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Backgrounds: Pregnancy termination during the second trimester in patients with placenta previa and placenta accreta spectrum (PAS) is a complex and challenging clinical problem. Based on our literature review, there has been a relative increase in the number of such cases being treated by hysterotomy and/or local uterine lesion resection and repair. In the present study, a retrospective analysis was conducted to compare the clinical outcomes when different management strategies were used to terminate pregnancy in the patients with placenta previa and PAS., Methods: A total of 51 patients who underwent pregnancy termination in the second trimester in Beijing Obstetrics and Gynecology Hospital between June 2013 and December 2018 were retrospectively analyzed in this study. All patients having previous caesarean delivery (CD) were diagnosed with placenta previa status and PAS., Results: ① Among the 51 patients, 16 cases received mifepristone and misoprostol medical termination, 15 cases received mifepristone and Rivanol medical termination, but 1 of them was transferred to hysterotomy due to failed labor induction, another 20 cases were performed planned hysterotomy. There was no placenta percreta cases and uterine artery embolization (UAE) was all performed before surgery.② There were 31 cases who underwent medical termination and 30 cases were vaginal delivery. Dilation and evacuation (D&E) were used in 20 cases of medical abortion failure and in all 30 cases of difficult manual removal of placental tissue. ③ A statistically significant difference was found among the three different strategies in terms of gestational weeks, the type of placenta previa status, main operative success rate and β-HCG regression time (P < 0.05). ④ There were 4(7.8%) cases who were taken up for hysterectomy because of life-threatening bleeding or severe bacteremia during or after delivery and hysterotomy. The uterus was preserved with the implanted placenta partly or completely left in situ in 47(92.2%) cases. Combined medical and/or surgical management were used for the residual placenta and the time of menstrual recovery was 52(range: 33 to 86) days after pregnancy termination., Conclusions: Terminating a pregnancy by vaginal delivery through medical induction of labor may be feasible if clinicians have an overall understanding of gestational age, the type of placenta previa status, the type of placenta accreta, and patients concerns about preserving fertility. A collaborative team effort in tertiary medical centers with a very experience MDT and combined application of multiple methods is required to optimize patient outcomes., (© 2021. The Author(s).)

The aim of this study was to investigate early clinical features and risk factors for cesarean scar pregnancy (CSP). Study group of 206 CSP patients out of 6853 women with early pregnancies, diagnosed from 2014 to 2016 was compared with a randomly selected control group of 412 patients. Early clinical features for CSP were vaginal bleeding (OR: 9.65; 95% CI: 5.67-16.41), lower abdominal pain (OR: 3.8; 95% CI: 1.52-9.54) and increased white blood cells (OR: 1.30; 95% CI: 1.12-1.50). Important risk factors for CSP were artificial abortion within the last pregnancy (OR: 4.13; 95% CI: 2.23-7.66), 0 ∼ 1 year and 2 ∼ 3 year interval between present and last pregnancy (OR: 2.27; 95% CI: 1.11-4.67 and OR: 2.15; 95% CI: 1.15-4.03). Pregnancy problems are important issues within the scope of 'Gynecological Endocrinology'. Vaginal bleeding and lower abdominal pain, although unspecific, could be early clinical symptoms of CSP, especially if main risk factors exist such as abortion within the last pregnancy and short interval to the last pregnancy. Knowing this can help for prevention and early diagnosis CSP which can reduce life-threatening complications such as massive hemorrhage and can avoid hysterectomy. Consequence also must be to avoid unwanted pregnancies by using effective contraception, especially in risk patients.

Objective: To estimate cesarean delivery rates and indications by region in mainland China., Methods: A cross sectional survey of all deliveries in 39 hospitals in 14 provinces of mainland China from January 1 to December 31, 2011 was evaluated for mode of delivery, cesarean delivery rates and indications for delivery., Results: (1) A survey of a total of 112 138 women at delivery with gestations greater than 24 weeks was analyzed. 79 631 and 32 507 deliveries were obtained from the tertiary and secondary hospitals respectively. 90 971 were primipara, 21 167 were multipara. Of these pregnancies, 61 084, 49 734 and 1 320 cases resulted in cesarean delivery, vaginal delivery and operative vaginal delivery respectively, the cesarean delivery rate was 54.472% (61 084/112 138). Among 61 084 women who had cesarean delivery, 14 998 cases of the cesarean deliveries were performed without medical indications, 46 086 cases of the cesarean deliveries had medical indications. The cesarean delivery rate of the tertiary hospitals was 55.927% (44 535/79 631), and was significant higher than that in the secondary hospitals (50.909%, 16 549/32 507; P < 0.01). (2) Overall 24.553 % (14 998/61 084) of cesarean deliveries were performed without medical indications. 19.744% (8 793/44 535) of the cesarean deliveries without medical indications were performed in the tertiary hospitals, and was significant lower than in the secondary hospitals (37.495%, 6 205/16 549;P < 0.01). (3) Maternal request was the most common indication (24.553% of all cesarean deliveries), followed by fetal distress (12.507% , 7 640/61 084), cephalopelvic disproportion (11.787%, 7 200/61 084), previous uterine surgery (10.374%, 6 337/61 084), malpresentation (5.815%, 3 552/61 084), failure to progress (5.710%, 3 488/61 084) and suspected macrosomia (5.594%, 3 417/61 084)., Conclusions: The increasing caesarean section rate in mainland China is explained mainly by the high non-indicated caesarean section rate. The main medical indications of the cesarean deliveries included fetal distress, cephalopelvic disproportion, previous uterine surgery, malpresentation and failure to progress.

