| Objective : To discuss the high-risk factors, prenatal diagnosis method, expectant management, pregnancy outcome, type and therapeutic measures, thereby providing clinical management basis for its prevention and treatment.Methods : 136 pregnant women with placenta previa hospitalized and delivered in our hospital from January to December 2013 were enrolled as the case group, and 136 pregnant women without placenta previa in our hospital at the same period were selected as the control group. Retrospective analysis to the high-risk factors, diagnosis accuracy of color doppler ultrasound and MR, pregnancy outcome during perinatal stage as well as the therapeutic measures was performed.Results:1. High-risk factor analysis for placenta previa: In case group, there were 27 cases for patients aged 35 years old and above(19.85%), 28 cases for patients experiencing cesarean section(20.59%); 37 cases had two or more times of abortion(27.21%), and 7 cases had two or more times of delivery(5.15%), which were all higher than that of contrast group, and the difference between the two groups was statistically significant, and Logistic regression analysis was conducted to further confirm that the advanced age, history of cesarean section, multiple abortions and deliveries were the independent high-risk factors of placenta previa.2. Comparison of prenatal diagnosis method for placenta previa: 59 patients in case group were given with the combination of color doppler ultrasound and MR, where the accuracy of color doppler ultrasound was 79.66% and MR was 74.58% with respect to the diagnosis and classification of placenta previa, while for the diagnosis of placental implantation, the sensitivity and specificity of color doppler ultrasound were 8.70% and 97.22% respectively, and the positive predictive value(PPV) and negative predictive value(NPV) were 66.67% and 62.50%; these figures presented respectively as 73.91%, 86.11%, 77.27% and 83.78% for MR. There was no statistically significant difference between the two methods in terms of placenta previa diagnosis and classification, and the accuracy of them was consistent. The diagnosis of placental implantation showed statistically significant difference, which indicated that accuracy of placental implantation of MR was higher than color doppler ultrasound.3. Comparison on complications at different gestational weeks and delivery period and pregnancy outcome in case group: The case group was divided into two groups:37 weeks above(≥37 group) and less than 37 weeks(<37 group). In terms of the complications, 67 cases in ≥37 group showed antepartum bleeding of 125.47±190.41 ml, postpartum bleeding of 589.10±1052.75 ml, which showed no statistically significant difference; and for perinatal outcome, the average birth weight in ≥37 group was 2945.59±595.49 g, and there were 2 cases with 1-min Apgar score of ≤7, 6 cases were transferred to pediatrics department; the average birth weight in <37 group was 2463.19±662.61 g, with 14 cases of 1-min Apgar score of ≤7 and 52 cases transferred to pediatrics department, showing the statistically significant difference. All of above indicated that there was no impact of placenta previa expectant management on the maternal, and perinatal prognosis was favorable.4. Comparison between case group and control group in terms of complications at different gestational weeks and delivery period and perinatal outcome in case group: The antepartum/postpartum bleeding rate, mean postpartum bleeding volume, C-section rate and postpartum blood transfusion rate of pregnant women in case group were significantly higher than those of control group(P<0.05), moreover, the perinatal premature incidence, rates of neonatal asphyxia and newborns transfer were also higher than those of control group(P<0.05), which showed poor pregnancy outcome of case group.5. Analysis on delivery modes of different types of placenta previa in case group: C-section rates for low-lying placenta, marginal placental previa, partial placenta praevia, total placenta praevia and pernicious placenta previa were respectively 74.19%, 94.44%, 100.00%, 98.11% and 100%. This indicated that partial placenta praevia and marginal placental previa may be available for vaginal trial production, while other three kinds of placental previa must receive C-section and allow termination of pregnancy.6. Analysis on pregnancy outcomes of different types of placenta previa in case group: The antepartum/postpartum bleeding rate, postpartum blood transfusion rate, placenta implantation rate, application rate of intraoperative special hemostasis method, hysterectomy and incidence of postpartum anemia for total placenta praevia and pernicious placenta previa were greater than those of other three types, while the perinatal premature incidence, rates of neonatal asphyxia and newborns transfer for total placenta praevia was highest, which showed that these two types of placenta praevia can be harmful to both mother and fetus.Conclusions:1. In allusion to the high-risk factors of placenta previa, women of child-bearing age should enhance self-protection awareness, take safe and effective contraceptive measures to reduce the number of induced abortions and decrease the cesarean section rate.2. Color doppler ultrasound would be the preferred method, and MR may also be used along with it if suspected placenta previa and highly suspicious of placental implantation are found, thus improving diagnostic accuracy.3. Reasonable expectant management shall be given if the mother and perinatal fetus are safe, to extend the gestational age, improve perinatal outcomes and avoid iatrogenic preterm labor.4. Some of low-lying placenta and marginal placental previa may be available for vaginal trial production, while partial, total and pernicious placenta previa must receive cesarean section and allow termination of pregnancy.5. Placental previa shows poor pregnancy outcome, total and pernicious placenta previa are harmful to both mother and fetus, therefore, perinatal management shall pay close attention to the type of placental previa, make full preparation while choose the right time for pregnancy termination. |
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