| Objective: To investigate the pathogenic related factors of different types of placenta previa and the characteristics of placenta previa pregnancy outcome in order to provide a clinical basis for the prevention of placenta previa and for the proper treatment improving the perinatal outcome of placenta previa pregnant women. Methods: By collecting the past clinical data of 342 placenta previa patients whose pregnancy were terminated during their stay in the First Affiliated Hospital of Wannan Medical College in the last ten yeas from April 2004 to March 2014 for the research, we make a retrospective analyses on the related factors of placenta previa, the characteristics of different types of placenta previa and the pregnancy outcomes. Based on the relations of placenta previa and intracervical mouth, we divide these placenta previa patients into three groups: the group of complete placenta previa, the group of partial placenta previa and the group of marginal placenta previa. Based on whether they have a C-section history, these patients are divided into two groups: the pernicious placenta previa group and the not pernicious placenta previa group. Based on the time periods of their stay in the hospital, these patients are divided into two groups: the first five years group from April 1, 2004 to March 31, 2009 and the second five years group from April 1, 2009 to March 31, 2014. Based on the placenta conglutination locations, these patients are divided into two groups: the front wall placenta previa and the non-front wall placenta previa. By comparing the obstetric risk factors among these groups, we can analyze the pregnancy outcomes of different groups of placenta previa pregnant patients. Results: 1. A comparison among the three groups of complete placenta previa, partial placenta previa and marginal placenta previa: by comparison with the two groups of partial placenta previa and marginal placenta previa, we find the group of complete placenta previa has a significantly higher percentage of such three kinds of patients as had pregnancy more than or equal to three times, as had an abortion more than or equal to two times and as had a cesarean delivery. Difference among the three groups has a statistical significance in comparison(P<0.05). It is statistically significant to compare the group of complete placenta previa with the other two groups(P<0.05). It is not statistically significant to compare the group of partial placenta previa with the group of marginal placenta previa(P>0.05). There is a significantly higher proportion of having a hysterectomy as a final treatment in the group of complete placenta previa than the other two groups. Difference among the three groups has a statistical significance in comparison(P<0.05). When we compare two groups one time, only the group of complete placenta previa and the group of marginal placenta previa have a statistical significance in comparison(P<0.05). The group of complete placenta previa has the fewest gestational weeks of termination of pregnancy, closely followed by the group of marginal placenta previa. The group of partial placenta previa has the most gestational weeks of termination of pregnancy. When we compare two groups one time, only the group of complete placenta previa and the group of marginal placenta previa have a statistical significance in comparison(P=0.033<0.05). The group of complete placenta previa has a highest percentage of intrapartum bleeding amount more than 500 milliliters, closely followed by the group of partial placenta previa. The group of marginal placenta previa has the lowest percentage of intrapartum bleeding amount more than 500 milliliters. Difference among the three groups has a statistical significance in comparison(P<0.05). When we compare two groups one time, only the group of complete placenta previa has a statistical significance in comparison with the other two groups(P<0.05). There is no statistical significance comparing the group of marginal placenta previa with the group of partial placenta previa(P>0.05). The group of complete placenta previa has the highest premature birth rate, closely followed by the group of partial placenta previa. The group of marginal placenta previa has the lowest premature birth rate. Difference among the three groups has a statistical significance in comparison(X2=15.887, P<0.05). When we compare two groups one time, only the group of complete placenta previa has a statistical significance in comparison with the other two groups(P<0.05). There is no statistical significance comparing the group of partial placenta previa with the group of marginal placenta previa(P>0.05). 