Bleeding-related outcomes of low-risk total placenta previa are equivalent to those of partial/marginal placenta previa
Bleeding-related outcomes of low-risk total placenta previa are equivalent to those of partial/marginal placenta previa
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低风险完全性前置胎盘的出血相关结局与部分/边缘性前置胎盘相同
DOI：
10.1016/j.tjog.2022.03.007
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发表时间：
2022
影响因子：
2.1
通讯作者：
Fujiwara Hiroyuki
中科院分区：
文献类型：
--
作者：
Ogoyama Manabu;Takahashi Hironori;Baba Yosuke;Yamamoto Hiromichi;Horie Kenji;Nagayama Shiho;Suzuki Hirotada;Usui Rie;Ohkuchi Akihide;Matsubara Shigeki;Fujiwara Hiroyuki
目的明确“低风险全PP”患者是否比部分/边缘性PP患者出血更多。材料和方法回顾性队列研究涉及2006年4月至2018年12月期间的PP患者。超声确定胎盘位置。从医学图表中检索PP患者的背景以及产科和新生儿结局。结果本研究纳入349例PP患者，根据胎盘与内腔的距离将PP患者分为全PP （n = 174）、部分PP （n = 52）和边缘PP （n = 123）三种类型。在全PP患者中，既往CS、前胎盘和超声显示的胎盘腔隙三个因素显著增加了CS出血量、子宫切除术需要、同源输血（≥10 U）和ICU住院。“低风险全PP患者”与“部分/边缘性PP患者”这三个因素均不存在的全PP患者在出血相关不良结局（失血量≥2000 mL、同源输血量、子宫切除需求、ICU入院）方面无显著差异（19.8 vs 17.1%; p = 0.604, 3.7 vs 1.1%; p = 0.330, 1.2 vs 1.1%; p = 1.000, 1.2 vs 1.1%; p = 1.000）。结论超声显示既往CS、前胎盘和胎盘腔隙是导致全PP患者出血相关不良预后的危险因素。没有这三个因素的全部PP患者与部分/边缘性PP患者表现出相同的出血相关不良结局。
ObjectiveTo clarify whether “low-risk total PP” patients bleed more than partial/marginal PP patients.Materials and methodsThe retrospective cohort study was performed involving patients with PP between April 2006 and December 2018. The placental position was determined by ultrasound. From medical charts, the backgrounds as well as obstetric and neonatal outcomes of PP patients were retrieved.ResultsThis study included 349 patients with PP, which was classified into three types according to the distance between the placenta and internal ostium: total (n = 174), partial (n = 52), and marginal (n = 123) PP. In total PP patients, three factors (prior CS, anterior placenta, and placental lacunae on ultrasound) significantly increased blood loss at CS, the need for hysterectomy, homologous transfusion (≥10 U), and ICU admission. No significant difference was observed in bleeding-related poor outcomes (rate of blood loss ≥2000 mL, amount of homologous transfusion, need for hysterectomy, and ICU admission) between total PP patients without all three factors: “low-risk total PP patients” and partial/marginal PP patients (19.8 vs. 17.1%; p = 0.604, 3.7 vs. 1.1%; p = 0.330, 1.2 vs. 1.1%; p = 1.000, and 1.2 vs. 1.1%; p = 1.000, respectively).ConclusionPrior CS, anterior placenta, and placental lacunae on ultrasound were risk factors for a bleeding-related poor outcome in total PP patients. Total PP patients without these three factors showed the same bleeding-related poor outcome as partial/marginal PP patients.