Analysis On The Termination Of Pregnancy In The Second Trimester Of47Pregnant Women With Placenta Previa And A Three-cases Report

Placenta previa is a state in which the placenta is implanted in the loweruterus segment within the zone of effacement and dilatation of the cervix[10].Uterine isthmus lengthen to form part of the uterus cavity since12weeks ofpregnancy, and gradually form the lower part uterus segment during the thirdtrimester. In placenta previa, the placenta can not extend in coordination withthe uterine isthmus when the uterine isthmus lengthen, thus the dislocation ofplacenta and the uterine myometrium that placenta attaches to causehemorrhage, threatened abortion and abortion.Some pregnant women withplacenta previa status need to end the pregnancy because of repeated bleeding,inevitable abortion, fetal malformation and so an. Choosing the best ways caneffectively reduce patients suffering, and reduce their economic costs.Objective: To investigate the best way to terminate the pregnancy forwomen with placenta previa in the second trimester of their pregnancy.Methods: analysis the medical records of47pregnant women withplacenta previa that have ended their pregnancy in the second trimesterbetween April2007to March2013in Second Hospital of Hebei MedicalUniversity, and analysis three typical cases.Results: The planned mode of delivery for all the47patients,24cases ofvaginal delivery,23cases of cesarean section births.11cases of natural laborsuccessfully delivered naturally. In the total13cases of drug induced abortion,12caces underwent successfully. One case of drug induced abortion byamniotic injection failed because of extensive bleeding after the delivery ofthe placenta, and ended with hysterectomy surgery for intraoperative massivebleeding.23birthed by cesarean section surgery, including7cases ofhysterectomy for intraoperative bleeding, and in16cases the cesarean section births surgery worked. The analysis of all the47patiants28.19±5.00year(18～40years), pregnant time23.29±3.49weeks(14.43～27.71weeks), the mount of bleeding1021.49±1654.23mL(90～6500mL),enter the blood component average1010.64±1580.31mL(0～5600mL).Bleeding of patients that vaginal delivered is448.26±419.84mL(90～1500mL), bleeding of cases of cesarean births is218.25±208.87mL(100～1000mL). All of the eight cases of hysterectomy wereconfirmed to be of placenta accreta by surgery and pathology, and all the eightpatient were complete placenta previa and used to have cesarean section.Analysis of cases of hysterectomy: age28.19±1.92years (27～33years),pregnant time22.4464±4.05weeks (14.43～26.57weeks), blood loss4150.00±1953.75mL(800～6500mL), content of input blood components3950.00±1419.00mL(0～5600mL).Case1: Patient was pregnant24+6weeks, second pregnancy, multiparous,came to hospital mainly for paroxysmal abdominal pain，with no vaginalbleeding. Ultrasound examination (5days before admission) showed: Placentaprevia. Without much vaginal bleeding after admission, doctor made artificialrupture of membranes when the cervix got6cm broad. Then vaginal bleedingincreased in short time raging1000mL, with decrease of blood pressure.Establishment of dual fluid path was made immediately to add volume, andtransfuse red blood cells. In order to shorten the production process, brokenfetal surgery was done, and finally uterine contractions well, vaginal bleedingmuch stable vital signs.Case2:23+2weeks pregnant patients, first pregnancy, with centralplacenta previa, finally vaginal delivered. The placenta is delivered first, andfollowed by the fetus. prenatal and births bleeding of about300mL.Case3Patient was pregnant24+2weeks, the third pregnancy, completeplacenta previa, and the patient had ever delivered by cesarean section once.During this cesarean section bleeding was turbulent after removing theplacenta. Several way were used to haemostasis, such as injection ofcarboprost tromethamine, uterine isthmus tied with a tourniquet, sutura of uterine wall, ligation of bilateral uterine artery and tamponade of the cavea oflower segment uterine. After suturing the uterus, the abdomen was closed afterinsure that there was no more bleeding.The total intraoperative bleeding was about900ml, and two units of redblood cells and plasma of300mL were injected.1+hours after the surgeryvaginal bleeding began to increase and gradually caused hemorrhagic shock,DIC. And the case ended with hysterectomy in laparotomy.Conclusion:1Different treatment should be chosen after comprehensive assessmentof maternal condition including location of the placenta, history of abortion,history of cesarean section, and so on. And the will of patient should beconsidered too.2It’s basically safe for a pregnant woman with placenta previa to delivertransvaginally in the second trimenster, when the woman does not havecesarean section record. But doctors must be well prepared; the fluid pathmust be made before delivery, cross-matched blood should be at hand, andrescue equipment and drugs must be at place. Though transvaginal deliverymay sometimes make great blood lost, transvaginal delivery dose less damageto the pregnant woman, and it takes less time to recover for the women thatdeliver transvaginally.3To women with both placenta previa and cesarean section record,doctors must pay more attention to diagnose carefully and clearly whetherdose they have placenta accrete. Any should be take serious. Any patient withplacenta previa and any imaging sign of placenta accreta should give uptransvaginal delivery and choose cesarean section instead because of thatlaparotomy made haemostasis easier and more effective. And partumhemorrhage should also be closely observed after cesarean section for timelydetection and treatment of a variety of childbirth complications.