Abstract
Amaç: Plasenta previalı (PP) gebelerde acil müdahalenin risk faktörlerini ve sonuçlarını araştırmak.
Gereç ve yöntem: Bu retrospektif çalışma Haziran 2015 ile Ocak 2021 tarihleri arasında yapıldı. PP'li gebeler cerrahi planlamaya göre acil ve planlı müdahale gruplarına ayrıldı. Gruplar demografik özellikler, antepartum kanama (AK) varlığı, operasyon özellikleri, anne ve yenidoğan sonuçları açısından karşılaştırıldı.
Bulgular: PP'li toplam 434 hasta analiz edildi. Çalışma süresince PP sıklığı %0,52 idi. 168 (%38,7) gebeye acil müdahale yapılırken, 266 (%61,3) gebeye planlı müdahale yapıldı. PP’lı gebelerin 208 (%47,9)’sinde AK öyküsü vardı. Gebelerde AK öyküsünün olması acil müdahale riskinin 3.026 kat artmasıyla ilişkiliydi [%95 güven aralığı (GA), 1.990–4.603; p = 0.000]. Gebelikte kilo alımı acil müdahale riskinin 0,932 (%95 GA, 0,887–0,987; p = 0,004) kat azalmasıyla ilişkilendirildi. Acil müdahale grubunda, operasyon sırasında daha fazla ek cerrahi prosedür gerekti ve daha fazla masif transfüzyon yapıldı (p = 0.000 ve p = 0.000). Acil müdahale, olumsuz maternal sonuçlarda 3.064 (% 95 GA, 1.571-5.975) kat ve olumsuz fetal sonuçlarda 7.5 (%95 GA, 4.841–11.620) kat artışa neden oldu. Sonuç: PP'li gebelerde doğumda acil müdahale sıklığı yüksektir ve bu durum artan olumsuz maternal ve neonatal sonuçlarla ilişkilidir. Acil müdahalenin öngörülmesinde en etkili faktör AK'dir.
References
- Reference1 Placenta Previa. In: F.G.Cunningham, K.J.Leveno, S.L.Bloom, et al eds, Williams Obstetrics. 25th ed. New York: Mc Graw-Hill Education; 2018:773-82
- Reference2 Jauniaux E, Alfirevic Z, Bhide AG, et al. Royal College of Obstetricians and Gynaecologists. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG. 2019 Jan;126(1):e1-e48.
- Reference3 Gibbins KJ, Einerson BD, Varner MW, Silver RM. Placenta previa and maternal hemorrhagic morbidity. J Matern Fetal Neonatal Med. 2018 Feb;31(4):494-9.
- Reference4 Erfani H, Kassir E, Fox KA, et al. Placenta previa without morbidly adherent placenta: comparison of characteristics and outcomes between planned and emergent deliveries in a tertiary center. J Matern Fetal Neonatal Med. 2019 Mar;32(6):906-9.
- Reference5 Wang Y, Zeng L, Niu Z, et al. An observation study of the emergency intervention in placenta accreta spectrum. Arch Gynecol Obstet. 2019 Jun;299(6):1579-86.
- Reference6 ACOG Committee Opinion No. 764: Medically Indicated Late-Preterm and Early-Term Deliveries. Obstet Gynecol 2019;133(2):e151-e155.
- Reference7 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017 Oct;130(4):e168-e186.
- Reference8 Patil V, Shetmahajan M. Massive transfusion and massive transfusion protocol. Indian J Anaesth. 2014 Sep;58(5):590-5.
- Reference9 Erez O, Novack L, Beer-Weisel R, et al. DIC score in pregnant women--a population-based modification of the International Society on Thrombosis and Hemostasis score. PLoS One. 2014 Apr 11;9(4):e93240.
- Reference10 Shamshirsaz AA, Fox KA, Erfani H, et al. Outcomes of Planned Compared With Urgent Deliveries Using a Multidisciplinary Team Approach for Morbidly Adherent Placenta. Obstet Gynecol. 2018 Feb;131(2):234-41.
- Reference11 Bhandari S, Raja EA, Shetty A, Bhattacharya S. Maternal and perinatal consequences of antepartum haemorrhage of unknown origin. BJOG. 2014 Jan;121(1):44-50; discussion 50-2.
- Reference12 Sabourin JN, Lee T, Magee LA, von Dadelszen P, Demianczuk N. Indications for, timing of, and modes of delivery in a national cohort of women admitted with antepartum hemorrhage at 22+0 to 28+6 weeks' gestation. J Obstet Gynaecol Can. 2012 Nov;34(11):1043-52.
- Reference13 Sinha P, Kuruba N. Ante-partum haemorrhage: an update. J Obstet Gynaecol. 2008 May;28(4):377-81.
- Reference14 Celik OY, Obut M, Keles A, et al. Outcomes of pregnancies diagnosed with circumvallate placenta, and use of uterine artery pulsatility index and maternal serum alpha-fetoprotein for prediction of adverse outcomes. Eur J Obstet Gynecol Reprod Biol. 2021 Jul;262:57-61.
