Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage

Predictors of adverse neonatal outcome in pregnancies complicated by placenta previa

INTRODUCTION

We aimed to underline the determinants of adverse neonatal outcome in gestations complicated by placenta previa (PP).

METHODS

A retrospective study including all women diagnosed with placenta previa carrying a singleton gestation who delivered between 2011 and June 2019. Gestations with adverse neonatal outcomes were compared to those without. In a secondary analysis, we further studied the rate of Placenta accreta spectrum (PAS) in relation to number of previous cesarean deliveries.

RESULTS

Overall, 548/84,558 (0.6%) singleton deliveries were complicated by PP (0.6%). PAS was noted in 105 (19.2%) cases. After exclusion of PAS cases, adverse neonatal outcome occurred in 149/443 (33.6%), median gestational age of delivery was 37 ^0/7 with a median birthweight of 2780 g. In a univariate analysis, adverse neonatal outcome was associated with emergent delivery and general anesthesia [56.8% vs. 20.8%, OR 5.00 (95% CI) 3.24-7.72, p < 0.001 and 54.4% vs. 24.8%, OR 3.60 (95% CI) 2.37-5.47, p < 0.001, respectively]. Gestational age at delivery was lower in the adverse outcome group (mean 35 ^1/7 vs. 37 ^3/7, p < 0.001). In a multivariate regression analysis, general anesthesia and gestational age at delivery were independently associated with adverse neonatal outcome [adjusted odds ratio (aOR) 2.26 (95% CI) 1.18-4.31, p = 0.01, aOR 1.10 (95% CI) 1.05-1.16, p < 0.001. Analysis of the rate of PAS among women with previous cesarean delivery and PP revealed that no cases of PAS were noted when no prior cesarean delivery was present. The rate of PAS for previous 1, 2, 3, 4 and 5 cesarean deliveries was 26.7%, 43.5%, 65.5%, 55.6% and 66.7% respectively.

DISCUSSION

Efforts should be made to avoid general anesthesia in deliveries of PP.

The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study

Background

Severe obstetric haemorrhage caused by placenta accreta spectrum (PAS) results in significant maternal morbidity and mortality. The effectiveness of prophylactic balloon occlusion of the internal iliac artery in PAS patients remains controversial. Therefore, we conducted a retrospective case-control study to investigate the clinical effectiveness of this treatment.

Methods

The clinical data of 104 patients with PAS complicated with placenta previa who delivered by caesarean section between January 2016 and January 2019 were collected, and the patients were divided into two groups. The study group (48 cases) underwent internal iliac artery preset balloon occlusion before caesarean section and uterine artery embolisation according to the bleeding status after surgery, while the control group (56 cases) did not undergo internal iliac artery preset balloon occlusion before caesarean section.

Results

The operation and hospitalisation times in the study group were longer than those in the control group. Additionally, the hysterectomy rate in the study group was significantly higher than that in the control group. No significant differences in blood loss, blood transfusion volume, urinary system injury, postoperative ICU transfer rate, or neonatal scores were identified between the groups. Among the patients without invasive placenta (placenta increta and percreta), blood loss was lower in the study group, and the caesarean hysterectomy rate did not significantly differ between the groups. Among the patients with invasive placenta, blood loss and the caesarean hysterectomy rate did not significantly differ between the groups. The risk of hysterectomy in the study group was related to invasive placenta penetration, a large area of placental invasion, or abnormal vascular filling. One patient in the study group had a thrombus in the left lower extremity artery.

Conclusions

Balloon occlusion of the internal iliac artery is effective for haemostasis of placenta previa in the absence of invasive placenta. For patients with invasive placenta, especially placenta percreta, a large area of placental invasion or abnormal vascular filling suggests the need for hysterectomy. The risks of the prophylactic use of internal iliac artery balloon occlusion include vascular injury and thrombus formation.

Acute complete uterine inversion after controlled cord traction of placenta following vaginal delivery: a case report

Early recognition and active management of the third stage of labor will reduce the risks associated with uterine inversion. All staff members in the maternal unit should be updated with Green‐Top guidelines No. 52 and be appropriately trained in the PROMPT course to provide a standardized approach in obstetric emergencies.