Objective: To examine the treatment of previous cesarean delivery scar defect after cesarean delivery and the feasibility of laparoscopic uterine repair or hysteroscopic scar excision., Study Design: A retrospective clinical study that took place from June 2009 to March 2013 and included 41 women who had previously had cesarean deliveries., Results: Seventeen women underwent a laparoscopic approach for the repair of scar diverticula, and 24 women underwent a hysteroscopic resection of fibrotic tissue overhanging underneath the diverticula. Most women remained free of symptoms over a 3- to 16-month follow-up and 6 women became pregnant without pregnancy complications., Conclusion: Women with a history of cesarean delivery combined with irregular perimenstrual bleeding should undergo combined hysteroscopy and ultrasound examination to detect latent scar defects. In diagnosed cases, in those who desired future pregnancies and had a residual myometrial thickness of <3.5 mm or a defect that accounted for ≥50% of the anterior uterine wall, laparoscopic surgical repair was performed with good postoperative anatomic outcomes. Women with residual myometrial thickness of ≥3.5 mm or a defect that accounted for <50% of the anterior uterine wall were treated with hysteroscopic surgery and had a relief of symptoms.

Objective: To estimate the association between uterine fibroids and adverse obstetric outcomes. Methods: This was a retrospective cross-sectional study of 112,403 deliveries from 14 provinces and 39 different hospitals in 2011 in mainland China. We compared pregnancy outcomes in women with and without uterine fibroids who underwent detailed second trimester obstetric ultrasonography during 18 to 22 weeks. Obstetric outcomes include cesarean delivery, breech presentation, preterm delivery, placenta previa, placental abruption, premature rupture of membranes and neonatal birthweight. Univariate analyses and multivariate logistic regression analyses were performed. Results: Of 112,403 women who underwent routine obstetric survey, 3,012 (2.68%) women were identified with at least 1 fibroid. By univariate and multivariate analyses, the presence of uterine fibroids was significantly associated with cesarean delivery (Adjusted odds radio [AOR] 1.8, 95% confidence interval [CI] 1.7–2.0), breech presentation (AOR 1.3, 95% CI 1.2–1.5) and postpartum hemorrhage (AOR 1.2, 95% CI 1.1–1.4). The size of uterine fibroids and location in uterus had important effect on the mode of delivery. The rates of PPH were significantly higher with increasing size of the uterine fibroid (P<0.001). And the location of fibroid (intramural, submucosal or subserosal) also have a statistically significant impact on the risk of PPH (5.6% [subserosal] vs 4.7% [submucosal] vs 8.6% [intramural]). Conclusion: Pregnant women with uterine fibroids are at increased risk for cesarean delivery, breech presentation and postpartum hemorrhage. And different characteristics of uterine fibroids affect obstetric outcomes through different ways. Such detailed information may be useful in risk-stratifying pregnant women with fibroids. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Clinical analysis of second trimester pregnancy termination after previous caesarean delivery in 51 patients with placenta previa and placenta accreta spectrum."

Objective: To survey the proportion of births born after assisted reproductive technology (ART) and compare the obstetric and prenatal complications between ART and spontaneous pregnancy in women in mainland China. Design: Retrospective analysis. Setting: Thirty-nine hospitals. Patient(s): A total of 112,403 deliveries from 14 provinces and 39 different hospitals composed our retrospective study. Intervention(s): A multiprovince, hospital-based survey was performed. Main Outcome Measure(s): The prevalence of obstetric complications, mode of delivery, and prenatal outcomes were compared between ART and spontaneous pregnancy. For each group, data included singleton and twin deliveries. Result(s): The proportion of infants born as a result of ART in mainland China was about 1.013% in 2011. The incidence of hypertensive disorder in pregnancy (11.0%, odds ratio [OR], 1.27, 95% confidence interval [CI] 1.04–1.60), premature delivery (27.0%, OR, 4.53, 95% CI 3.91–5.25), gestational diabetes mellitus (15.1%, OR 3.05, 95% CI 2.57–3.60), and placenta previa (4.5%, OR 2.18, 95% CI 1.62–2.94) were markedly increased in women who conceived using ART. The cesarean section rate in the ART pregnancy group was 85.3%, which is significantly higher than spontaneous pregnancies (54.0%). Compared with spontaneous pregnancy, ART pregnancy had a significantly increased incidence of low birth weight babies (29.7%) and birth gestational age of less than 37 weeks (30.0%). Infants conceived by ART have increased low 5-minute Apgar and mortality. Conclusion(s): This population-based survey demonstrates that the proportion of births from ART in mainland China was about 1.013% in 2011. Multiple gestation is significantly increased in ART pregnancies, relative to spontaneous pregnancies. The increasing incidence and risk of maternal complications in ART pregnancies (e.g., premature delivery, placenta previa, gestational diabetes mellitus) are found in singleton and twin gestations in ART. A higher cesarean section rate, low birth weight infants, and higher infant mortality rate were also observed in ART pregnancies. Our survey provides a comprehensive overview of the prevalence of ART and ART-associated complications in mainland China, and provides insight into attitudes toward ART among the mainland Chinese population. [ABSTRACT FROM AUTHOR]