2. A comparison between the two groups of the pernicious placenta previa group and the not pernicious placenta previa group: by comparison with the not pernicious placenta previa group, we find the pernicious placenta previa group has a significantly higher percentage of intrapartum bleeding amount more than 500 milliliters, having a hysterectomy and placenta implantation as a treatment. Difference between the two groups has a statistical significance in comparison(P<0.05). But they don’t have a significant difference when compared in the incidence of placental adherence. Compared with the not pernicious placenta previa group, the pernicious placenta previa group has a significantly higher percentage of the incidence of premature infants, neonatal asphyxia and stillbirth rate. Difference between the two groups has a statistical significance in comparison(P<0.05). But the comparison between the two groups in the rate of perinatal infant mortality has no statistic significance(P>0.05). 3. A comparison between the two groups of the first five years group from April 1, 2004 to March 31, 2009 and the second five years group from April 1, 2009 to March 31, 2014: the second five years group(3.24%) has a a significantly higher percentage in the incidence of placenta previa than the first five years group(1.88%). Difference between the two groups has a statistical significance in comparison(X2=17.003, P<0.05). The second five years group has a a significantly lower percentage than the first five years group in the following four aspects: the percentage of the not pernicious placenta previa patients with bleeding amount more than 500 milliliters, the volume of blood transfusion, the rate of neonatal asphyxia and the rate of hysterectomy. Difference between the two groups has a statistical significance in comparison(P<0.05). But they don’t have a significant difference when compared in the gestational weeks of termination of pregnancy. The second five years group has a a significantly lower percentage than the first five years group in the proportion of placenta previa patients having a hysterectomy as a final treatment. Difference between the two groups has a statistical significance in comparison(P<0.05). The second five years group has a slightly higher percentage than the first five years group in the proportion of the pernicious placenta previa patients with intrapartum bleeding amount more than 500 milliliters and the blood transfusion rate. But it has a slightly lower percentage than the first five years group in the rate of neonatal asphyxia and the gestational weeks of delivery. However the comparison between the two groups has no statistic significance(P>0.05). 4. A comparison between the front wall placenta previa group and the non-front-wall placenta previa group: the front-wall placenta previa group has a a significantly higher percentage than the non-front-wall placenta previa group in the two kinds of patients: having an abortion more than or equal to two times or being pregnant more than or equal to three times. Difference between the two groups has a statistical significance in comparison(P<0.05). The front-wall placenta previa group has a a significantly higher percentage than the non-front-wall placenta previa group in the four aspects: the number of patients with intrapartum bleeding amount more than 500 milliliters, the blood transfusion rate, the placenta implantation rate and the hysterectomy rate. Difference between the two groups has a statistical significance in comparison(P<0.05). The neonatal asphyxia rates of the two groups are 14.18% and 11.94%. There is little difference between them. Also the comparison between them has no statistic significance(P>0.05). Conclusions: 1. The types of placenta previa are closely related to the happening of intrapartum bleeding, the hysterectomy and the pregnancy outcome. And the occurrences of all types of placenta previa are closely related to pregnancy times, abortion times and the history of cesarean deliveries. Along with an increasing number of pregnancy times, abortion times and the histories of cesarean deliveries, the risk of complete placenta previa in the subsequent pregnancy is increasing. The complete placenta previa group has a a significantly higher percentage than the other two placenta previa groups in the intrapartum bleeding amount, the hysterectomy rate and the premature birth rate. 2. The pernicious placenta previa group has a a significantly higher percentage than the not pernicious placenta previa group in the postpartum bleeding rate, the placenta implantation rate, the hysterectomy rate, adverse pregnancy outcomes like the incidence of premature infants, neonatal asphyxia and stillbirth rate and the number of patients with intrapartum bleeding amount more than 500 milliliters. 3. The occurrence of placenta previa is obviously on the rise compared with the previous years. Meanwhile in the recent years the not pernicious placenta previa has an apparent decline in the intrapartum bleeding amount, the hysterectomy rate and the premature birth rate. The pernicious placenta previa group has no difference in adverse pregnancy outcomes compared with the previous years except the hysterectomy rate decreasing slightly. 4. The front wall placenta previa is more dangerous than the non-front-wall placenta previa. The occurrence of the front wall placenta previa is possibly related to pregnancy times and abortion times. |
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