- Reference15 Huang S, Zuo Q, Wang T, et al. Maternal and neonatal outcomes of repeated antepartum bleeding in 493 placenta previa cases: a retrospective study. J Matern Fetal Neonatal Med. 2021 Jan 31:1-6.
- Reference16 Long SY, Yang Q, Chi R, Luo L. Maternal and Neonatal Outcomes Resulting from Antepartum Hemorrhage in Women with Placenta Previa and Its Associated Risk Factors: A Single-Center Retrospective Study. Ther Clin Risk Manag. 2021 Jan 12;17:31-8.
- Reference17 Ruiter L, Eschbach SJ, Burgers M, et al. Predictors for Emergency Cesarean Delivery in Women with Placenta Previa. Am J Perinatol 2016;33(14):1407-14.
- Reference18 Han Z, Mulla S, Beyene J, Liao G, McDonald SD. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol 2011;40(1):65-101.
- Reference19 Nohr EA, Vaeth M, Baker JL, et al. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr. 2008 Jun;87(6):1750-9.
- Reference20 Durukan H, Durukan Ö B, Yazıcı FG. Planned versus urgent deliveries in placenta previa: maternal, surgical and neonatal results. Arch Gynecol Obstet. 2019 Dec;300(6):1541-9.
- Reference21 Fan D, Wu S, Liu L, et al. Prevalence of antepartum hemorrhage in women with placenta previa: a systematic review and meta-analysis. Sci Rep. 2017 Jan 9;7:40320.
- Reference22 Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine (SMFM) Consult Series #44: Management of bleeding in the late preterm period. Am J Obstet Gynecol. 2018 Jan;218(1):B2-B8.
- Reference23 Titapant V, Tongdee T, Pooliam J, Wataganara T. Retrospective analysis of 113 consecutive cases of placenta accreta spectrum from a single tertiary care center. J Matern Fetal Neonatal Med. 2020 Oct;33(19):3324-31.
- Reference24 Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol. 2015 Feb;212(2):218.e1-9.
- Reference25 Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG. 2009 Apr;116(5):648-54.
- Reference26 Pri-Paz S, Fuchs KM, Gaddipati S, et al. Comparison between emergent and elective delivery in women with placenta accreta. J Matern Fetal Neonatal Med. 2013 Jul;26(10):1007-11.
- Reference27 van den Akker T, Brobbel C, Dekkers OM, Bloemenkamp KWM. Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis. Obstet Gynecol. 2016 Dec;128(6):1281-94.
Risk factors and outcomes of emergency intervention in pregnant women with placenta previa: an observational study
Abstract
Aim: To investigate the risk factors and outcomes of emergency intervention in pregnant women with placenta previa (PP).
Material and method: This retrospective study was conducted between June 2015 and January 2021. Pregnant women with PP were divided into emergency and planned intervention groups according to surgical planning. The groups were compared in terms of demographic characteristics, presence of antepartum hemorrhage (APH), operation characteristics, and maternal and neonatal outcomes.
Results: A total of 434 patients with PP were analyzed. The frequency of PP was 0.52%. The emergency intervention was performed in 168 (38.7%) pregnant women, whereas planned intervention was performed in 266 (61.3%). APH was present in 208 (47.9%) patients; the presence of APH was associated with increased risk of emergency intervention by 3.026 [95% confidence interval (CI), 1.990–4.603; p = 0.000]-fold. The weight gained during pregnancy was associated with reduced risk of emergency intervention by 0.932 (95% CI, 0.887–0.978; p = 0.004)-fold. In the emergency intervention group, more additional surgical procedures and massive transfusion were performed during the operation (p = 0.000 and p = 0.000) Emergency intervention resulted in an increase in adverse maternal and fetal outcomes by 3.064 (95% CI, 1.571–5.975) and 7.5 (95% CI, 4.841–11.620)-fold, respectively.
Conclusion: The frequency of an emergency intervention is high in those with PP and is associated with increased adverse maternal and neonatal outcomes.The most effective factor in the prediction of emergency intervention is APH.
Keywords
antepartum hemorrhage emergency intervention maternal and neonatal outcomes placenta previa
References
- Reference1 Placenta Previa. In: F.G.Cunningham, K.J.Leveno, S.L.Bloom, et al eds, Williams Obstetrics. 25th ed. New York: Mc Graw-Hill Education; 2018:773-82
- Reference2 Jauniaux E, Alfirevic Z, Bhide AG, et al. Royal College of Obstetricians and Gynaecologists. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG. 2019 Jan;126(1):e1-e48.
- Reference3 Gibbins KJ, Einerson BD, Varner MW, Silver RM. Placenta previa and maternal hemorrhagic morbidity. J Matern Fetal Neonatal Med. 2018 Feb;31(4):494-9.
- Reference4 Erfani H, Kassir E, Fox KA, et al. Placenta previa without morbidly adherent placenta: comparison of characteristics and outcomes between planned and emergent deliveries in a tertiary center. J Matern Fetal Neonatal Med. 2019 Mar;32(6):906-9.
