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Placenta previa with posterior extrauterine adhesion: clinical features and management practice
- Source :
- BMC Surgery, Vol 21, Iss 1, Pp 1-10 (2021), BMC Surgery
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.
- Subjects :
- Adult
medicine.medical_specialty
Blood Loss, Surgical
Endometriosis
lcsh:Surgery
Placenta previa
03 medical and health sciences
Magnetic resonance imaging
0302 clinical medicine
Pregnancy
Placenta
medicine
Humans
030212 general & internal medicine
Retrospective Studies
Bakri balloon
030219 obstetrics & reproductive medicine
medicine.diagnostic_test
Cesarean Section
business.industry
Postpartum Hemorrhage
Infant, Newborn
Retrospective cohort study
lcsh:RD1-811
General Medicine
Middle Aged
medicine.disease
Surgery
medicine.anatomical_structure
Cohort
Propensity score matching
Adhesion
Premature Birth
Female
business
Research Article
Subjects
Details
- ISSN :
- 14712482
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- BMC Surgery
- Accession number :
- edsair.doi.dedup.....a41298f62ced77230933b383399755e0
- Full Text :
- https://doi.org/10.1186/s12893-020-01027-9