Sertel Emre, Demir Merve, Üçüzler Şimal, Yetim Çağcıl, Yavuz Arzu
Kocaeli City Hospital, Clinic of Obstetrics and Gynecology, Kocaeli, Turkey.
Bahçeşehir University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey.
Turk J Obstet Gynecol. 2024 Dec 12;21(4):286-295. doi: 10.4274/tjod.galenos.2024.58291.
This study aimed to compare emergency and planned cesarean section cases in pregnancies complicated with placenta previa (PP) and subgroups with and without placenta accreta spectrum (PAS) in terms of obstetric, neonatal, and surgical outcomes.
This retrospective cohort study included 128 patients diagnosed with PP who underwent cesarean section. Obstetric, neonatal, and surgical outcomes of all cases with PP and subgroups with and without PAS were compared according to whether they were emergency or planned cesarean section.
Of the 128 women with PP, 60 planned and 68 underwent emergency cesarean section. In all patients with PP and in the PAS and non-PAS subgroups, the neonatal outcomes of patients who underwent emergency cesarean section were more negative than those of patients who underwent planned cesarean section. It was observed that more hysterectomy were performed in the emergency group than in the elective group in all patients with PP and PAS patients (p=0.027 and p=0.012 respectively). It was observed that patients with PP and non-PAS were hospitalized after cesarean section for a longer period of time in the emergency group than in the planned group (p=0.044 and p=0.002 respectively).
Planned cesarean section leads to better obstetric, neonatal, and surgical outcomes compared with emergency cesarean section in pregnancies complicated by PP, especially in those with PAS. Our findings suggest that planned delivery strategies should be considered for patients with PP. Decisions regarding the timing of delivery should balance maternal risks and benefits with fetal and fetal risks and benefits.
本研究旨在比较妊娠合并前置胎盘（PP）以及伴有或不伴有胎盘植入谱系疾病（PAS）亚组的急诊剖宫产和择期剖宫产病例在产科、新生儿及手术结局方面的差异。
这项回顾性队列研究纳入了128例诊断为PP并接受剖宫产的患者。根据剖宫产是急诊还是择期，比较所有PP病例以及伴有和不伴有PAS亚组的产科、新生儿及手术结局。
128例PP女性中，60例为择期剖宫产，68例为急诊剖宫产。在所有PP患者以及PAS和非PAS亚组中，急诊剖宫产患者的新生儿结局比择期剖宫产患者更差。观察发现，所有PP患者及PAS患者中，急诊组行子宫切除术的比例高于择期组（分别为p = 0.027和p = 0.012）。观察发现，PP合并非PAS患者剖宫产术后急诊组的住院时间比择期组长（分别为p = 0.044和p = 0.002）。
在妊娠合并PP尤其是合并PAS的情况下，择期剖宫产与急诊剖宫产相比，可带来更好的产科、新生儿及手术结局。我们的研究结果表明，对于PP患者应考虑采用择期分娩策略。关于分娩时机的决策应在母胎风险和获益之间取得平衡。
