Planned versus urgent deliveries in placenta previa: maternal, surgical and neonatal results

Durukan, Hüseyin; Durukan, Ömer Birol; Yazici, Faik Gürkan

doi:10.1007/s00404-019-05349-9

Cited by 20 publications

(36 citation statements)

References 15 publications

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“…Erfani et al, demonstrated that 42.8% of PP patients without morbidly adherent placenta underwent ECD due to bleeding or labor contractions [19]. Durukan et al, observed that 43.8% of patients could not reach the scheduled time and were delivered earlier [18]. We consider that the low ECD rate in our study than in previous studies was because of we exclude patients with PAS and previous history of uterine interventions.…”

Section: Discusionmentioning

confidence: 68%

“…The decision to perform an ECD was mostly made by the attending surgeon due to severe hemorrhage or premature onset of delivery. This decision could be partly iatrogenic or frequently as a result of a condition that compromises fetal or maternal stability [18]. The mean delivery time of our PCD group (157 patients, 66.2%) was 36.84 ± 1.75 week.…”

Section: Discusionmentioning

confidence: 97%

“…Balayla et al, reported that early-term (37 0/7 and 38 6/7 weeks of pregnancy) delivery in PP was associated with fewer complications and no greater risk than late-preterm (34 0/7 and 36 6/7 weeks of gestation) delivery [17]. Durukan et al, suggested scheduling a cesarean section for PP patients beyond 38 weeks of gestation concerning fetal lung maturation since maternal mortality is significantly low [18]. Erfani et al [19], reported that PP patients without PAS and significant hemorrhage and with proper planning and monitoring, cesarean delivery might be safely delayed until 36-37 weeks of gestation in a tertiary referral center.…”

Section: Discusionmentioning

confidence: 99%

“…Severe antepartum and postpartum hemorrhage in PP is associated with increased risk of maternal morbidity, ICU requirement, blood or blood product transfusion, and the necessity for additional drugs and procedures to staunch bleeding, including uterine compression sutures, balloon tamponade, and hysterectomy [22,[25][26][27][28]. Durukan et al [18], found that the total amount of transfused blood and blood products, intraoperative interventions, and ICU requirement were significantly higher, preoperative and predischarge hemoglobin levels were significantly lower in the ECD group than those of the PCD group. Our results have demonstrated that ICU requirement was significantly higher, and hospital LOS were significantly longer in the ECD group than in the PCD group.…”

Section: Discusionmentioning

confidence: 99%

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The comparison of maternal and neonatal outcomes between planned and emergency cesarean deliveries in placenta previa patients without placenta accreata spectrum

2022

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Objectives: This study aims to investigate whether a significant difference exists in maternal and fetal outcomes between planned cesarean delivery (PCD) compared to emergency cesarean delivery (ECD) in placenta previa (PP) patients without placenta accreata spectrum (PAS) in a tertiary referral hospital. Material and methods:This retrospective cohort study included 237 singleton pregnant women who were diagnosed with PP without PAS at the time of delivery. PP patients who were delivered at the scheduled time were included in the PCD group. Patients with PP delivered in an emergency setting before the scheduled date were assigned to the ECD group. We recorded demographic and clinical characteristics, maternal and neonatal outcomes. Results:Of the 237 patients who met the inclusion criteria, 157 patients (66.8%) underwent PCD, and 80 patients required ECD (33.2%). Patients' hospitalization and pre-discharge hemoglobin levels were significantly lower in the ECD group (11.25 ± 1.97 g/dL and 9.74 ± 2.09 g/dL, respectively) than in the PCD group (10.77 ± 2.67 g/dL and 9.27 ± 2.70, p = 0.002 and p = 0.004, respectively). While six patients (7.5%) were required intensive care unit (ICU) admission in the ECD group, no patient was required to follow up in ICU in the PCD group (p < 0.001). The hospital length of stay (LOS) was tended to be significantly longer in the ECD group (2.8 ± 0.7 days) than in the PCD group (2.4 ± 0.6 days, p < 0.001). Neonatal outcomes of birth weight, Apgar scores, NICU admission, and neonatal death were significantly better in the PCD group than in the ECD group. Conclusions:The PCD group has better maternal outcomes, including preoperative and discharge hemoglobin levels, ICU admission and hospital LOS, and better neonatal outcomes than the ECD group. Clinicians should pay regard to that scheduling the delivery to advanced pregnancy weeks has a failure possibility, and patients could not reach the scheduled day due to the emergency states.

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Section: Discusionmentioning

confidence: 68%

Section: Discusionmentioning

confidence: 97%

Section: Discusionmentioning

confidence: 99%

Section: Discusionmentioning

confidence: 99%

See 2 more Smart Citations

The comparison of maternal and neonatal outcomes between planned and emergency cesarean deliveries in placenta previa patients without placenta accreata spectrum

2022

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“…Placenta previa is described as the implantation of the placenta to the lower uterine segment outside the regular site and thus closes the internal os of the cervix uteri partially or completely 1 . It occurs in 0.3-0.5% of all pregnancies 2 .…”

