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Objective:To investigate the clinical characteristics of vasa previa (VP) with low-lying placenta (LP).Methods:A retrospective case-control study was conducted on pregnant women with VP who delivered at Guangzhou Women and Children's Medical Center from January 2015 to August 2021. According to the status of LP, these cases were classified into VP with LP (VP+LP) and VP without LP (VP-LP) group. The cases diagnosed with placenta previa (PP, n=128) during the same period were collected as control. Maternal-fetal clinical characteristics and outcomes were compared among the three groups using t-test, Mann-Whitney U test, and Chi-square test (or Fisher's exact test). Results:During the study period, 116 VP cases were diagnosed, accounting for 0.085% (116/136 450) of all deliveries. Apart from one case of intrauterine death caused by non-VP reasons in the third trimester, there were 64 in the VP+LP group and 51 in the VP-LP group. VP+LP cases accounted for about 2.9% (64/2 219) of all the cases with PP or LP. The proportions of multiparae and women with a history of cesarean section were significantly higher in the VP+LP group than in the VP-LP group [62.5% (40/64) vs 39.2% (20/51), χ 2= 6.17, P=0.013; 31.3% (20/64) vs 13.7% (7/51), χ 2= 4.85, P=0.028]. Besides, a rare type of VP (type Ⅲ) was only found in the VP+LP group (9.4%, 6/64). The median gestational age at first diagnosis by prenatal ultrasound was significantly larger in the VP+LP group than in the VP-LP group [28.3 (23.6-31.7) vs 23.9 (23.3-25.9) weeks, Z=2.61, P=0.007]. There was no significant difference in the incidence of antepartum hemorrhage between the two groups. In contrast, the amount of postpartum hemorrhage was significantly increased in the VP+LP group [550 (436-732) vs 420 (300-540) ml, Z=3.37, P=0.001]. Compared with the VP-LP group, the VP+LP group showed a lower incidence of lower neonatal Apgar score (<7 at 5 min) and hypoxic-ischemic encephalopathy [0.0%(0/64) vs 6.9%(4/58), 0.0%(0/64) vs 8.6% (5/58), Fisher's exact test, both P<0.05]. No neonatal death was reported in the VP+LP and VP-LP groups. No significant difference in the incidence of antepartum hemorrhage was found between the VP+LP group and the PP group. Still, the median time at delivery was earlier [36.0 (34.3-36.9) vs 37.0 (35.7-37.3) weeks, Z=3.79, P<0.001], and the incidence of abnormal fetal heart rate was higher [10.9% (7/64) vs 3.1% (4/128), Fisher's exact test , P=0.044] in the VP+LP group. Furthermore, the neonatal NICU admission rate and the incidence of respiratory distress syndrome were significantly higher in the VP+LP group than in the PP group [36.4% (24/66) vs 12.1% (16/132), χ 2= 16.04, P<0.001; 25.8% (17/66) vs 12.1% (16/132), χ 2= 5.89, P=0.015]. Conclusions:For VP+LP cases, there might be an additional type (type Ⅲ VP). Patients with VP+LP would have more blood loss within 24 h after delivery and a higher risk of adverse neonatal outcomes. Intensive attention should be paid to those diagnosed with LP during the third trimester to identify any VP.
