This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta, and that in women with and without previous cesarean se...This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta, and that in women with and without previous cesarean section. In this study, placenta previa was defined as a placenta lying within 20 mm of the internal cervical os or overlapping it. We recruited 183 women diagnosed with previa between 20+0 weeks and 25+6 weeks. They were grouped according to their placenta location(anterior or posterior) and history of cesarean section. Comparative analysis was performed on demographic data, resolution rate of previa and pregnancy outcomes between anterior group and posterior group, and on those between cesarean section group and non-cesarean section group. Women with an anterior placenta tended to be advanced in parity(P=0.040) and have increased number of dilatation and curettage(P=0.044). The women in cesarean section group were significantly older(P=0.000) and had more parity(P=0.000), gravidity(P=0.000), and dilatation and curettage(P=0.048) than in non-cesarean section group. Resolution of previa at delivery occurred in 87.43% women in this study. Women with a posterior placenta had a higher rate of resolution(P=0.030), while history of cesarean section made no difference. Gestational age at resolution was earlier in posterior group(P=0.002) and non-cesarean section group(P=0.008) than in anterior group and cesarean section group correspondingly. Placenta location and prior cesarean section did not influence obstetric outcomes and neonatal outcomes. This study indicates that it is more likely to have subsequent resolution of the previa when the placenta is posteriorly located for women who are diagnosed with placenta previa in the second trimester.展开更多
Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: ...Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: This was a non-comparative retrospective study of 188 patients diagnosed with pernicious placenta previa who underwent cesarean section in The First Hospital of Jilin University, China, from 1 January 2013 to 1 January 2018. Successful group was defined as those in which the intraoperative bleeding was managed by either modified CHO or by B-lynch suture technique and those who had further intervention including hysterectomy were designated as failure group. Results: Out of 217 patients, 188 met inclusion criteria and 29 patients were excluded. In 188 cases, 183 (97.34%) cases successes and 5 (2.65%) cases had hysterectomy. Among included group, 118 patients (62.76%) had undergone emergency cesarean section and 70 patients (37.23%) underwent elective cesarean section. The emergency group had significantly lesser gestation period of gestation at the time of cesarean section (P = 0.021) and lower neonatal weight (P = 0.001) than that of elective group. The estimated blood loss during surgery was 500 - 3200 ml (mean: 925 ml). Additionally, the amount of bleeding was found to be significantly more in patient with intraoperative complication (P = 0.007) and in patient with implanted placenta (P 0.001). Conclusion: The conservative compression suture technique including modified CHO and B-lynch suture technique during the cesarean delivery is a feasible, safe and effective alternative conservative surgical technique for the management of bleeding in case of pernicious placenta previa. Besides good surgical outcome and proper neonatal result this technique also reduces the rate of hysterectomy, thus conserving the fertility.展开更多
