Comparison of Adverse Maternal and Neonatal Outcomes in Women Affected by Placenta Previa With and Without a History of Cesarean Delivery: A Cohort Study

2021 ◽  
Author(s):  
Ri-hua Xie ◽  
Sihao Zeng ◽  
Lepeng Zhou ◽  
Suiwen Wen ◽  
Yan Liao ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cesarean Delivery ◽  
Placenta Previa ◽  
Neonatal Outcomes ◽  
History Of ◽  
Maternal And Neonatal Outcomes

scholarly journals Anesthetic management in cesarean delivery of women with placenta previa: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dazhi Fan ◽  
Jiaming Rao ◽  
Dongxin Lin ◽  
Huishan Zhang ◽  
Zixing Zhou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Transfusion ◽  
Blood Loss ◽  
General Anesthesia ◽  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Placenta Previa ◽  
Neuraxial Anesthesia ◽  
Estimated Blood Loss ◽  
Maternal And Neonatal Outcomes

Abstract Background The incidence of placenta preiva is rising. Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa. Anesthesia is important during the cesarean delivery. The aim of this study is to assess maternal and neonatal outcomes of patients with placenta previa managed with neuraxial anesthesia as compared to those who underwent general anesthesia during cesarean delivery. Methods A retrospective cohort study was performed of all patients with placenta preiva at our large academic institution from January 1, 2014 to June 30, 2019. Patients were managed neuraxial anesthesia and general anesthesia during cesarean delivery. Results We identified 1234 patients with placenta previa who underwent cesarean delivery at our institution. Neuraxial anesthesia was performed in 737 (59.7%), and general anesthesia was completed in 497 (40.3%) patients. The mean estimated blood loss at neuraxial anesthesia of 558.96 ± 42.77 ml were significantly lower than the estimated blood loss at general anesthesia of 1952.51 ± 180 ml (p < 0.001). One hundred and forty-six of 737 (19.8%) patients required blood transfusion at neuraxial anesthesia, whereas 381 out of 497 (76.7%) patients required blood transfusion at general anesthesia. The rate neonatal asphyxia and admission to NICU at neuraxial anesthesia was significantly lower than general anesthesia (2.7% vs. 19.5 and 18.2% vs. 44.1%, respectively). After adjusting confounding factors, blood loss was less, Apgar score at 1- and 5-min were higher, and the rate of blood transfusion, neonatal asphyxia, and admission to NICU were lower in the neuraxial group. Conclusions Our data demonstrated that neuraxial anesthesia is associated with better maternal and neonatal outcomes during cesarean delivery in women with placenta previa.

scholarly journals Clinical outcomes of placenta previa with and without coverage of a uterine scar: A retrospective cohort study in a tertiary hospital

2019 ◽  
Author(s):  
Jiaming Rao ◽  
Dazhi Fan ◽  
Zixing Zhou ◽  
Gengdong Chen ◽  
Huiting Ma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postpartum Hemorrhage ◽  
Retrospective Cohort ◽  
Placenta Previa ◽  
Fetal Distress ◽  
Neonatal Outcomes ◽  
Intraoperative Blood Loss ◽  
Maternal And Neonatal Outcomes ◽  
Uterine Scar ◽  
Singleton Pregnancies

Abstract Background To compare the maternal and neonatal outcomes of placenta previa (PP) with and without coverage of a uterine scar in China. Methods A retrospective cohort study comparing all singleton pregnancies with PP was conducted at a tertiary, university-affiliated medical center between January 2012 and April 2017. Maternal and neonatal outcomes of PP with and without coverage of a uterine scar were compared. Results There were 58,062 deliveries during the study period, of which 738 (1.27%) were complicated PP in singleton pregnancies and were further classified into two groups: the PP with coverage of a uterine scar group (PPCS, n=166) and the PP without coverage of a uterine scar group (Non-PPCS, n=572). Overall, the PPCS group had poorer maternal and neonatal outcomes for premature birth (< 37 weeks,68.1% vs 54.8%; P=0.010), cesarean section(100% vs 97.6%; P=0.042), Intraoperative blood loss > 1000 ml (78.3% vs 16.0%; P<0.001) or > 3000ml (29.5% vs 3.0%; P<0.001), postpartum hemorrhage(48.8% vs 15.7%; P<0.001), transfusion (35.2% vs 16.1%; P<0.001), hemorrhage shock(8.4% vs 1.9%; P<0.001), hysterectomy (3.0% vs 0.5%; P=0.006) and fetal distress (36.1% vs 12.0%; P<0.001) than the Non-PPCS group. In pregnancies complicated without abnormal invasive placenta (AIP, n=587), the PPCS group had poorer maternal and neonatal outcomes for Intraoperative blood loss > 1000 ml (69.0% vs 12.5%; P<0.001) or > 3000ml (9.2% vs 1.0%; P<0.001), bleeding within 2-24 hours after delivery (114.7±283.9 vs 47.7±45.1 ml, P<0.001), postpartum hemorrhage (70.1% vs 15.2%, P<0.001), transfusion (28.7% vs 13.6%, P<0.001) and fetal stress (35.6% vs 11.4%, P<0.001) than the Non-PPCS group. Conclusion The PPCS group had poorer maternal and neonatal outcomes than the Non-PPCS group. Women with PPCS were more likely to have intraoperative and postpartum hemorrhage, transfusion and fetal distress, even without AIP.