- Reference5 Wang Y, Zeng L, Niu Z, et al. An observation study of the emergency intervention in placenta accreta spectrum. Arch Gynecol Obstet. 2019 Jun;299(6):1579-86.
- Reference6 ACOG Committee Opinion No. 764: Medically Indicated Late-Preterm and Early-Term Deliveries. Obstet Gynecol 2019;133(2):e151-e155.
- Reference7 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017 Oct;130(4):e168-e186.
- Reference8 Patil V, Shetmahajan M. Massive transfusion and massive transfusion protocol. Indian J Anaesth. 2014 Sep;58(5):590-5.
- Reference9 Erez O, Novack L, Beer-Weisel R, et al. DIC score in pregnant women--a population-based modification of the International Society on Thrombosis and Hemostasis score. PLoS One. 2014 Apr 11;9(4):e93240.
- Reference10 Shamshirsaz AA, Fox KA, Erfani H, et al. Outcomes of Planned Compared With Urgent Deliveries Using a Multidisciplinary Team Approach for Morbidly Adherent Placenta. Obstet Gynecol. 2018 Feb;131(2):234-41.
- Reference11 Bhandari S, Raja EA, Shetty A, Bhattacharya S. Maternal and perinatal consequences of antepartum haemorrhage of unknown origin. BJOG. 2014 Jan;121(1):44-50; discussion 50-2.
- Reference12 Sabourin JN, Lee T, Magee LA, von Dadelszen P, Demianczuk N. Indications for, timing of, and modes of delivery in a national cohort of women admitted with antepartum hemorrhage at 22+0 to 28+6 weeks' gestation. J Obstet Gynaecol Can. 2012 Nov;34(11):1043-52.
- Reference13 Sinha P, Kuruba N. Ante-partum haemorrhage: an update. J Obstet Gynaecol. 2008 May;28(4):377-81.
- Reference14 Celik OY, Obut M, Keles A, et al. Outcomes of pregnancies diagnosed with circumvallate placenta, and use of uterine artery pulsatility index and maternal serum alpha-fetoprotein for prediction of adverse outcomes. Eur J Obstet Gynecol Reprod Biol. 2021 Jul;262:57-61.
- Reference15 Huang S, Zuo Q, Wang T, et al. Maternal and neonatal outcomes of repeated antepartum bleeding in 493 placenta previa cases: a retrospective study. J Matern Fetal Neonatal Med. 2021 Jan 31:1-6.
- Reference16 Long SY, Yang Q, Chi R, Luo L. Maternal and Neonatal Outcomes Resulting from Antepartum Hemorrhage in Women with Placenta Previa and Its Associated Risk Factors: A Single-Center Retrospective Study. Ther Clin Risk Manag. 2021 Jan 12;17:31-8.
- Reference17 Ruiter L, Eschbach SJ, Burgers M, et al. Predictors for Emergency Cesarean Delivery in Women with Placenta Previa. Am J Perinatol 2016;33(14):1407-14.
- Reference18 Han Z, Mulla S, Beyene J, Liao G, McDonald SD. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol 2011;40(1):65-101.
- Reference19 Nohr EA, Vaeth M, Baker JL, et al. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr. 2008 Jun;87(6):1750-9.
- Reference20 Durukan H, Durukan Ö B, Yazıcı FG. Planned versus urgent deliveries in placenta previa: maternal, surgical and neonatal results. Arch Gynecol Obstet. 2019 Dec;300(6):1541-9.
- Reference21 Fan D, Wu S, Liu L, et al. Prevalence of antepartum hemorrhage in women with placenta previa: a systematic review and meta-analysis. Sci Rep. 2017 Jan 9;7:40320.
- Reference22 Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine (SMFM) Consult Series #44: Management of bleeding in the late preterm period. Am J Obstet Gynecol. 2018 Jan;218(1):B2-B8.
- Reference23 Titapant V, Tongdee T, Pooliam J, Wataganara T. Retrospective analysis of 113 consecutive cases of placenta accreta spectrum from a single tertiary care center. J Matern Fetal Neonatal Med. 2020 Oct;33(19):3324-31.
- Reference24 Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol. 2015 Feb;212(2):218.e1-9.
- Reference25 Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG. 2009 Apr;116(5):648-54.
- Reference26 Pri-Paz S, Fuchs KM, Gaddipati S, et al. Comparison between emergent and elective delivery in women with placenta accreta. J Matern Fetal Neonatal Med. 2013 Jul;26(10):1007-11.
- Reference27 van den Akker T, Brobbel C, Dekkers OM, Bloemenkamp KWM. Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis. Obstet Gynecol. 2016 Dec;128(6):1281-94.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original research article |
| Authors | |
| Publication Date | August 31, 2022 |
| Submission Date | April 27, 2022 |
| Published in Issue | Year 2022 Volume: 55 Issue: 2 |