Section: Introductionmentioning

confidence: 99%

Retrospective Evaluation of Placenta Previa Cases: A Secondary-center Experince

Mehmet¹,

Oğlak²

2020

Namık Kemal Tıp Dergisi

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This study aimed to evaluate the maternal and neonatal outcomes of placenta previa cases managed in our hospital. Materials and Methods: The records of 107 placenta previa cases delivered between 2011 and 2016 were retrospectively reviewed. Age, gravida, parity, red blood cell (RBC)-fresh frozen plasma (FFP) transfusion necessity, the gestational week at birth, birth weight, 1st and 5th minute Apgar score, the number of previous cesarean sections, requiring additional surgical intervention (internal iliac artery ligation [IIAL], peripartum hysterectomy) and maternal complications were examined. Results: RBC-FFP transfusion and IIAL rates were significantly higher in complete placenta previa cases than the partial placenta previa cases. RBC-TDP transfusion, IIAL and peripartum hysterectomy rates were significantly higher in placenta accreata spectrum (PAS) cases compared to those cases with normal placental invasion. Prematurity risk increased in all placenta previa subgroups. Conclusion: Pregnancy complicated by placenta previa increases the risk of adverse maternal and neonatal outcomes, especially if there is concurrent placental invasion anomaly.

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Determinants of emergency Cesarean delivery in pregnancies complicated by placenta previa with or without placenta accreta spectrum disorder: analysis of ADoPAD cohort

2024

Ultrasound in Obstet & Gyne

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ObjectivesTo report the rate and the outcomes of unplanned caesarean delivery (CD) delivery in women with placenta accreta spectrum disorders (PAS) and placenta previa without PAS, and to elucidate the diagnostic accuracy of ultrasound in predicting this outcome.MethodsSecondary analysis of a multicenter prospective study involving 14 referral hospital in Italy (ADoPAD Study). Inclusion criteria were women with a low‐lying placenta (< 20 mm from the internal cervical os) or placenta previa (covering the os), aged ≥ 18 years, who underwent trans‐abdominal and transvaginal ultrasound assessment at ≥ 26 + 0 weeks of gestation.The primary outcome was the occurrence of emergency CD, defined as the need of immediate surgical intervention performed for emergency maternal or fetal indications, including active labour, cumulative maternal bleeding >500 ml, severe and persistent vaginal bleeding such that maternal hemodynamic stability cannot be achieved or maintained or category III fetal heart rate tracing unresponsive to resuscitative measures in women with PAS and in those with placenta previa with no PAS. The primary outcome was reported in the population of women with placenta previa and with no PAS confirmed after birth and in those with PAS separately. The secondary aim was to report the strength of association and to test the diagnostic accuracy of ultrasound in predicting emergency delivery. Univariate, multivariate, and diagnostic accuracy analyses were used to analyse the data.Results450 women (97 with PAS and 353 with placenta previa but not PAS) were included in the analysis. In women with PAS disorders, emergency CD was required in 21% (95% CI 14‐30%) and 60% women delivered before 34 weeks of gestation. Mean gestational age at delivery was 32.3±2.7 weeks in women undergoing emergency and 34.9±1.8 weeks (p<0.001) in those undergoing elective CD. Women undergoing emergency CD had a higher median estimated blood loss (2500 ml, IQR 1350‐4500 vs 1100 ml, IQR 625‐2500, p=0.012) and mean units of blood transfused (4.3±1.6 vs 0.8±2.2; p= 0.02) compared to those undergoing elective delivery. At univariate analysis, the presence of interrupted retroplacental space, bladder line and placental lacunae were more common in women not experiencing emergency CD. At multivariate analysis, only maternal BMI (OR: 0.83. 95% CI 0.69‐0.99, p= 0.045) was independently associated with emergency delivery in women with PAS. However, ultrasound signs of PAS, including presence of interrupted retroplacental space, bladder line and placental lacunae, were not associated neither predictive of emergency CD.In women with placenta previa but not PAS, emergency CD was required in 31.1% (95% CI 26.6‐36.2) and 32.8% delivered before 34 weeks of gestation. Mean gestational age at delivery was lower in women undergoing compared to those not undergoing emergency delivery (34.2±2.9 vs 36.7±1.6; p<0.001). Pregnancies complicated by emergency CD, had new‐borns with a lower birthweight (2330±620 g vs 2800±620 g, p<0.001) and had a higher risk of receiving blood transfusions (22.7% vs 10.7%, p= 0.003) compared to those who underwent elective CD. At multivariate analysis, only placental thickness (p= 0.046) and a cervical length < 25 mm (OR: 3.89, 95% CI 3.89‐11.33, p= 0.01) were associated with emergency CD. However, a short CL showed a low diagnostic accuracy for predicting emergency CD in these women.ConclusionEmergency CD complicated about 20% of women with PAS disorders and 30% of those with placenta previa and not PAS and is associated with a worse maternal and perinatal outcome compared to elective intervention. Prenatal ultrasound cannot entirely predict the risk of emergency delivery in women with these disorders.This article is protected by copyright. All rights reserved.

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Planned versus urgent deliveries in placenta previa: maternal, surgical and neonatal results

Cited by 20 publications

References 15 publications

The comparison of maternal and neonatal outcomes between planned and emergency cesarean deliveries in placenta previa patients without placenta accreata spectrum

The comparison of maternal and neonatal outcomes between planned and emergency cesarean deliveries in placenta previa patients without placenta accreata spectrum

Retrospective Evaluation of Placenta Previa Cases: A Secondary-center Experince

Determinants of emergency Cesarean delivery in pregnancies complicated by placenta previa with or without placenta accreta spectrum disorder: analysis of ADoPAD cohort

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