Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC.
Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC.
J Obstet Gynaecol Can. 2021 Apr;43(4):463-468. doi: 10.1016/j.jogc.2020.07.012. Epub 2020 Aug 25.
Early subchorionic hemorrhage may lead to a disruption in the placental-uterine matrix, which may result in an adherence of the placenta to the endometrium. We evaluated the effect of a first-trimester bleed on the need for a post-vaginal delivery dilatation and curettage (D&C) for removal of retained placenta.
We conducted a case-control study at a tertiary care centre between 2012 and 2016. Patients identified through medical records as having required a post-vaginal delivery D&C for retained placenta were considered cases and were matched 1:5 with patients delivering vaginally within 1 week who did not require a D&C. History of first-trimester bleeding and subchorionic hemorrhage were identified through chart review. Conditional logistic regression analyses estimated the effect of a first-trimester bleed on the requirement for D&C for retained placenta. Models were adjusted for maternal age and previous uterine surgery.
There were 68 cases of retained placenta requiring D&C, for an estimated 3 in 1000 deliveries. Patients requiring D&C were slightly older than controls but were otherwise comparable with respect to baseline demographic characteristics. In adjusted analyses, patients who required a postpartum D&C were more likely than controls to have had a first-trimester bleed at 11.8% and 0.6%, respectively (OR 25.3; 95% CI 4.7-135.4, P < 0.001). Postpartum D&C for retained placenta was associated with postpartum hemorrhage, need for blood transfusion, and manual removal of placenta.
First-trimester bleeding should be considered a high-risk determinant for post-vaginal delivery D&C for retained placenta and for severe postpartum hemorrhage.
早期的胎盘下出血可能导致胎盘-子宫基质的破坏，从而导致胎盘附着于子宫内膜。我们评估了初孕期出血对阴道分娩后因胎盘残留而需行刮宫术（D&C）的影响。
我们在 2012 年至 2016 年期间在一家三级保健中心进行了病例对照研究。通过病历确定需要因胎盘残留而行阴道分娩后 D&C 的患者为病例，并与在 1 周内阴道分娩且无需行 D&C 的患者以 1:5 的比例进行匹配。通过病历回顾确定初孕期出血和胎盘下出血的病史。条件逻辑回归分析估计了初孕期出血对因胎盘残留而行 D&C 的需求的影响。模型调整了产妇年龄和既往子宫手术。
有 68 例胎盘残留需要 D&C，估计每 1000 例分娩中有 3 例。需要行 D&C 的患者比对照组年龄稍大，但在基线人口统计学特征方面其他方面无差异。在调整分析中，需要产后 D&C 的患者比对照组更有可能在初孕期出血，分别为 11.8%和 0.6%（OR 25.3；95%CI 4.7-135.4，P<0.001）。产后因胎盘残留而行 D&C 与产后出血、需要输血和手动取出胎盘有关。
初孕期出血应被视为阴道分娩后因胎盘残留而行 D&C 和严重产后出血的高危决定因素。
