Random placenta margin incision for control hemorrhage during cesarean delivery complicated by complete placenta previa: a prospective cohort study

被引:16
作者
Fan, Dazhi [1 ,2 ,3 ]
Wu, Shuzhen [1 ,2 ]
Ye, Shaoxin [1 ,2 ]
Wang, Wen [2 ]
Wang, Lijuan [2 ]
Fu, Yao [2 ]
Zeng, Meng [2 ]
Liu, Yan [2 ]
Guo, Xiaoling [1 ,2 ]
Liu, Zhengping [1 ,2 ]
机构
[1] Southern Med Univ, Affiliated Maternal & Child Hlth Hosp Foshan, Foshan Inst Fetal Med, Foshan, Peoples R China
[2] Southern Med Univ, Affiliated Maternal & Child Hlth Hosp Foshan, Dept Obstet, Foshan, Peoples R China
[3] Anhui Med Univ, Sch Publ Hlth, Dept Epidemiol & Biostat, Hefei, Anhui, Peoples R China
关键词
Cesarean section; complete placenta previa; postpartum hemorrhage; prospective cohort; EMBOLIZATION; PREVALENCE; RISK;
D O I
10.1080/14767058.2018.1457638
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Introduction: Complete placenta previa (CPP) is one of the most problematic types of abnormal placenta, which is further complicated by placenta accreta or percreta that can unexpectedly lead to catastrophic blood loss, infection, multiple complications, emergency hysterectomy, and even death. The present study aimed to assess the efficacy of random placenta margin incision in controlling intraoperative and total blood loss during cesarean section for CPP women.Methods: A prospective cohort study, including a total of 100 consecutive pregnant women with CPP, was performed at a tertiary university-affiliated medical center between March 2016 and July 2017. All of them underwent random placenta margin incision, and intraoperative and total blood loss were analyzed. Through antenatal diagnosis using color Doppler, women were further divided into abnormally invasive placenta (AIP) and non-AIP groups, and anterior and posterior placenta groups. The protocol was registered with the Clinical Trial Registry under registration number NCT02695069.Results: Mean maternal age and gestational age at delivery were 32.265.03 years old and 36.21 +/- 2.07 weeks, respectively. Total duration of the surgical procedure time was 52.50 (42.43-64.00) min. Median estimated intraoperation blood loss was 746.43 (544.44-1092.86) ml. Total blood loss was 875.00 (604.50-1196.67) ml, and 38 (38.0%) had post-partum hemorrhage. The change from baseline in the median hemoglobin level was -0.33 (6.00-13.20). No women underwent hysterectomy due to massive hemorrhage during the study period. No women had an intraoperative urinary bladder injury, postoperative wound infection, and required relaparotomy, owing to intra-abdominal bleeding. The median hospitalization time was 5.41 (4.18-7.58) d.Conclusion: The random placenta margin incision may be a potentially valuable surgical procedure to control the volumes of intraoperative and postoperative blood loss and reduce the incidence of postpartum hemorrhage among women with complete placenta previa.
引用
收藏
页码:3054 / 3061
页数:8
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