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Clinical analysis of second-trimester pregnancy termination after previous caesarean delivery in 51 patients with placenta previa and placenta accreta spectrum: a retrospective study.
- Source :
-
BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2021 Aug 18; Vol. 21 (1), pp. 568. Date of Electronic Publication: 2021 Aug 18. - Publication Year :
- 2021
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Abstract
- 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.<br />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.<br />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.<br />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.<br /> (© 2021. The Author(s).)
- Subjects :
- Adult
China
Female
Humans
Hysterotomy
Mifepristone therapeutic use
Misoprostol therapeutic use
Placenta Accreta diagnostic imaging
Placenta Accreta drug therapy
Placenta Accreta surgery
Placenta Previa diagnostic imaging
Placenta Previa drug therapy
Placenta Previa surgery
Pregnancy
Pregnancy Trimester, Second
Retrospective Studies
Vaginal Birth after Cesarean adverse effects
Vaginal Birth after Cesarean statistics & numerical data
Young Adult
Abortifacient Agents, Steroidal therapeutic use
Abortion, Induced methods
Cesarean Section adverse effects
Labor, Induced methods
Placenta Accreta therapy
Placenta Previa therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2393
- Volume :
- 21
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC pregnancy and childbirth
- Publication Type :
- Academic Journal
- Accession number :
- 34407784
- Full Text :
- https://doi.org/10.1186/s12884-021-04017-8