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Emergent versus planned delivery in patients with placenta accreta spectrum disorders: A retrospective study
Medicine (United States) Số 51, năm 2021 (Tập 100, trang E28353-)
ISSN: 257974
ISSN: 257974
DOI: 10.1097/MD.0000000000028353
Tài liệu thuộc danh mục:
Article
English
Từ khóa: Adult; Cesarean Section; Delivery, Obstetric; Female; Humans; Magnetic Resonance Imaging; Placenta Accreta; Placenta Previa; Pregnancy; Pregnancy Outcome; Premature Birth; Retrospective Studies; Ultrasonography, Doppler; United States; Uterine Hemorrhage; adult; Apgar score; Article; birth weight; blood transfusion; cesarean section; clinical outcome; controlled study; elective surgery; emergency surgery; erythrocyte transfusion; female; gestational age; human; major clinical study; maternal age; medical record review; newborn mortality; nuclear magnetic resonance imaging; outcome assessment; placenta accreta; placenta previa; placenta tissue; placental delivery; premature labor; retrospective study; risk factor; social status; spontaneous abortion; vagina bleeding; Viet Nam; cesarean section; diagnostic imaging; Doppler ultrasonography; obstetric delivery; placenta accreta; placenta previa; pregnancy; pregnancy outcome; prematurity; procedures; United States; uterus bleeding
Tóm tắt tiếng anh
The aim of this study is to compare the clinical outcomes and to identify risk factors for emergent cesarean delivery and planned cesarean delivery in patients with placenta accreta spectrum (PAS) disorders in Vietnam. The medical records of patients admitted to our hospital with a diagnosis of PAS disorders >5 years were retrospectively reviewed. A total of 255 patients with PAS disorders were identified, including 95 cases in the emergent delivery group and 160 cases in the planned delivery group. The percentage of complete/partial placenta previa in the planned delivery group was significantly higher than that in the emergent delivery group (59.22% vs 32.16%, P = .027). Fewer patients in the planned group had vaginal bleeding compared with those in the emergent group (29 vs 36 cases, P < .001). The percentage of blood transfusion was similar between the 2 groups; however, the transfused units of pack red blood cells were greater in the emergent delivery group (5.3 � 0.33 vs 4.5 � 0.25 U, P = .036). When considering the neonatal outcomes, the data demonstrated that the planned delivery group had a significantly higher birth weight and a lower rate of preterm delivery than the emergent group (P < .001). The mean gestational age at delivery for the emergent group was 35.1 � 0.27 weeks compared with 38.0 � 0.10 weeks for the planned group (P < .001). The increased risk factors for emergent delivery were vaginal bleeding (odds ratio 2.86, 95% confidence interval 1.59-5.26) and preterm delivery (odds ratio 5.26, 95% confidence interval 2.13-14.29). Planned delivery is strongly associated with a lower need for blood transfusion and better neonatal outcomes compared with emergent delivery. Antenatal vaginal bleeding and preterm labor are risk factors for emergent delivery among patients with PAS disorders. Based on the results of this study, we recommend that the management strategies for patients with PAS disorders should be individualized to determine the optimal timing of delivery and to decrease the rate of emergent cesarean delivery. Copyright � 2021 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.
