Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5308-5311. doi: 10.1080/14767058.2021.1878493. Epub 2021 Jan 27.
The optimal gestational age at delivery for stable women with suspected placenta accreta is still subject of debate.
To estimate the likelihood of vaginal bleeding necessitating expedited delivery in women with placenta accreta according to gestational age at planned cesarean hysterectomy.
This was a multicenter cohort study. Singleton pregnancies at risk of placenta accreta because of placenta previa in the setting of prior cesarean delivery were included. Outcomes were compared in cohort of women who had planned cesarean hysterectomy at 34 0/7 - 34 6/7 weeks versus at 35 0/7 - 35 6/7 weeks. The primary outcome was incidence of vaginal bleeding severe enough to necessitate delivery.
118 singleton pregnancies with placenta previa in the setting of prior cesarean delivery, and confirmed placenta accreta at the time of delivery were included in the study. Women who had planned cesarean hysterectomy at 34 weeks had lower episodes of vaginal bleeding severe enough to necessitate immediate or emergency delivery (20.6% vs 38.0%; odds ratio (OR) 0.42, 95% confidence interval (CI) 0.19 to 0.96). Eight women (11.8%) in the 34 weeks group and 6 women (12.0%) in the 35 weeks group delivered before the planned date due to onset of spontaneous labor (OR 0.98, 95% CI 0.32 to 3.02).
In singleton gestations with suspected placenta accreta, planned cesarean hysterectomy at 34 0/7 - 34 6/7 weeks was associated with a decreased chance of unscheduled delivery due to severe vaginal bleeding.
In case of placenta accreta, planned cesarean hysterectomy at 34 weeks was associated with decreased chance of unscheduled delivery due to severe vaginal bleeding.
对于疑似胎盘植入的稳定孕妇，最佳分娩孕龄仍存在争议。
根据计划行剖宫产子宫切除术的孕龄，估计胎盘植入孕妇发生需要紧急分娩的阴道出血的可能性。
这是一项多中心队列研究。纳入因既往剖宫产而有前置胎盘风险且有胎盘植入的单胎妊娠。比较了计划在 34 0/7-34 6/7 周行剖宫产子宫切除术的孕妇和计划在 35 0/7-35 6/7 周行剖宫产子宫切除术的孕妇的结局。主要结局是阴道出血严重程度足以需要分娩的发生率。
研究纳入了 118 例因既往剖宫产而有前置胎盘且在分娩时确诊胎盘植入的单胎妊娠。计划在 34 周行剖宫产子宫切除术的孕妇阴道出血严重程度足以需要立即或紧急分娩的发生率较低（20.6%比 38.0%；优势比（OR）0.42，95%置信区间（CI）0.19 至 0.96）。34 周组中有 8 例（11.8%）和 35 周组中有 6 例（12.0%）孕妇因自发临产而在计划分娩日期前分娩（OR 0.98，95% CI 0.32 至 3.02）。
在疑似胎盘植入的单胎妊娠中，计划在 34 0/7-34 6/7 周行剖宫产子宫切除术与因严重阴道出血而导致无计划分娩的几率降低相关。
胎盘植入；剖宫产子宫切除术；阴道出血；分娩时机