scholarly journals Maternal and neonatal outcomes of placenta previa with and without coverage of a uterine scar: A retrospective cohort study in a tertiary hospital

2020 ◽  
Author(s):  
Jiaming Rao ◽  
Dazhi Fan ◽  
Zixing Zhou ◽  
Gengdong Chen ◽  
Pengsheng Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort ◽  
Placenta Previa ◽  
Fetal Distress ◽  
Neonatal Outcomes ◽  
Intraoperative Blood Loss ◽  
Maternal And Neonatal Outcomes ◽  
Uterine Scar ◽  
Singleton Pregnancies

Abstract Background To compare the maternal and neonatal outcomes of placenta previa (PP) with and without coverage of a uterine scar in Foshan, China. Methods A retrospective cohort study comparing all singleton pregnancies with PP was conducted at a tertiary, university-affiliated medical center from 1 January 2012 to 31 April 2017 in Foshan, China. Demographic, clinical and laboratory data were extracted from electronic medical records. Maternal and neonatal outcomes of PP with and without coverage of a uterine scar were compared by statistical method. Results There were 58,062 deliveries during the study period, of which 738 (1.27%) were complicated PP in singleton pregnancies and were further classified into two groups: the PP with coverage of a uterine scar group (PPCS, n = 166) and the PP without coverage of a uterine scar group (Non-PPCS, n = 572). Overall, premature birth (< 37 weeks,68.1% vs 54.8%; P = 0.010), cesarean section(100% vs 97.6%; P = 0.042), Intraoperative blood loss > 1000 ml (78.3% vs 16.0%; P < 0.001) or > 3000 ml (29.5% vs 3.0%; P < 0.001), postpartum hemorrhage(48.8% vs 15.7%; P < 0.001), transfusion (35.2% vs 16.1%; P < 0.001), hemorrhage shock(8.4% vs 1.9%; P < 0.001), hysterectomy (3.0% vs 0.5%; P = 0.006) and fetal distress (36.1% vs 12.0%; P < 0.001) had a significant difference between PPCS group and Non-PPCS group. After grouping by whether complicated with AIP, we found that PPCS was significant associated with more intraoperative blood loss༞1000 ml, intraoperative blood loss༞3000 ml, bleeding within 2–24 hours after delivery, fetal distress and higher hospitalization expenses than the Non-PPCS group. After grouping by whether complicated with AIP and different placenta positions(Anterior, Posterior and Ante-posterior or laterally positioned), we found that PPCS was significant associated with more intraoperative blood loss༞1000 ml and higher hospitalization expenses than the Non-PPCS in AIP women and more intraoperative blood loss༞1000 ml, postpartum hemorrhage and higher hospitalization expenses in Non-AIP women. Conclusion The PPCS group had poorer maternal and neonatal outcomes than the Non-PPCS group after grouping by whether pregnancies complicated with AIP or with different placental positions.

scholarly journals Maternal and neonatal outcomes in transverse and vertical skin incision for placenta previa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dazhi Fan ◽  
Huishan Zhang ◽  
Jiaming Rao ◽  
Dongxin Lin ◽  
Shuzhen Wu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cesarean Delivery ◽  
Placenta Previa ◽  
Skin Incision ◽  
Neonatal Outcomes ◽  
Lower Percentage ◽  
Estimated Blood Loss ◽  
Maternal And Neonatal Outcomes ◽  
Transverse Skin Incision ◽  
Vertical Skin Incision

