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Objective:To investigate the predictive value of maternal peripheral blood fetal DNA, creatine kinase (CK), and alpha-fetoprotein (AFP) in pregnant women with placenta previa complicated with adhesion or implantation.Methods:From April 2018 to April 2019, 72 patients with placenta previa confirmed by cesarean section in Chengde Central Hospital were retrospectively collected. Among them, 23 patients complicated with placental adhesion were enrolled in the placenta adhesion group, 19 patients complicated with placenta implantation were in the placenta implantation group, and 30 patients with simple placenta previa were in the simple placenta previa group. The amount of fetal DNA, CK and AFP in maternal peripheral blood were measured at 20 to 27 weeks of gestation. The general data of the three groups, the amount of fetal DNA in maternal peripheral blood, CK and AFP were compared. The value of the amount of fetal DNA, CK, and AFP in maternal peripheral blood for predivting placenta previa were analyzed. At the same time, the incidence of adverse pregnancy outcomes was counted, and patients were divided into adverse pregnancy outcomes group and good pregnancy outcomes group according to pregnancy outcomes. The fetal DNA amount, CK and AFP levels in the maternal peripheral blood of the two were compared, and the factors affecting the adverse pregnancy outcome of placenta previa were analyzed.Results:The levels of fetal DNA, CK and AFP in the maternal peripheral blood of the placenta implantation group were significantly higher than those of the placenta adhesion group and the simple placenta previa group: (1 018.96 ± 442.15) copies/ml vs. (659.27 ± 320.26) copies/ml and (390.64 ± 102.53) copies/ml , (103.54 ± 26.39) U/L vs. (88.30 ± 20.65) U/L and (62.78 ± 15.84) U/L, (319.65 ± 62.14) μg/L vs. (284.62 ± 55.96) and (232.64 ± 48.62) μg/L, and the difference was statistically significant ( P<0.01). The amount of fetal DNA in maternal peripheral blood was positively correlated with CK and AFP ( r = 0.899 and 0.769, P<0.01), and CK was positively correlated with AFP ( r = 0.782, P<0.01). The AUC of maternal peripheral blood fetal DNA in predicting placenta previa complicated with placenta adhesion was 0.842, and the sensitivity and specificity were 78.26% and 83.33% respectively. The levels of fetal DNA, CK and AFP in maternal peripheral blood of patients with adverse pregnancy outcomes were higher than those of patients with good pregnancy outcomes: (928.64 ± 257.73) copies/ml vs. (460.02 ± 188.95) copies/ml, (105.83 ± 26.88) U/L vs. (66.33 ± 20.39) U/L and (292.52 ± 58.39) μg/L vs. (259.29 ± 42.65) μg/L, and the difference was statistically significant ( P<0.05). Placenta adhesion, placenta implantation, postpartum hemorrhage, maternal peripheral blood fetal DNA, CK and AFP levels were influential factors for the adverse pregnancy outcome of placenta previa ( OR = 3.544, 4.183, 3.413, 3.222, 3.109 and 3.313, 95% CI 1.905 to 6.593, 2.401 to 7.286, 1.832 to 6.359, 1.729 to 6.005, 1.659 to 5.827 and 1.831 to 5.994, P<0.01). Conclusions:The amount of fetal DNA, CK and AFP in maternal peripheral blood have a certain predictive value in placenta previa complicated with placental adhesion or implantation, and are closely related to the pregnancy outcome of patients with placenta previa. Early detection of the above indicators will help clinically to formulate reasonable intervention measures and promote the improvement of pregnancy outcomes.
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OBJECTIVE: To discuss the clinical efficacy of HIFU combined uterine curettage and that of simple HIFU after vaginal delivery for placenta implantation.METHODS: HIFU were performed in 33 patients diagnosed with placenta implantation by MRI after vaginal delivery from 2013 to 2019. Among them,7 cases were treated with HIFU combined with uterine curettage(combination group),and the remaining 26 cases were HIFU group.The discharge of residual placental tissues and vaginal bleeding volume,vaginal bleeding time,time for menstrual resumption,hCG outcome and re-pregnancy were counted.RESULTS: There were no statistical differences in the vaginal discharge of lesion tissues,the vaginal bleeding volume up to menstrual resumption,vaginal bleeding time,time for menstrual resumptiom or hCG outcome(P>0.05),That is to say,the effect was equivalent.The hospitalization expenses and hospitalization time of HIFU combined with uterine curettage group were higher and longer than those of HIFU group,and the difference was statistically significant(P<0.05).CONCLUSION: HIFU is effective in the treatment of placenta-implanted patients.
