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Ⅰ.Effect of Placenta Previa and Low-lying Placenta on Maternal and Fetal-neonatal Outcomes. Ⅱ.Retained Placenta Percreta.

【摘要】:[Objective] Data were retrieved prospectively from cases of placenta previa and low-lying placenta and comparative studies between the effects of placenta previa and low-lying placenta on both maternal and fetal-neonatal outcomes were reported. [Methods] between January 2008 and November 2009, 104 women with prenatal diagnosis of placenta previa and low-lying placenta were collected in our department. Our institutional review board approved the study, and verbal informed consent was obtained from each patient. Data were statistically analyzed by using SPSS for Windows software (version 18.0) and logistic Excel Windows 2007. [Results] our cases concern 78.8% of placenta previa and 21.2% of low-lying placenta with a frequency of complete placenta previa (66%) and posterior location (45cases in PP group versus 11cases in LP). Concerning the risk factors, we found only that previous cesarean section as risk associated to both groups (P0.05); while, no statistical difference were found with other factors in both groups (P0.05). However, abnormal invasions were found in both groups (31 accretas for PP vs. 11for LP, 15 incretas for PP vs. 6 for LP and 2 percretas for PP vs. 1for LP). Clinical manifestation was present in 68 cases in PP group vs. 17cases in LP, although, eleven (11) patients with abnormal invasion remained qasymptomatic throughout their pregnancies (8 vs. 3 in pp and LP, respectively).Vaginal delivery was only attempted in 4.81% in PP group vs. 0.96% in LP group. Vertical extension in low-transverse uterine incision was performed in 14cases for PP group and only in one case for LP. In general, bleeding was moderated with a total mean of 359.23mL±384.25; although, it was slightly abundant in the LP than PP group (402.27±610.518ml in LP vs. 347.68±300.799ml in PP) and eventually 6patients in PP group vs.4in LP required blood transfusion; while, PPH was recorded in 14 cases in PP group versus 5 cases in LP group. Hysterectomy has been performed for 2patients (one of each group, respectively). Tocolytic agents, corticosteroid, antibiotics were generally used in the antepartum time, while, uterotonics agents; endouterine hemostastic suture and mifepristone were an additional treatment to the conservative management. Fetal malpresentation, low birth weight, low Apgar scores, fetal growth retardation, fetal/neonatal death and RDS were most common with PP than LP. Furthermore, patient with PP have more likely to have long duration of hospitalization than those of LP. [Conclusion] Placenta previa and low-lying placenta are both condition that may be life-threatening at various degrees for both mother and fetus. However, similar condition for maternal risk factors has been reported in both PP and LP group; although, concerning outcomes condition, women with PP have likely to have a better prognosis for maternal outcomes than those with LP contrary to fetal and neonatal outcomes condition in which, prognosis is better in LP group than PP group. Careful timing of delivery from 35 weeks of pregnancy in PP group and 36weeks in LP may be usually the only active therapy required in pregnancies to achieve normal outcome. Vertical extension in low-transverse uterine incision, uterotonic use and endouterine hemostastic suture are the encouraging conservative management options. The term of placenta percreta is used to describe any abnormal placental implantation in which the chorionic villi can reach not only the uterine serosa but also the adjacent organs. We reported an experience of successful conservative management of placenta percreta in the early second trimester of pregnancy. A 31 year-old patient presenting retained placenta following spontaneous abortion at 17weeks of gestation was referred to our department from outlying hospital for continuous vaginal bleeding after failed long period of oral mifepristone administration. Ultrasound and magnetic resonance imaging proved their roles in the diagnosis and in the follow up. Our patient desired the conservative management; however, Methotrexate embolization of uterine artery arteries, uterine curettage within 2weeks after Methotrexate embolization, surgical placenta removal with localized excision and uterine repair were chosen as skills. In our case, uterotonic agents showed a capital importance to prevent profuse hemorrhage. The follow up with serial serumβ-Human chorionic gonadotropin testing was performed.

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