Abstract Background Placenta previa, a serious obstetric issue, should be managed by experienced teams. The safe and appropriate mode of delivery for placenta previa is by cesarean delivery. However, no studies were found comparing either maternal or neonatal outcomes for different skin incision in women with placenta previa. The aim of this study was to compare maternal and neonatal outcomes by skin incision types (transverse compared with vertical) in a large cohort of women with placenta previa who were undergoing cesarean delivery. Methods This was a retrospective cohort study carried out between January 2014 and June 2019. All pregnant women with placenta previa had confirmed by ultrasonologist before delivery and obstetrician at delivery. The primary outcome was the estimated blood loss during the surgery and within the first 24 hours postoperatively. Mean (standard deviation), median (interquartile range) or frequency (percentage) was reported to variables. Appropriate parametric and nonparametric tests were used to analyses. Results The study included 1098 complete records, 332 (30.24%) cases in the vertical skin incision group and 766 (69.76%) cases in the transverse skin incision group. Those with vertical incision showed a higher percentage of preterm delivery, anterior placenta, abnormally invasive placenta, and history of previous cesarean delivery, and a lower percentage of first pregnancy, in vitro fertilization, and emergency cesarean delivery. After controlling for confounding factors, higher incidence of post-partum hemorrhage (OR 5.47, 95% CI 3.84–7.79), maternal intensive care unit (OR 4.30, 95% CI 2.86–6.45), transfusion (OR 5.97, 95% CI 4.15–8.58), and 5-min APGAR< 7 (OR 9.03, 95% CI 1.83–44.49), a more estimated blood loss (β 601.85, 95%CI 458.78–744.91), and a longer length of hospital stay after delivery (β 0.54, 95%CI 0.23–0.86) were found in the vertical skin incision group. Conclusions Our data demonstrated that transverse skin incision group showed the better perinatal outcomes in women with placenta previa. Future collaborative studies are needed to be done by centers for placenta previa to have a better understanding of the characteristics and the outcomes of the disease in the choosing skin incision.

scholarly journals The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Bi Shilei ◽  
Zhang Lizi ◽  
Li Yulian ◽  
Liang Yingyu ◽  
Huang Lijun ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Postpartum Hemorrhage ◽  
Placenta Previa ◽  
Subsequent Pregnancy ◽  
Abnormal Placentation ◽  
Historical Cohort ◽  
Historical Cohort Study ◽  
History Of

Background: Prior prelabor cesarean delivery (CD) was associated with an increase in the risk of placenta previa (PP) in a second delivery, whether it may impact postpartum hemorrhage (PPH) independent of abnormal placentation. This study aimed to assess the risk of PPH stratified by abnormal placentation following a first CD before the onset of labor (prelabor) or intrapartum CD.Methods: This multicenter, historical cohort study involved singleton, pregnant women at 28 weeks of gestation or greater with a CD history between January 2017 and December 2017 in 11 public tertiary hospitals within 7 provinces of China. PPH was analyzed in the subsequent pregnancy between women with prior prelabor CD and women with intrapartum CD. Furthermore, PPH was analyzed in pregnant women stratified by complications with PP alone [without placenta accreta spectrum (PAS) disorders], complications with PP and PAS, complications with PAS alone (without PP), and normal placentation. We performed multivariate logistic regression to calculate adjusted odds ratios (aOR) and 95% CI controlling for predefined covariates.Results: Out of 10,833 pregnant women, 1,197 (11%) women had a history of intrapartum CD and 9,636 (89%) women had a history of prelabor CD. Prior prelabor CD increased the risk of PP (aOR 1.91, 95% CI 1.40–2.60), PAS (aOR 1.68, 95% CI 1.11–2.24), and PPH (aOR 1.33, 95% CI 1.02–1.75) in a subsequent pregnancy. After stratification by complications with PP alone, PP and PAS, PAS alone, and normal placentation, prior prelabor CD only increased the risk of PPH (aOR 3.34, 95% CI 1.35–8.23) in a subsequent pregnancy complicated with PP and PAS.Conclusion: Compared to intrapartum CD, prior prelabor CD increased the risk of PPH in a subsequent pregnancy only when complicated by PP and PAS.

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