta (34.5% vs.2.5%), more blood loss during caesarean section (1412±602 vs.648±265 mL), blood transfusion (51.7% vs.4.9%), disseminated intravascular coagulation (13.8% vs.2.1%), and obstetric hysterectomy (13.8% vs.0.8%) than the FCS group (all P<0.05).The preterm infant rate (30.0% vs.13.0%), neonatal asphyxia rate (10.0% vs.4.9%), and perinatal mortality rate (6.7% vs.0.4%) of the RCS group were higher than those of the FCS group (all P<0.05). More patients had complete placenta previa and placenta accreta, postpartum hemorrhage, transfusion, uterine packing, obstetric hysterectomy, and perinatal morbidity in the placenta previa patients with previous caesarean section.The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.

Relationship between the incidence change in placenta previa and the proportion change of puerpera with abortion history

Objective To explore the change of the placenta previa incidence, and analyze the relationship between abortion rate and it, looking for corresponding prevention countermeasures for placenta previa. Methods With retrospective analysis method, 496 cases of placenta previa in 20 years were analyzed comparing with those cases with past abortion puerpera history. Results The placenta previa incidence is 1.01％, and it increased significantly over the past 15 years. The constituent ratios of central type placenta previa significantly increased too. The abortion history has a high proportion in the placenta previa patients. The past puerpera abortion incidence was 33.6％, which rose dramatically over the past 15 years. Conclusion The past puerpera abortion incidence' s increasing may be the reason why incidence of the placenta previa rises. Key words: Placenta previa; Abortion; Incidence; Change

Risk Factors of Neonatal Anemia in Placenta Previa

Placenta previa is a major cause of neonatal anemia. The purpose of this study was to elucidate the risk factors of neonatal anemia in placenta previa. The study was conducted on 158 placenta previa patients at 3 hospitals in affiliation with the Catholic Medical Center, Seoul, Korea from May 1999 through December 2009. The subjects were divided in to 2 groups: 47 placenta previa patients with neonatal anemia, and 113 placenta previa patients without neonatal anemia. The subjects' characteristics were compared. Logistic regression was used to control for confounding factors. Anterior placental location (OR 2.48; 95% CI: 1.20-5.11) was an independent risk factor of neonatal anemia after controlling for potential confounders. To manage neonatal anemia in placenta previa patients, obstetricians should do their best to detect placental location. Pediatricians should consider the high possibility of neonatal anemia in cases involving anterior placental location.

Maternal Outcomes According to Placental Position in Placental Previa

The purpose of this retrospective cohort study was to elucidate whether the location of placenta below uterine incision in cesarean section is important in the development of maternal complications in placenta previa patients. The study was conducted on 409 patients 414 parturition at 3 hospitals in affiliation with the Catholic Medical Center, Seoul, Korea from May 1999 to December 2009. The subjects were divided to two groups: the group whose placenta was located in the anterior portion of the uterus (anterior group) and the group whose placenta was located in the posterior portion of the uterus (posterior group). And then they are compared to each other. Logistic regression was used to control for confounding factors. In the anterior group, regardless of confounding factors, the incidence of excessive blood loss (OR 2.97; 95% CI: 1.64-5.37), massive transfusion (OR 3.31; 95% CI: 1.33-8.26), placental accreta (OR 2.60, 95% CI: 1.40-4.83), and hysterectomy (OR 3.47, 95% CI: 1.39-8.68) was higher. Sonographic determination of the placental position where its location beneath the uterine incision is very important to predict maternal outcomes in placenta previa patients, and such cases, close attention should be paid for massive hemorrhage.

