Outcomes of Planned Compared With Urgent Deliveries Using a Multidisciplinary Team Approach for Morbidly Adherent Placenta
Outcomes of Planned Compared With Urgent Deliveries Using a Multidisciplinary Team Approach for Morbidly Adherent Placenta
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DOI：
10.1097/aog.0000000000002442
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发表时间：
2018-02-01
影响因子：
7.2
通讯作者：
Belfort, Michael A.
中科院分区：
文献类型：
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作者：
Shamshirsaz, Alireza A.;Fox, Karin A.;Belfort, Michael A.
目的：比较计划和紧急剖宫产子宫切除术的病态粘连胎盘由一个多学科team.METHODS管理的结果：这是一项回顾性病例对照研究的妇女与产前怀疑和病理证实的病态粘连胎盘行剖宫产子宫切除术之间的2011年1月1日，2017年2月30日。分娩时间分为计划（妊娠34-35周分娩）或紧急（由于子宫收缩、出血或两者兼而有之而需要紧急分娩）。主要结局变量为复合孕产妇发病率。结果：130例患者行子宫切除术。60例（46.2%）需要紧急分娩。在34例（56.7%）紧急分娩和26例（37.1%）计划分娩中确定了复合孕产妇发病率（P= 0.03）。计划分娩组输注的红细胞和新鲜冷冻血浆单位较少（红细胞，中位数四分位数范围3 [0-8] vs 1 [0-4]，P=.0 - 2;新鲜冷冻血浆，中位数四分位数范围1 [0-2] vs 0 [0-0]，P=.001）。与计划分娩组相比，紧急分娩组的低Apgar评分和呼吸窘迫综合征的发生率更高（5分钟Apgar评分小于7分，34例[59.6%]对14例[23.3%]，P
OBJECTIVE: To compare outcomes between planned and urgent cesarean hysterectomy for morbidly adherent placenta managed by a multidisciplinary team.METHODS: This is a retrospective case-control study of women with singleton pregnancies with antenatally suspected and pathologically confirmed morbidly adherent placenta who underwent cesarean hysterectomy between January 1, 2011, and February 30, 2017. Timing of delivery was classified as either planned (delivery at 34-35 weeks of gestation) or urgent (need for urgent delivery as a result of uterine contractions, bleeding, or both). The primary outcome variable was composite maternal morbidity. Logistic regression analysis was used to evaluate risk factors for urgent delivery.RESULTS: One hundred thirty patients underwent hysterectomy. Sixty (46.2%) required urgent delivery. Composite maternal morbidity was identified in 34 (56.7%) of the urgent and 26 (37.1%) of the planned deliveries (P=.03). Fewer units of red blood cells and fresh frozen plasma were transfused in the planned delivery group (red blood cells, median interquartile range 3 [0-8] versus 1 [0-4], P=.02; fresh frozen plasma, median interquartile range 1 [0-2] versus 0 [0-0], P=.001). Rates of low Apgar score and respiratory distress syndrome were higher in the urgent compared with the planned delivery group (5-minute Apgar score less than 7, 34 [59.6%] versus 14 [23.3%], P