目的系统评价剖宫产术中不同时机行血管介入阻断对凶险性前置胎盘患者及胎儿的影响。方法采用计算机检索PubMed、Embase、Medline、Web of Science、维普、万方数据库、中国知网、中国生物医学文献数据库等中不同时机行血管介入阻断对...目的系统评价剖宫产术中不同时机行血管介入阻断对凶险性前置胎盘患者及胎儿的影响。方法采用计算机检索PubMed、Embase、Medline、Web of Science、维普、万方数据库、中国知网、中国生物医学文献数据库等中不同时机行血管介入阻断对凶险性前置胎盘的相关研究。检索时限为建库至2024年3月1日,由两名研究员独立筛选随机对照或回顾性文献、提取数据,选用Review Manager 5.4.1软件分析,参照Cochrane协作网提供的偏倚风险评估工具对文献质量进行评估。结果共纳入12篇目标文献,1030例凶险性前置胎盘患者。Meta分析结果显示,胎儿娩出前阻断可降低术后子宫切除率(OR=0.54,95%CI:0.33~0.89)和术后入住ICU病房率(OR=0.34,95%CI:0.19~0.63),但不能降低序贯子宫动脉栓塞率(OR=0.61,95%CI:0.28~1.32)。此外,对胎儿1 min Apgar评分(MD=0.11,95%CI:-0.23~0.46)、5 min Apgar评分(MD=0.10,95%CI:-0.04~0.24)、1 min Apgar评分≤7分(OR=0.81,95%CI:0.36~1.85)、5 min Apgar评分≤7分(OR=0.93,95%CI:0.33~2.63)无明显影响。结论胎儿娩出前介入阻断的临床价值更高,且不会增加胎儿不良结局。展开更多
目的荟萃分析回收式自体输血(IOCS)在前置胎盘剖宫产术中的安全性和有效性。方法计算机检索PubMed、Web of Science、Embase、the Cochrane Library of clinical trials、中国知网(CNKI)及万方数据知识服务平台。检索时限设定为建库至2...目的荟萃分析回收式自体输血(IOCS)在前置胎盘剖宫产术中的安全性和有效性。方法计算机检索PubMed、Web of Science、Embase、the Cochrane Library of clinical trials、中国知网(CNKI)及万方数据知识服务平台。检索时限设定为建库至2022年12月。采用R 4.1.2与Stata 12.0软件计算IOCS组和异体输血(ABT)组之间的标准化均数差(SMD)或相对危险度(RR)及95%置信区间(CI)和预测区间(PI)。结果本次Meta分析共纳入5项随机对照试验和10项回顾性队列研究。队列研究的合并结果显示,与ABT组相比,接受IOCS的前置胎盘孕产妇术后血红蛋白(Hb)浓度(SMD=0.626,95%CI:0.103~1.149;95%PI:-1.320~2.572)与红细胞压积较高(SMD=0.617,95%CI:0.130~1.104;95%PI:-1.084~2.317)。在随机对照试验中,接受IOCS的前置胎盘孕产妇发生不良事件的风险比ABT组低72.7%(RR=0.273,95%CI:0.082~0.904)。IOCS组和ABT组术后凝血酶原时间(PT)、活化凝血酶原时间(APTT)、纤维蛋白原(Fib)浓度、血尿素氮(BUN)和肌酐(Cr)差异均无无统计学意义。结论接受IOCS的前置胎盘孕产妇术后Hb浓度和Hct均高于接受ABT的妇女。IOCS对术后凝血参数和肾功能参数无显著影响。在接受剖宫产术的前置胎盘孕产妇中,IOCS与较低的输血相关不良事件发生风险有关。展开更多
目的:探讨髂内动脉球囊预置阻断术在植入型凶险性前置胎盘中的临床价值。方法:选取2021年7月—2024年1月阳江市人民医院收治的60例植入型凶险性前置胎盘患者。根据随机数表法将其分为对照组与观察组,各30例。两组均行剖宫产,对照组应用...目的:探讨髂内动脉球囊预置阻断术在植入型凶险性前置胎盘中的临床价值。方法:选取2021年7月—2024年1月阳江市人民医院收治的60例植入型凶险性前置胎盘患者。根据随机数表法将其分为对照组与观察组,各30例。两组均行剖宫产,对照组应用常规止血措施,观察组应用双侧髂内动脉球囊预置术。比较两组围手术期指标、新生儿情况、子宫切除率、并发症。结果:观察组术中出血量少于对照组,手术时间与住院时间均短于对照组,差异有统计学意义(P<0.05)。两组新生儿出生1 min、5 min、10 min Apgar评分比较,差异无统计学意义(P>0.05)。观察组子宫切除率、并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论:双侧髂内动脉球囊预置术应用于植入型凶险性前置胎盘患者中效果显著,能够减少产妇术中出血量,降低大出血风险,缩短手术时间和住院时间,降低患者子宫切除率与术后并发症发生率。展开更多
目的:本回顾性研究旨在探讨完全性前置胎盘(CPP)患者剖宫产术后子宫的恢复情况,并探讨剖宫产术中不同止血方式对剖宫产术后子宫恢复的影响。方法:对2020年7月至2022年12月在厦门大学附属妇女儿童医院行剖宫产术的169例患者的临床资料进...目的:本回顾性研究旨在探讨完全性前置胎盘(CPP)患者剖宫产术后子宫的恢复情况,并探讨剖宫产术中不同止血方式对剖宫产术后子宫恢复的影响。方法:对2020年7月至2022年12月在厦门大学附属妇女儿童医院行剖宫产术的169例患者的临床资料进行回顾性分析,其中包括89例CPP组和80例非前置胎盘患者(非CPP)组,比较术后子宫内膜厚度(EN)、月经恢复和子宫动脉血流的变化,并且比较不同止血方式对其影响。结果:与非CPP组相比,CPP组的估计失血量(EBL)更多(950.337±109.901 vs 484.750±175.290,P<0.001),月经恢复延迟(6.985±2.617 vs 5.433±4.083,P<0.001),EN减少(0.441±0.116 vs 0.501±0.120,P=0.001),术后第42天的子宫阻力指数(RI)更低(0.843±0.033 vs 0.858±0.031,P=0.003)。两组产后月经周期变化、搏动指数(PI)和子宫动脉收缩舒张比(S/D)无统计学意义(均P>0.05)。亚组分析显示,CPP组中不同止血方式对月经恢复、EN和第42天RI指数影响差异无明显统计学意义(均P>0.05)。结论:CPP患者剖宫产术后月经恢复、EN和第42天血供可能受到影响。CPP组术后患者月经恢复时间较长,EN较薄,第42天RI指数较低。而剖宫产术中不同止血方法对术后子宫功能恢复的影响无明显统计学意义。展开更多
基金supported by grants from National Natural Science Foundation of China(Nos.30672243 and 81200354)Hubei Provincial Population and Family Planning Commission of China(No.JS-20130017)Huazhong University of Science and Technology(No.2013YGYL016)