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Objective@#To evaluate the effect of cervical lifting suture in treatment of placenta previa with increta and percreta.@*Methods@#From January 2016 to June 2017, 65 cases (0.78%, 65/8 322) were diagnosed placenta previa with increta and percreta by prenatal ultrasonic score system and confirmed by intraoperative findings in the department of obstetrics and gynecology of Peking University Third Hospital. Totally 62 cases (0.75%, 62/8 322) were included, because 3 cases underwent hysterectomy with placenta in situ. According to ultrasonic score system, 62 cases were divided into two groups, score 5-9 group (n=42, 67.7%) and score≥10 group (n=20, 32.3%) , cervical lifting suture techniques were all performed in cesarean sections. Demographic and clinical data were collected and compared.@*Results@#(1) There were no significant differences between two groups in age, gravidity, parity, cesarean section history ratio and gestational week of termination (all P>0.05) . (2) In score≥10 group, the median intraoperative bleeding volume was 4 000 ml (1 200-13 000 ml) , while in score 5-9 group, it was 1 600 ml (700-10 000 ml) , intraoperative blood transfusion volume was 2 000 ml (800-8 800 ml) in score≥10 group, while 1 200 ml (0-8 000 ml) in score 5-9 group. The median operation time was 240 minutes (108-1 200 minutes) in score≥10 group, significantly higher than that in score 5-9 group, which was 135 minutes (69-335 minutes; all P< 0.05). In 8 cases for hysterectomy (12.9%,8/62) , 3 cases in score 5-9 group, 5 cases in score≥10 group. (3) In score≥10 group, the rate of postoperative ICU registration was 80% and mean hospitalization time was (6.3±1.7) days, were significantly different, compared with those in score 5-9 group, which were 26%, (4.9±1.9) days. No serious postpartum complications were found in both groups, and there were no significant differences in Apgar score and weight of newborns (all P>0.05) .@*Conclusion@#Cervical lifting suture in placenta previa with increta and percreta could significantly reduce postpartum hemorrhage and retain uterine.
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Objective To explore the value of ultrasound scoring system in predicting the type and risk of placenta accreta.Methods Clinical data of 180 placenta accreta patients who delivered in the Peking University Third Hospital between January 2005 and November 2014,were retrospectively analyzed.Prenatal ultrasonographic features were analyzed,including position and thickness of the placenta,disappearance of hypoechoes in posterior placenta,continuousness of bladder line,existence of lacuna,condition of the subplacental vascularity,completeness of cervical morphology,existence of cervical sinus,and history of cesarean section.A score of 0,1 or 2 was given to each item,and a sum-up was calculated for each patient.The cut-off scores of patients with placenta accreta,placenta increta and placenta percreta were calculated by receiver operating characteristic carve,respectively.At the same time,blood loss and hysterectomy rate were compared among the three groups.Variance analysis,rank sum or Chi-square tests were used for statistical analysis.Results Among the 180 cases,there were 115 cases of placenta accreta,38 of planceta increta and 27 of placenta percreta.Placenta increta and percreta were defined as the severe type.Blood loss in placenta accreta was lower than in the severe type [200 (100-4 000) ml vs 3 025 (100-15 000) ml,P＜0.01].There was no difference in blood loss between patients with placenta increta or percreta (P=0.350).No hysterectomy was performed for patients with placenta accreta,the rate being lower than in the severe type [0 vs 29.2％ (19/65),P＜0.01].Among the severe type,18.4％ (7/38) of the placenta increta patients underwent hysterectomy,the rate being lower than in placenta percreta patients [44.4％ (12/27),P＜0.01].The score in placenta accreta was lower than in the severe type [(1.88± 1.45) vs (7.01 ±2.15) scores,P＜0.01].In the severe type,the score in placenta increta was lower than in placenta percreta [(6.08 ± 2.62) vs (8.74 ± 2.75),P＜0.01].The receiver operating characteristic curve showed that the cut-off score of placenta accreta and the severe type was 5 [area under the curve (AUC)=94.3％,the score ≥ 4.5,the sensitivity=81.5％,and the specificity=95.7％],the cut-off score of placenta accreta and increta was 3 (AUC=91.1％,score ≥ 2.5,the sensitivity=92.1％,and the specificity=75.7％),and the cut-off score of placenta increta and percreta was 10 (AUC=74.6％,score ≥ 9.5,the sensitivity=55.6％,and the specificity=89.5％).Conclusions Ultrasound scoring system is effective in assessing types of placenta accreta and predicting its associate risks,and alerting the possibility of hysterectomy.It also facilitates preoperative planning and guides physicians in formulating subsequent treatment plans.Placenta accreta and the severe type (placenta increta and percreta) can be distinguished by cut-offscores ≥ 5,and a score ≥ 10 implies a higher risk of placenta percreta.