Evaluation of “J”-shaped uterine incision during caesarean section in patients with placenta previa: A retrospective study

This study evaluated the efficacy and safety of "J"-shaped uterine incision for caesarean section for patients diagnosed with placenta previa. A total of 55 consecutive cases of placenta previa treated in Union Hospital were retrospectively analyzed over a period of two years and 10 months. The subjects were divided into two groups with respect to the uterine incision. Twenty-four pregnant women with placenta previa who were indicated for caesarean section underwent the procedure using a new "J"-shaped uterine incision and 31 pregnant women with placenta previa received caesarean section that used the traditional transverse incision. The two groups were compared in terms of operation time, estimated blood loss, infant expulsion time, exhaust time and postoperative recovery. Meanwhile, comparison was also made in neonatal clinical data between the two groups. Compared with the "J"-shaped incision group, the traditional incision group had a lower Apgar scores (P<0.05). However, there existed no statistically significant differences in the overall time of operation and postoperative period of breaking wind (P>0.05). It is concluded that, with caesarean section for placenta previa patients, the "J"-shaped uterine incision significantly decreases intraoperative blood loss and facilitates the fetal delivery.

Placenta previa-accreta: Risk factors and complications

The purpose of this study was to identify risk factors and complications of placenta previa-accreta (PA). Patients with placenta previa (n = 347) delivered over 20 years were reviewed, divided into PA (cases, n = 22) and no accreta (controls, n = 325), and compared. Cases were older with a higher incidence of smoking and previous cesarean delivery (CS). Grandmultiparity, recurrent abortions, anterior/central placentae, and low socioeconomic status were similar. PA incidence increased with the number of previous CS: 1.9%, 15.6%, 23.5%, 29.4%, 33.3%, and 50.0% after 0, 1, 2, 3, 4, and 5 previous CS, respectively. Hypertensive disorders (odds ratio [OR] 13.9, 95%CI 2.1-91.2], P = .006), smoking (OR 3.4, 95%CI 1.1-10.2, P = .031) and previous CS (OR 7.9, 95%CI 1.7-37.4, P = .009) were selected by the stepwise logistic regression analysis as predictors of PA. Cases had a longer hospital stay, a higher estimated blood loss, and need for transfusion. Cesarean hysterectomy and hypogastric artery ligation were only performed in PA cases. The 2 groups had a similar delivery gestational age and neonatal outcome. Hypertensive disorders, smoking, and previous cesarean are risk factors for accreta in placenta previa patients. Placenta previa-accreta is associated with higher maternal morbidity, but similar neonatal outcome compared with patients with an isolated placenta previa.

Placenta Prévia: Fatores de risco para o Acretismo

Objetivo: investigação dos fatores de risco associados ao acretismo em pacientes com placenta prévia (PP). Métodos: foi realizada uma análise retrospectiva caso-controle de todos os prontuários de pacientes com diagnóstico de PP que tiveram seus partos na Maternidade Escola Vila Nova Cachoeirinha (São Paulo) entre 1986 e 1998. O grupo com acretismo foi comparado ao grupo sem acretismo quanto à idade, paridade, antecedentes de abortamentos, curetagens e cesarianas, o tipo de PP e a área predominante de inserção placentária. Para avaliar a associação entre a variável dependente (acretismo placentário) e as variáveis independentes (características maternas e placentária) foram utilizados o teste do chi², análise univariada e multivariada, considerando-se significantes os valores de p < 0,05. Resultados: o levantamento de 245 casos de PP evidenciou que os fatores de risco, significativamente associados ao acretismo, foram o tipo de PP centro-total (odds ratio (OR): 2,93) e o antecedente de duas ou mais cesarianas (OR: 2,54). Utilizando estes resultados foi possível construir um modelo preditivo para a probabilidade de ter acretismo, segundo o qual uma paciente com PP centro-total e duas ou mais cesáreas teria uma probabilidade de 44,4% de apresentar acretismo placentário. Conclusões: os resultados deste estudo podem ajudar o obstetra a classificar suas gestantes com PP em diferentes categorias de risco para o acretismo, o que possibilita a adoção de medidas apropriadas para lidar com possíveis complicações no parto daquelas pacientes com maior risco de acretismo.

Observations on a short series of placenta previa patients delivered by abdominal cesarean section at the Boston Lying-In Hospital

Observations on a short series of placenta previa patients delivered by abdominal cesarean section at the Boston Lying-In Hospital