Oğlak Süleyman Cemil, Ölmez Fatma, Tunç Şeyhmus
Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
Department of Obstetrics and Gynecology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey.
Ochsner J. 2022 Summer;22(2):146-153. doi: 10.31486/toj.21.0138.
The optimal delivery timing for patients with placenta previa remains controversial in the literature. To reduce spontaneous vaginal bleeding rates, which occur increasingly with advancing gestational weeks, elective cesarean delivery is advocated between 36 and 37 weeks of gestation, but this clinical approach does not take into consideration numerous patient variables. Few papers identify the risk factors for emergency cesarean delivery in patients with placenta previa. An enhanced understanding of these variables could help with determining patients at high risk for emergency cesarean delivery and individualizing delivery date scheduling. This study sought to identify predictor variables associated with emergency cesarean delivery in pregnant patients with placenta previa in a tertiary referral hospital. We also investigated differences in maternal and perinatal outcomes between patients with placenta previa who underwent emergency vs planned cesarean delivery. This retrospective cohort study included 208 singleton pregnancy patients who had a confirmed diagnosis of placenta previa at the time of delivery and who underwent cesarean delivery in our hospital beyond 24 weeks of gestation. To define risk factors of the outcome variable (emergency vs planned cesarean delivery), univariate and multiple logistic regression analysis and adjusted odds ratios with their confidence intervals were calculated. Ninety-seven patients (46.6%) required emergency cesarean delivery, and 111 patients (53.4%) underwent planned cesarean delivery. Antepartum bleeding episode (37.1% and 20.7%, =0.013) and first antepartum bleeding episode ≤28 weeks of gestation (36.1% and 14.4%, <0.001) were significantly higher in the emergency group than the planned group. Antepartum bleeding episode (odds ratio [OR]=1.968, 95% CI 1.001-4.200, =0.042), first antepartum bleeding episode ≤28 weeks of gestation (OR=2.750, 95% CI 1.315-5.748, =0.007), and preoperative hemoglobin level (OR=0.713, 95% CI 0.595-0.854, <0.001) were the independent predictors significantly associated with emergency cesarean delivery. Three factors-antepartum bleeding episode during pregnancy, first antepartum bleeding episode ≤28 weeks of gestation, and lower preoperative hemoglobin level-might be useful in predicting emergency cesarean delivery in pregnancies complicated with placenta previa.
前置胎盘患者的最佳分娩时机在文献中仍存在争议。为降低随着孕周增加而日益增多的自发性阴道出血发生率，提倡在妊娠36至37周之间进行择期剖宫产，但这种临床方法未考虑众多患者变量。很少有论文指出前置胎盘患者急诊剖宫产的危险因素。对这些变量的深入了解有助于确定急诊剖宫产的高危患者，并个性化安排分娩日期。本研究旨在确定一所三级转诊医院中前置胎盘孕妇急诊剖宫产的预测变量。我们还调查了接受急诊剖宫产与计划剖宫产的前置胎盘患者在孕产妇和围产儿结局方面的差异。这项回顾性队列研究纳入了208名单胎妊娠患者，她们在分娩时确诊为前置胎盘，并在我院妊娠24周后接受了剖宫产。为确定结局变量（急诊剖宫产与计划剖宫产）的危险因素，计算了单因素和多因素逻辑回归分析以及带有置信区间的调整比值比。97例患者（46.6%）需要急诊剖宫产，111例患者（53.4%）接受了计划剖宫产。急诊组的产前出血发作（37.1%和20.7%，P=0.013）以及首次产前出血发作发生在妊娠≤28周（36.1%和14.4%，P<0.001）的比例显著高于计划组。产前出血发作（比值比[OR]=1.968，95%置信区间1.001 - 4.200；P=0.042）、首次产前出血发作≤28周妊娠（OR=2.750，95%置信区间1.315 - 5.748；P=0.007）以及术前血红蛋白水平（OR=0.713，95%置信区间0.595 - 0.854；P<0.001）是与急诊剖宫产显著相关的独立预测因素。孕期产前出血发作、首次产前出血发作≤28周妊娠以及术前血红蛋白水平较低这三个因素可能有助于预测前置胎盘合并妊娠的急诊剖宫产情况。