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OBJECTIVE: To discuss the clinical significance of cesarean scar pregnancy with expectatant treatment.METHODS: Collect 21 cases of CSP between 2012 and 2017 in the Third Affiliated Hospital of Guangzhou Medical University.Group A had 8 cases who were pregnant again after intervention treatment,and group B had 13 cases who insisted on expecting treatment.We summarized clinical indexes of both groups,such as preserving uterus,bladder rupture,admission to ICU,blood transfusion,placenta implantation,etc. in order to further study the significance of expecting treatment for CSP.RESULTS: All of group A were pregnant again after intervention treatment,of whom 1 was CSP again and hysterectomy was performed at 15 weeks due to placenta implantation,while another 7 were uterine pregnancy,of whom 3 were term birth and had no placenta implantation,and another 4 were terminated in response to the requirements of patients,of whom 1 was treated with drug abortion and 3 underwent dilatation and curettage.Uterus was preserved in the 7 women,and there was no bladder rupture,no admission to ICU,no blood transfusion,and no placenta implantation.Among the 13 cases in group B, 6 cases underwent cesarean section during third trimester,including 3 cases of premature delivery and 3 cases of delivery at 37 weeks.5 cases were pregnant to second trimester,containing 4 cases received hysterectomy and 1 case suffered subtotal hysterectomy.2 cases were pregnant to first pregnancy, including 1 case of abdominal nidus resection, 1 case of ultrasound-guided dilation and curettage;Among the13 patients, 4 cases underwent bladder rupture, 4 cases lost uterus, 5 cases were admitted to the ICU, and 10 cases required blood transfusion.Placental implantation occurred in 11 cases who were pregnant to second and third trimester.CONCLUSION: Most of CSP with expecting treatment will develop into placenta implantation inevitably in the late stage of pregnancy.The patients with CSP can be pregnant again after early intervention and have extremely low possibility of a second CSP.
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The medical records of firstly diagnosed patients with the discharge diagnosis contained " placenta implantation,cesarean section" at Peking University Third Hospital from 2012 to 2016,were collected.The records included the type of placenta implantation,anesthetic methods,intraoperative blood loss,abdominal aorta balloon placement,hysterectomy,requirement for intensive care unit (ICU) admission and length of hospital stay,and the anesthetic management experience was summarized in the patients with placenta implantation undergoing cesarean section.A total of 156 patients were included in this study,and among the 156 patients,there were 70 cases of accreta (44.9％),50 cases of increta (32.1％) and 36 cases of percreta (23.1％).The intraoperative blood loss was (624±451) ml,(2100±1283) ml and (5281 ±3114) ml,the ratio of neuraxial anesthesia was 92％,62％ and 14％,the ratio of neuraxial anesthesia combined with general anesthesia was 4％,20％ and 61％,and the ratio of general anesthesia was 4％,18％ and 25％ in the patients of accreta,of increta and of percreta,respectively.The abdominal aorta balloon was placed during surgery in 14 cases,and among the 14 cases,there were 3 cases of increta and 11 cases of percreta.Forty-nine patients were transferred to ICU after operation,and among the 49 patients,there was 1 case of accreta,16 cases of increta and 32 cases of percreta.Anesthesiologists should pay attention to the preoperative interview and assessment,actively try to work with multi-departments,make anesthetic regimen according to patient's condition,closely monitor patient's vital signs during operation,concern about the operating process and blood loss,and ensure proper infusion and transfusion for the patients with placenta implantation undergoing cesarean section,and in addition,the critically ill patients should be transferred to ICU after operation for intensive monitoring and treatment.
