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 Impact of epidural labor analgesia using sufentanil combined with low-concentration ropivacaine on maternal and neonatal outcomes: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Le Zhang ◽  
Chengjie Xu ◽  
Yue Li
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Postpartum Hemorrhage ◽  
Retrospective Cohort ◽  
Fetal Distress ◽  
Labor Analgesia ◽  
Neonatal Outcomes ◽  
Apgar Scores ◽  
Maternal And Neonatal Outcomes ◽  
First Stage Of Labor

Abstract Background Whether epidural administered sufentanil combined with low-concentration ropivacaine affected labor progress as well as maternal and neonatal outcomes still remained unknown. The aim of this study was to assess the impact of epidural sufentanil plus ropivacaine on maternal and neonatal outcomes. Methods This is a retrospective cohort study. Data of singleton full-term pregnancy women who received epidural labor analgesia for vaginal delivery from May 2018 to June 2020 were collected. Parturients were divided into two groups (the R group and the SR group) according to different medication regimens for epidural labor analgesia. The implementation of epidural analgesia during labor was performed with 0.167 % ropivacaine in the R group and 0.1 % ropivacaine in combination with 0.5 µg/ml sufentanil in the SR group. The primary outcome of our study included the duration of labor progress and the incidence of maternal fever, postpartum hemorrhage, fetal distress and neonatal Apgar scores less than 7 at 1 and 5 min. The secondary outcome included the incidence of episiotomy, instrumental delivery, caesarean section and grade III meconium-stained amniotic fluid. Results There were a total 3778 deliveries during the study period, 1994 and 1784 parturients were included in the R group and in the SR group, respectively. The length of the first stage of labor was remarkably shorter in the R group in comparison to the SR group (548.0 ± 273.0 vs. 570.9 ± 273.0, P = 0.013). No significant difference was found in the incidence of maternal fever, postpartum hemorrhage, fetal distress and in the neonatal Apgar scores less than 7 at 1 and 5 min between two groups. Other Maternal outcomes were comparable in the R group and the SR group. Conclusions 0.5 µg/ml sufentanil plus 0.1 % ropivacaine for epidural labor analgesia prolonged the duration of the first stage of labor, but did not have additional impact on maternal and neonatal outcomes compared with the sole 0.167 % ropivacaine. Trial registration Clinical Research Information Service with registration number ChiCTR2100045162. Registered 7 April 2021.

scholarly journals Comparison of Maternal and Neonatal Outcomes between Acute Fatty Liver of Pregnancy and Hemolysis, Elevated Liver Enzymes and Low Platelets Syndrome: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Sau Xiong Ang ◽  
Chie-Pein Chen ◽  
Fang-Ju Sun ◽  
Chen-Yu Chen
Keyword(s):  
Cohort Study ◽  
Fatty Liver ◽  
Retrospective Cohort Study ◽  
Hellp Syndrome ◽  
Retrospective Cohort ◽  
Liver Enzymes ◽  
Neonatal Outcomes ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver ◽  
Maternal And Neonatal Outcomes

Abstract Background: Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome.Methods: This retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were analyzed.Results: During the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0% versus 23.8%) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7% versus 13.8%), acute kidney injury (61.9% versus 15.0%), disseminated intravascular coagulopathy (66.7% versus 8.8%), and sepsis (47.6% versus 10.0%) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1% versus 33.3%), neonatal respiratory distress syndrome (39.2% versus 8.3%) and neonatal sepsis (34.2% versus 12.5%) were noted in the HELLP syndrome group.Conclusions: AFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

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.

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