Huang Fusen, Wang Jingjie, Xu Yi, Xiong Qiuju, Wang Wenjian, Zhuo Jia, Xia Qiuling, Yang Xiaojuan
Department of Anesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Radiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Surg. 2022 Oct 21;9:1028494. doi: 10.3389/fsurg.2022.1028494. eCollection 2022.
Abnormal placentation is a spectrum disorder that includes creta, increta, and percreta; the term placenta accreta spectrum (PAS) disorders is used as a broad term to describe all of these conditions. PAS can lead to life-threatening hemorrhage. The predictive value of cervical length (CL) in patients with PAS remains controversial. Thus, this study investigated the relationship between CL and the probability of major bleeding in patients with PAS and placenta previa.
This retrospective cohort study was conducted at a comprehensive tertiary hospital in Chongqing, China, between January 2018 and December 2020. The target independent and dependent variables were CL and intraoperative massive bleeding, respectively. The covariates included demographic, clinical, and ultrasound characteristics. Logistic regression was used to explore the association between CL and massive bleeding.
In total, 317 participants were enrolled, in whom the prevalence of massive bleeding was 41.9% (133/317). The threshold of CL associated with massive bleeding (≥1,000 ml) was 33 mm based on a receiver operating characteristic curve. In the fully adjusted model for each additional unit of CL, the risk of massive bleeding decreased by 7% [95% confidence interval (CI), 0.88-0.98]. The risk of major bleeding was reduced by 44% in patients with a CL greater than 33 mm (95% CI, 0.33-0.97) compared with patients with a CL less than 33 mm.
CL was negatively associated with massive intraoperative bleeding in patients with PAS combined with placenta previa. When the CL was greater than 33 mm, the risk of bleeding decreased by 44%. Thus, CL can be used as a standalone parameter to identify the risk of massive intraoperative bleeding in patients with suspected PAS.
胎盘植入异常是一种谱系疾病，包括胎盘黏连、胎盘植入和穿透性胎盘植入；胎盘植入谱系（PAS）疾病这一术语被用作描述所有这些情况的广义术语。PAS可导致危及生命的出血。宫颈长度（CL）在PAS患者中的预测价值仍存在争议。因此，本研究调查了CL与PAS合并前置胎盘患者大出血概率之间的关系。
本回顾性队列研究于2018年1月至2020年12月在中国重庆的一家综合性三级医院进行。目标自变量和因变量分别为CL和术中大量出血。协变量包括人口统计学、临床和超声特征。采用逻辑回归分析CL与大量出血之间的关联。
共纳入317名参与者，其中大量出血的患病率为41.9%（133/317）。根据受试者工作特征曲线，与大量出血（≥1000 ml）相关的CL阈值为33 mm。在完全调整模型中，CL每增加一个单位，大量出血的风险降低7%[95%置信区间（CI），0.88 - 0.98]。与CL小于33 mm的患者相比，CL大于33 mm的患者大出血风险降低了44%（95%CI，0.33 - 0.97）。
CL与PAS合并前置胎盘患者术中大量出血呈负相关。当CL大于33 mm时，出血风险降低44%。因此，CL可作为一个独立参数来识别疑似PAS患者术中大量出血的风险。