文摘This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta, and that in women with and without previous cesarean section. In this study, placenta previa was defined as a placenta lying within 20 mm of the internal cervical os or overlapping it. We recruited 183 women diagnosed with previa between 20+0 weeks and 25+6 weeks. They were grouped according to their placenta location(anterior or posterior) and history of cesarean section. Comparative analysis was performed on demographic data, resolution rate of previa and pregnancy outcomes between anterior group and posterior group, and on those between cesarean section group and non-cesarean section group. Women with an anterior placenta tended to be advanced in parity(P=0.040) and have increased number of dilatation and curettage(P=0.044). The women in cesarean section group were significantly older(P=0.000) and had more parity(P=0.000), gravidity(P=0.000), and dilatation and curettage(P=0.048) than in non-cesarean section group. Resolution of previa at delivery occurred in 87.43% women in this study. Women with a posterior placenta had a higher rate of resolution(P=0.030), while history of cesarean section made no difference. Gestational age at resolution was earlier in posterior group(P=0.002) and non-cesarean section group(P=0.008) than in anterior group and cesarean section group correspondingly. Placenta location and prior cesarean section did not influence obstetric outcomes and neonatal outcomes. This study indicates that it is more likely to have subsequent resolution of the previa when the placenta is posteriorly located for women who are diagnosed with placenta previa in the second trimester.
文摘Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: This was a non-comparative retrospective study of 188 patients diagnosed with pernicious placenta previa who underwent cesarean section in The First Hospital of Jilin University, China, from 1 January 2013 to 1 January 2018. Successful group was defined as those in which the intraoperative bleeding was managed by either modified CHO or by B-lynch suture technique and those who had further intervention including hysterectomy were designated as failure group. Results: Out of 217 patients, 188 met inclusion criteria and 29 patients were excluded. In 188 cases, 183 (97.34%) cases successes and 5 (2.65%) cases had hysterectomy. Among included group, 118 patients (62.76%) had undergone emergency cesarean section and 70 patients (37.23%) underwent elective cesarean section. The emergency group had significantly lesser gestation period of gestation at the time of cesarean section (P = 0.021) and lower neonatal weight (P = 0.001) than that of elective group. The estimated blood loss during surgery was 500 - 3200 ml (mean: 925 ml). Additionally, the amount of bleeding was found to be significantly more in patient with intraoperative complication (P = 0.007) and in patient with implanted placenta (P 0.001). Conclusion: The conservative compression suture technique including modified CHO and B-lynch suture technique during the cesarean delivery is a feasible, safe and effective alternative conservative surgical technique for the management of bleeding in case of pernicious placenta previa. Besides good surgical outcome and proper neonatal result this technique also reduces the rate of hysterectomy, thus conserving the fertility.
