Maternal Outcomes of Placental Position in Placental Previa Patients with Scar Uterine

doi:10.3877/cma.j.issn.1673-5250.2014.01.020

Objective

To discuss the effects of placental position in placental previa patients with scar uterine on maternal outcomes.

Methods

The study was conducted on 13 patients underwent cesarean section at the Chengdu Women and Children's Center Hospital from September 2011 to August 2012. They were divided into two groups according to different the location of the main part of the placenta, observation group (n=9, placenta was located in the anterior portion of the uterus) and posterior group (n=4, placenta was located in the posterior portion of the uterus) . There had no significant differences of age and gestational weeks between two groups (P>0.05) . The study protocol was approved by the Ethical Review Board of Investigation in Chengdu Women's and Children's Central Hospital. Informed consent was obtained from all participates. The accurate diagnosis were made in all most cases from the ultrasound and magnetic resonance imaging (MRI) . The bleeding amount during operation, hysterectomy and pestoperative complications between two groups were analyzed.

Results

The bleeding amount during operation were 850-7 055 mL and 350-1 200 mL in observation group and control group, respectively, with significant difference (P<0.01) ．The rate of hysterectomy in observation group and control group were 55.56% (5/ 9) and 25.00%(1/ 4) , respectively.

Conclusions

Sonographic determination and MRI of the placental position in the anterior portion where its location beneath the uterine incision is very important to predict maternal outcomes in placenta previa patients with scar uterine, and such cases, close attention should be paid for massive hemorrhage.

Key words: Pernicious placenta previa, Scar uterus, Placental accrete, Massive hemorrhage

表1 两组患者一般情况比较[n（％）]

Table 1 Comparison of general information between two groups[n（% ）]

组别	n	平均年龄(岁)	距离前次剖宫产平均时间(年)	人工终止妊娠术史(次)		产前平均出血量(mL)
组别	n	平均年龄(岁)	距离前次剖宫产平均时间(年)	1	≥2	产前平均出血量(mL)
前壁组	9	28.17	6.30	3(33.33)	6 (66.66)	51.7
后壁组	4	37.25	9.25	0 (0.00)	4(100.00)	45.0
P		>0.05	>0.05	>0.05	>0.05	>0.05

表1 两组患者一般情况比较[n（％）]

Table 1 Comparison of general information between two groups[n（% ）]

组别	n	平均年龄(岁)	距离前次剖宫产平均时间(年)	人工终止妊娠术史(次)		产前平均出血量(mL)
组别	n	平均年龄(岁)	距离前次剖宫产平均时间(年)	1	≥2	产前平均出血量(mL)
前壁组	9	28.17	6.30	3(33.33)	6 (66.66)	51.7
后壁组	4	37.25	9.25	0 (0.00)	4(100.00)	45.0
P		>0.05	>0.05	>0.05	>0.05	>0.05

表2 术中出血量比较（mL）

Table 2 Comparison of blood loss during operation between two groups(mL）

前壁组(n=9)		后壁组(n = 4)
出血量	秩次	出血量	秩次
850	4.0	350	1.0
1 000	5.0	800	2.5
1 200	6.5	800	2.5
2 200	8.0	1 200	6.0
2 950	9.0
3 450	10.0
4 120	11.0
5 500	12.0
7 055	13.0
	T1 = 78.5		T2=12.0

表2 术中出血量比较（mL）

Table 2 Comparison of blood loss during operation between two groups(mL）

前壁组(n=9)		后壁组(n = 4)
出血量	秩次	出血量	秩次
850	4.0	350	1.0
1 000	5.0	800	2.5
1 200	6.5	800	2.5
2 200	8.0	1 200	6.0
2 950	9.0
3 450	10.0
4 120	11.0
5 500	12.0
7 055	13.0
	T1 = 78.5		T2=12.0

表3 两组患者术后切除子宫情况比较[n（％）]

Table 3 Comparison of hysterectomy between two groups [n（％）]

组别	n	子宫切除率	子宫未切除率
前壁组	9	5(55.56)	4(44.44)
后壁组	4	1(25.00)	3(75.00)
合计	13	6(46.15)	7(53.85)

表3 两组患者术后切除子宫情况比较[n（％）]

Table 3 Comparison of hysterectomy between two groups [n（％）]

组别	n	子宫切除率	子宫未切除率
前壁组	9	5(55.56)	4(44.44)
后壁组	4	1(25.00)	3(75.00)
合计	13	6(46.15)	7(53.85)

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