Pregnancy ; Female ; Humans ; Placenta Accreta/surgery* ; Cesarean Section ; Retrospective Studies ; Biomarkers ; Hysterectomy ; Placenta Previa ; Placenta

Female ; Humans ; Placenta Accreta ; surgery ; Placenta Previa ; surgery ; Pregnancy ; Suture Techniques ; Tourniquets

OBJECTIVE: To investigate the application of modified cesarean hysterectomy for placenta previa percreta in the third trimester via peritoneum lateral approach. METHODS: Data of 8 patients at 34 weeks or more gestation, who underwent cesarean hysterectomy for placenta previa percreta in Xiangya Hospital, Central South University, between January 2008 and December 2011, were analyzed retrospectively. The patients were divided into a modified cesarean hysterectomy by peritoneum lateral approach group (modified group, n=4) and a conventional cesarean hysterectomy group (conventional group, n=4), according to the principles of the case-control and the operation performed by the same doctor. The incidence of blood loss, the number of transfusions of RBC, and the ocurrnce of complications were compared between the 2 groups. RESULTS: The blood loss in the modified group and the conventional group was (2280±687) mL and (6150±2023) mL, and the number of transfusions of RBC was (4.5±2.1) U and (11.7±8.9) U, respectively. There was no coagulation disorder and ureteral injury in the modified group whereas there were 2 disorders and 1 injury in the conventional group. Two patients with bladder laceration were observed in the 2 groups. CONCLUSION Large amounts of bleeding will be onset in the placenta previa percreta. Modified cesarean hysterectomy for placenta previa percreta can reduce the blood loss and the incidence of related complications in the operation.
Adult ; Cesarean Section ; methods ; Female ; Humans ; Hysterectomy ; methods ; Peritoneum ; surgery ; Placenta Accreta ; surgery ; Placenta Previa ; surgery ; Pregnancy ; Pregnancy Trimester, Third

Blood Loss, Surgical ; Cesarean Section/adverse effects* ; Female ; Humans ; Hysterectomy ; Placenta Accreta/surgery* ; Placenta Previa/surgery* ; Pregnancy ; Retrospective Studies

BACKGROUND: Massive bleeding is the main concern for the management of placenta percreta (PP). Intra-abdominal aortic balloon occlusion (IABO) is one method for pelvic devascularization, but the efficacy of IABO is uncertain. This study aims to investigate the outcomes of IABO in PP patients. METHODS: We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015. PP cases with/without the use of IABO were analyzed. Propensity score matching analysis was performed to reduce the effect of selection bias. Postpartum hemorrhage (PPH) and the rate of hysterectomy, as well as neonatal outcomes, were analyzed. RESULTS: One hundred and thirty-two matched pairs of patients were included in the final analysis. Compared with the control group, maternal outcomes, including PPH (68.9% vs. 87.9%, χ2 = 13.984, P < 0.001), hysterectomy (8.3% vs. 65.2%, χ2 = 91.672, P < 0.001), and repeated surgery (1.5% vs. 12.1%, χ2 = 11.686, P = 0.001) were significantly reduced in the IABO group. For neonatal outcomes, Apgar scores at 1 minute (8.67 ± 1.79 vs. 8.53 ± 1.68, t = -0.638, P = 0.947) and 5 minutes (9.43 ± 1.55 vs. 9.53 ± 1.26, t = 0.566, P = 0.293) were not significantly different between the two groups. CONCLUSIONS IABO can significantly reduce blood loss, hysterectomies, and repeated surgeries. This procedure has not shown harmful effects on neonatal outcomes.
Aorta ; Balloon Occlusion/methods* ; Blood Loss, Surgical ; Female ; Humans ; Hysterectomy ; Infant, Newborn ; Placenta Accreta/surgery* ; Placenta Previa/surgery* ; Postpartum Hemorrhage ; Pregnancy ; Retrospective Studies

