Department of Obstetrics and Gynecology, College of Medicine, King Khalid University and Abha Maternity and Children's Hospital (AMCH), Saudi Arabia.
Department of Family and Community Medicine, College of Medicine, King Khalid University, Saudi Arabia.
Eur J Obstet Gynecol Reprod Biol. 2024 May;296:280-285. doi: 10.1016/j.ejogrb.2024.03.012. Epub 2024 Mar 13.
To compare maternal characteristics and outcomes among patients having major placenta previa (PP) with and without previous cesarean section (CS). And to determine if previous CS alone is a risk factor for associated adverse maternal outcomes in these patients.
This is a retrospective analysis including two groups of major PP patients, with previous CS (n = 184) and without CS (n = 115); who were admitted to Abha Maternity and Children's Hospital over the last ten-years (January 2012-December 2021), Aseer region, Saudi Arabia.
Compared to those without previous CS, major PP patients with previous CS had significantly advanced ages with higher mean numbers of gravidity and parity, but significantly less rates of previous uterine surgery and IVF pregnancies. Moreover, they were more likely to acquire higher rates of adverse maternal outcomes. In the same way, these patients had an increased Odds Ratios of cesarean hysterectomy (OR of 20.462), urinary tract injuries (OR of 12.361), associated PAS (OR of 4.375), moderate/ heavy intra-operative bleeding (OR of 2.153) and the need for transfusion of 3+ units of packed RBCs (OR of 1.849).
(1) Patients with combined existence of major PP and previous CS had significantly higher rates of adverse maternal outcomes (2) Alone, prior CS in major PP patients increased the Odds Ratios of cesarean hysterectomy, urinary tract injuries, diagnosis of PAS, excessive intra-operative bleeding and repeated packed RBCs transfusions. (3) Among our PP patients with previous CS, the increased rate and OR of PAS diagnosis could in-part explain the adverse maternal outcomes.
比较合并和不合并剖宫产史的重度胎盘前置患者的产妇特征和结局，并确定剖宫产史是否是这些患者发生不良母婴结局的危险因素。
这是一项回顾性分析，纳入了过去十年（2012 年 1 月至 2021 年 12 月）在沙特阿拉伯阿西尔地区阿巴母婴医院就诊的两组重度胎盘前置患者，一组有剖宫产史（n=184），另一组无剖宫产史（n=115）。
与无剖宫产史的患者相比，合并剖宫产史的重度胎盘前置患者年龄明显更大，孕次和产次更多，但既往子宫手术和 IVF 妊娠的比例明显更低。此外，她们更有可能发生不良母婴结局。同样，这些患者发生剖宫产子宫切除术（OR 为 20.462）、泌尿道损伤（OR 为 12.361）、相关 PAS（OR 为 4.375）、中度/重度术中出血（OR 为 2.153）和需要输注 3+单位浓缩红细胞（OR 为 1.849）的可能性增加。
（1）合并重度胎盘前置和剖宫产史的患者不良母婴结局发生率明显更高。（2）单独来看，重度胎盘前置患者的剖宫产史增加了行剖宫产子宫切除术、泌尿道损伤、PAS 诊断、术中出血过多和重复输注浓缩红细胞的可能性。（3）在我们有剖宫产史的胎盘前置患者中，PAS 诊断的发生率和比值比增加可能部分解释了不良母婴结局的发生。
