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Severe outcomes and strategies for the prediction and treatment in pregnancies with pernicious placenta previa and prior cesarean delivery -- a national retrospective study
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  • Guiqin Bai,
  • Weilin Chen,
  • Xianghua Huang,
  • Shaojie Zhao,
  • Shuping Zhao,
  • Xiujuan Chen,
  • Suwen Chen,
  • Hua Yang,
  • Xia Lu,
  • Guanyuan Liu,
  • Qionghua Chen,
  • Linai Zhang,
  • Li Jin,
  • Yongzheng Wu
Guiqin Bai
Xi'an Jiaotong University Medical College First Affiliated Hospital
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Weilin Chen
Peking Union Medical College Hospital
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Xianghua Huang
Hebei Medical University No2 Hospital
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Shaojie Zhao
Nanjing Medical University
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Shuping Zhao
Qingdao Women and Children's Hospital
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Xiujuan Chen
Fujian Province Maternal and Child Health Hospital
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Suwen Chen
Capital Medical University Beijing Obstetrics and Gynecology Hospital
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Hua Yang
Tianjin Central Hospital of Obstetrics and Gynecology
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Xia Lu
Xin Jiang Medical University
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Guanyuan Liu
Beijing Chaoyang Hospital
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Qionghua Chen
Xiamen University and Fujian Medical University Affiliated First Hospital
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Linai Zhang
Shanxi Maternal and Child Health Hospital
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Li Jin
Peking Union Medical College Hospital
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Yongzheng Wu
Institut Pasteur
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Abstract

Objectives To evaluate the severe outcomes in pregnancies with pernicious placenta previa and prior cesarean delivery, and to analyze the predictive examinations and prevention strategies regarding severe complications in these women. Design Multicentre retrospective cohort study. Setting Thirteen hospitals in China. Population Selected 747 women with pernicious placenta previa and prior cesarean history. Methods The basic data relating to pregnancy, the examinations during gestation and the outcomes were collected and analyzed. Main outcome measures Outcomes including massive bleeding, placenta implantation and hysterectomy were monitored. Results Our results showed that placental implantation occurred in 47.5% of patients and the hysterectomy rate was 10.4%. The incidence of massive bleeding and blood transfusion was 55.8% and 64%, respectively. The women with placenta implantation predicted by both ultrasound and MRI had higher blood loss than those diagnosed only by either one of the examinations. Surprisingly, vascular occlusion had no effect on the occurrence of severe hemorrhage and hysterectomy. The latter was even higher in the vascular blocking group compared to that in the non-blocking group (34.2% and 8.6%, respectively). Conclusions: The pregnancies with pernicious placenta previa and prior cesarean delivery, had a dramatically higher risk of placenta implantation, hysterectomy and massive hemorrhage. MRI combined with ultrasound examination presented high accuracy in predicting severe outcomes in these patients. Vascular occlusion does not appear to be an effective approach to prevent severe outcomes. Surgical hemostasis should be the key goal in blocking massive bleeding, preserving the uterus and improving the prognosis of the patients.