Objective: To analyze associated factors and adverse pregnancy outcomes of postpartum hemorrhage in the caesarean section of puerperae with different types of placenta previa. Methods: This retrospective research was a case-control study. Puerperae with cesarean section of placenta previa from January 2019 to December 2020 in Women's Hospital, School of Medicine, Zhejiang University were collected and divided into the<1 000 ml control group or ≥1 000 ml postpartum hemorrhage group according to the amount of blood loss during cesarean section. Differences in continuous variables were analyzed by t-test and categorical variables were analyzed by χ² test. The risk factors of postpartum hemorrhage were analyzed by logistic multivariate regression. Results: A total of 962 puerperae were enrolled with 773 cases in the control group and 189 cases in the postpartum hemorrhage group. The incidence of gestational weeks, gravidity, parity, induced abortion, placental accreta and preoperative hemoglobin<110 g/L was significantly different between two groups in different types of placenta previa (P<0.001). Logistic multivariate regression model analysis showed that the independent risk factors of postpartum hemorrhage in the caesarean section of low-lying placenta included placental accreta (OR=12.713, 95%CI: 4.296-37.625), preoperative hemoglobin<110 g/L (OR=2.377, 95%CI: 1.062-5.321), and prenatal vaginal bleeding (OR=4.244, 95%CI: 1.865-9.656). The independent risk factors of postpartum hemorrhage in the caesarean section of placenta previa included once induced abortion (OR=2.789, 95%CI:1.189-6.544), induced abortion≥2 (OR=2.843, 95%CI:1.101-7.339), placental accreta (OR=6.079, 95%CI:3.697-9.996), HBsAg positive (OR=3.891, 95%CI:1.385-10.929), and placental attachment to the anterior uterine wall (OR=2.307, 95%CI:1.285-4.142). The rate of postpartum hemorrhage and premature delivery in puerperae with placenta previa was higher than that in puerperae with low-lying placenta (P<0.001). Conclusions: The associated factors of postpartum hemorrhage in puerperae with different types of placenta previa are different. Placenta accreta is the common risk factor of postpartum hemorrhage in puerperae with low-lying placenta and placenta previa.
Female ; Pregnancy ; Humans ; Cesarean Section ; Postpartum Hemorrhage/surgery* ; Pregnancy Outcome ; Retrospective Studies ; Case-Control Studies ; Placenta Previa/surgery* ; Placenta ; Risk Factors

Abnormal attachment of the placenta (Placenta accreta, increta, and percreta) is an uncommon but potentially lethal cause of maternal mortality from massive postpartum hemorrhage. A 33-yr-old woman, who had been diagnosed with a placenta previa, was referred at 30 weeks gestation. On ultrasound, a complete type of placenta previa and multiple intraplacental lacunae, suggestive of placenta accreta, were noted. For further evaluation of the placenta, pelvis MRI was performed and revealed findings suspicious of a placenta increta. An elective cesarean delivery and subsequent hysterectomy were planned for the patient at 38 weeks gestation. On the day of delivery, endovascular catheters for balloon occlusion were placed within the hypogastric arteries, prior to the cesarean section. In the operating room, immediately after the delivery of the baby, bilateral hypogastric arteries were occluded by inflation of the balloons in the catheters previously placed within. With the placenta retained within the uterus, a total hysterectomy was performed in the usual fashion. The occluding balloons were deflated after closure of the vaginal cuff with hemostasis. The patient had stable vital signs and normal laboratory findings during the recovery period; she was discharged six days after delivery without complications. The final pathology confirmed a placenta increta.
Adult ; Arteries/*surgery ; *Catheterization ; Cesarean Section ; Female ; Gestational Age ; Humans ; Hysterectomy/*methods ; Placenta/*blood supply/ultrasonography ; Placenta Accreta/*surgery/ultrasonography ; Placenta Previa/*surgery/ultrasonography ; Postpartum Hemorrhage/*prevention & control ; Pregnancy ; Treatment Outcome

OBJECTIVETo investigate the roles of MMPs-9, TIMP-1 and TIMP-2 in cesarean section scar healing.

METHODSThe expressions of the MMPs-9, TIMP-1 and TIMP-2 were detected by EnVision immunohistochemistry in 22 pregnant women with serious complications of the uterine scar, including 8 with early caesarean scar pregnancy (CSP) and 14 with full-term pregnancy undergoing hysterectomy for placenta previa or implanted placenta. Thirty-eight full-term pregnant women without serious complications of the uterine scar and 32 normal full-term pregnant women served as the control I and control II groups, respectively.

RESULTSThe expressions of MMPs-9 and TIMP-1 differed significantly between the 3 groups (P<0.05), whereas TIMP-2 did not (P>0.05). Spearman rank correlation analysis showed that the expression of MMPs-9 in the uterine scar tissues was positively correlated with poor uterine scar healing with the correlation coefficients of 0.309 and 0.643. An increased severity of poor healing scar was associated with a significantly increased expression of MMPs-9 (P<0.05).

CONCLUSIONThe imbalanced expressions of MMPs-9 and TIMP-1 in injury repair can be related to poor uterine scar healing and CSP.

Adult ; Cesarean Section ; adverse effects ; Cicatrix ; etiology ; metabolism ; Female ; Humans ; Matrix Metalloproteinase 9 ; metabolism ; Placenta Previa ; surgery ; Pregnancy ; Tissue Inhibitor of Metalloproteinase-1 ; metabolism ; Tissue Inhibitor of Metalloproteinase-2 ; metabolism ; Uterus ; pathology ; Wound Healing ; Young Adult