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Objective To discuss the clinical application of ultrasound-guided temporary balloon occlusion in performing cesarean section for patients with pernicious placenta previa.Methods At Qujing Municipal First People's Hospital,the Interventional Department and Ultrasonography Department assisted the Obstetrics Department to accomplished cesarean section for 13 patients with pernicious placenta previa.The diagnosis of central placenta previa was confirmed by both color ultrasound and MRI in all the 13 patients.Before cesarean section,the balloons were placed in bilateral common iliac arteries or in abdominal aorta,and the balloons were inflated at the same time when the fetus was delivered so as to temporarily obstruct the target vessels.Based on the hemostatic condition,the balloon was timely withdrawn.Results Among the 13 patients,temporary abdominal aorta occlusion was employed in one and temporary bilateral common iliac artery occlusion in 12.Ultrasound-guided occlusion was successfully accomplished in 12 patients,and the average blocking time was ＜15 min.The amount of intraoperative blood loss was 800-1500 ml.Conclusion Ultrasound-guided temporary balloon occlusion before cesarean section is safe with reliable effect in treating pernicious placenta previa,it can remarkably reduce the amount of intraoperative blood loos,and it has no X-ray radiation damage,therefore,this technique is worthy of clinical application.
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Objective To discuss the clinical efficacy of balloon occlusion technique in treating pernicious placenta previa.Methods Between January 2015 and March 2016,a total of 16 matcrnal patients with pernicious placenta previa,who were admitted to the Interventional Department of Qujing Municipal First People's Hospital,received balloon occlusion management to assist obstetrician in dealing with placenta previa.Central type of placenta previa with highly suspected placenta implantation were diagnosed in 15 patients by color ultrasound or MRI.Balloon catheters were placed in bilateral internal iliac arteries before cesarean section was carried out,and immediately after the fetus was taken out the balloons were inflated to temporary occlude the targeted arteries.Based on the hemostatic status the balloon catheters were timely retrieved.One patient received emergency temporary balloon occlusion of abdominal aorta,and laparotomy revealed that the placenta had penetrated to the subserosa of uterine anterior wall,and total hysterectomy had to be carried out.Results Successful balloon occlusion was achieved in all 16 patients.The mean blocking time of the artery was 15 minutes and the amount of blood loss was 300-1200 ml.Conclusion In treating pernicious placenta previa,balloon occlusion treatment before cesarean section is safe and reliable,it can significantly reduce the amount of blood loss during surgery,make quick and effective hemostasis,provide a clear surgical field for the performance of cesarean section,and,more important,save the maternal life.This effective technique has fully showed the necessity of multidisciplinary collaboration,including obstetrics,interventional radiology,etc.
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Objective:To investigate the anesthetic choice for patients undergoing cesarean section complicated with placenta implantation.Methods: A retrospective case review of the patients with placenta implantation between 2008 and 2013 at Peking University Third Hospital was conducted in the International Classification of Diseases (ICD)-9 codes,excluding natural birth and not first diagnosed in our hospital,a total of 96 cases were incorporated into this study.According to the degree of implantation,they were divided into three groups: accreta group,increta group and percreta group.We analyzed the time from the start of surgery to baby delivery and the anesthetic technique.Results: The accreta group included 49 cases,the increta group 33 cases,and the percreta group 14 cases.The average time from the start of surgery to fetus delivery in the three groups were (6.7±3.0) min,(7.2±4.6) min,and (11.9±4.9) min,and the percreta group was significantly different from the accreta group and the increta group (P<0.05).There were significant differences among the three groups in anesthetic choices (P<0.001): in the accreta group,45 cases (91.8％) underwent spinal anesthesia,2 cases (4.1％) underwent general anesthesia,and 2 cases (4.1％) were converted to general anesthesia after spinal anesthesia during the operation;in the increta group,22 cases (66.7％) underwent spinal anesthesia,4 cases (12.1％) underwent general anesthesia,and 7 cases(21.2％) were converted to general anesthesia after spinal anesthesia;in the percreta group,2 cases (14.3％) underwent spinal anesthesia,2 cases (14.3％) underwent general anesthesia,and 10 cases (71.4％) were converted to general anesthesia after spinal anesthesia.Conclusion: Spinal anesthesia can be used as the first choice of cesarean section complicated with placenta implantation and general anesthesia should be considered in placenta percreta.
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Objective To explore the MRI diagnostic value for pernicious placental abnormalities.Methods MRI findings of 1 5 patients with pernicious placenta previa were retrospectively analyzed after cesarean section.Results Among all cases,total placenta previa was,1 1 cases and partial placenta previa was 4 cases.The placenta located in the anterior wall in 8 cases,posterior wall in 4 cases,lateral wall in 3 cases.4 cases were diagnosed as normal placenta,6 cases as adhesion,4 cases as implanted,and 1 case as penetrating.These cases had certain special MR features.Conclusion MRI is helpful in diagnosing the location and type of the perni-cious placenta,and showing whether complicated with previa implantation and penetrating.