文摘目的系统评价剖宫产术中不同时机行血管介入阻断对凶险性前置胎盘患者及胎儿的影响。方法采用计算机检索PubMed、Embase、Medline、Web of Science、维普、万方数据库、中国知网、中国生物医学文献数据库等中不同时机行血管介入阻断对凶险性前置胎盘的相关研究。检索时限为建库至2024年3月1日,由两名研究员独立筛选随机对照或回顾性文献、提取数据,选用Review Manager 5.4.1软件分析,参照Cochrane协作网提供的偏倚风险评估工具对文献质量进行评估。结果共纳入12篇目标文献,1030例凶险性前置胎盘患者。Meta分析结果显示,胎儿娩出前阻断可降低术后子宫切除率(OR=0.54,95%CI:0.33~0.89)和术后入住ICU病房率(OR=0.34,95%CI:0.19~0.63),但不能降低序贯子宫动脉栓塞率(OR=0.61,95%CI:0.28~1.32)。此外,对胎儿1 min Apgar评分(MD=0.11,95%CI:-0.23~0.46)、5 min Apgar评分(MD=0.10,95%CI:-0.04~0.24)、1 min Apgar评分≤7分(OR=0.81,95%CI:0.36~1.85)、5 min Apgar评分≤7分(OR=0.93,95%CI:0.33~2.63)无明显影响。结论胎儿娩出前介入阻断的临床价值更高,且不会增加胎儿不良结局。
文摘目的荟萃分析回收式自体输血(IOCS)在前置胎盘剖宫产术中的安全性和有效性。方法计算机检索PubMed、Web of Science、Embase、the Cochrane Library of clinical trials、中国知网(CNKI)及万方数据知识服务平台。检索时限设定为建库至2022年12月。采用R 4.1.2与Stata 12.0软件计算IOCS组和异体输血(ABT)组之间的标准化均数差(SMD)或相对危险度(RR)及95%置信区间(CI)和预测区间(PI)。结果本次Meta分析共纳入5项随机对照试验和10项回顾性队列研究。队列研究的合并结果显示,与ABT组相比,接受IOCS的前置胎盘孕产妇术后血红蛋白(Hb)浓度(SMD=0.626,95%CI:0.103~1.149;95%PI:-1.320~2.572)与红细胞压积较高(SMD=0.617,95%CI:0.130~1.104;95%PI:-1.084~2.317)。在随机对照试验中,接受IOCS的前置胎盘孕产妇发生不良事件的风险比ABT组低72.7%(RR=0.273,95%CI:0.082~0.904)。IOCS组和ABT组术后凝血酶原时间(PT)、活化凝血酶原时间(APTT)、纤维蛋白原(Fib)浓度、血尿素氮(BUN)和肌酐(Cr)差异均无无统计学意义。结论接受IOCS的前置胎盘孕产妇术后Hb浓度和Hct均高于接受ABT的妇女。IOCS对术后凝血参数和肾功能参数无显著影响。在接受剖宫产术的前置胎盘孕产妇中,IOCS与较低的输血相关不良事件发生风险有关。
文摘目的:探讨髂内动脉球囊预置阻断术在植入型凶险性前置胎盘中的临床价值。方法:选取2021年7月—2024年1月阳江市人民医院收治的60例植入型凶险性前置胎盘患者。根据随机数表法将其分为对照组与观察组,各30例。两组均行剖宫产,对照组应用常规止血措施,观察组应用双侧髂内动脉球囊预置术。比较两组围手术期指标、新生儿情况、子宫切除率、并发症。结果:观察组术中出血量少于对照组,手术时间与住院时间均短于对照组,差异有统计学意义(P<0.05)。两组新生儿出生1 min、5 min、10 min Apgar评分比较,差异无统计学意义(P>0.05)。观察组子宫切除率、并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论:双侧髂内动脉球囊预置术应用于植入型凶险性前置胎盘患者中效果显著,能够减少产妇术中出血量,降低大出血风险,缩短手术时间和住院时间,降低患者子宫切除率与术后并发症发生率。
文摘目的:本回顾性研究旨在探讨完全性前置胎盘(CPP)患者剖宫产术后子宫的恢复情况,并探讨剖宫产术中不同止血方式对剖宫产术后子宫恢复的影响。方法:对2020年7月至2022年12月在厦门大学附属妇女儿童医院行剖宫产术的169例患者的临床资料进行回顾性分析,其中包括89例CPP组和80例非前置胎盘患者(非CPP)组,比较术后子宫内膜厚度(EN)、月经恢复和子宫动脉血流的变化,并且比较不同止血方式对其影响。结果:与非CPP组相比,CPP组的估计失血量(EBL)更多(950.337±109.901 vs 484.750±175.290,P<0.001),月经恢复延迟(6.985±2.617 vs 5.433±4.083,P<0.001),EN减少(0.441±0.116 vs 0.501±0.120,P=0.001),术后第42天的子宫阻力指数(RI)更低(0.843±0.033 vs 0.858±0.031,P=0.003)。两组产后月经周期变化、搏动指数(PI)和子宫动脉收缩舒张比(S/D)无统计学意义(均P>0.05)。亚组分析显示,CPP组中不同止血方式对月经恢复、EN和第42天RI指数影响差异无明显统计学意义(均P>0.05)。结论:CPP患者剖宫产术后月经恢复、EN和第42天血供可能受到影响。CPP组术后患者月经恢复时间较长,EN较薄,第42天RI指数较低。而剖宫产术中不同止血方法对术后子宫功能恢复的影响无明显统计学意义。
