Severe outcomes and strategies for the prediction and treatment in
pregnancies with pernicious placenta previa and prior cesarean delivery
-- a national retrospective study
Abstract
Objectives To evaluate the severe outcomes in pregnancies with
pernicious placenta previa and prior cesarean delivery, and to analyze
the predictive examinations and prevention strategies regarding severe
complications in these women. Design Multicentre retrospective cohort
study. Setting Thirteen hospitals in China. Population Selected 747
women with pernicious placenta previa and prior cesarean history.
Methods The basic data relating to pregnancy, the examinations during
gestation and the outcomes were collected and analyzed. Main outcome
measures Outcomes including massive bleeding, placenta implantation and
hysterectomy were monitored. Results Our results showed that placental
implantation occurred in 47.5% of patients and the hysterectomy rate
was 10.4%. The incidence of massive bleeding and blood transfusion was
55.8% and 64%, respectively. The women with placenta implantation
predicted by both ultrasound and MRI had higher blood loss than those
diagnosed only by either one of the examinations. Surprisingly, vascular
occlusion had no effect on the occurrence of severe hemorrhage and
hysterectomy. The latter was even higher in the vascular blocking group
compared to that in the non-blocking group (34.2% and 8.6%,
respectively). Conclusions: The pregnancies with pernicious placenta
previa and prior cesarean delivery, had a dramatically higher risk of
placenta implantation, hysterectomy and massive hemorrhage. MRI combined
with ultrasound examination presented high accuracy in predicting severe
outcomes in these patients. Vascular occlusion does not appear to be an
effective approach to prevent severe outcomes. Surgical hemostasis
should be the key goal in blocking massive bleeding, preserving the
uterus and improving the prognosis of the patients.