| Objective: To review and summarize the data of women with pernicious placenta previa,analyze its clinical characteristics and pregnancy outcomes,and provide basis for clinical diagnosis and treatment.Methods:Collected the clinical data of 110 cases of women with placenta previa in our hospital from 2015 to 2020,and divided them into three groups according to whether they were scarred uterus and the relationship between placenta previa and scars.Group A has 24 cases of pernicious placenta previa group.Group B has 28 cases of the scarred uterus group and group C has 58 cases of the non-scarred placenta previa group.The clinical data of the three groups were compared,the trend of pernicious placenta previa and risk factors were explored,and the auxiliary examination methods,pregnancy outcome,and the hemostatic effect of closing the scar diverticulum were compared and analyzed.Results: 1.From 2015 to 2020,the proportion of pernicious placenta previa in our hospital giving birth to placenta previa increased from 14.3% to 41.7%,and the incidence of pernicious placenta previa rose from 1.4‰ to 5.1‰,showing a significant upward trend.2.The average number of cesarean sections in group A was(1.21±0.42)times,group B was(1.04±0.19)times,group C was(0.00±0.00)times,and the number of cesarean sections in group A was higher than that of B and C Group,the difference was statistically significant(P<0.05);Logistic regression analysis showed that the number of abortions was ≥3 times(OR=6.03,P=0.018)、cesarean section ≥2 times(OR=12.78,P=0.032)and the placenta was located on the anterior wall(OR=14.32,P<0.01)are independent risk factors for pernicious placenta previa.3.The proportion of placenta accreta in group A was 91.7%,and penetrating placenta accreta accounted for 40.9%.Compared with groups B and C,the difference was highly statistically significant(P<0.01).4.In group A the rate of interventional operation(12,50.0%),hysterectomy rate(5,20.8%),operation time(159.96±78.18min),intraoperative blood loss(1627.08±1261.55ml),intraoperative blood transfusion(995.43±743.73ml),blood transfusion rate(23,95.8%),transfer to ICU rate(15,62.5%),and average postoperative hospital stay(8.38±3.03 days)are higher than those in groups B and C,with high differences statistically significant(P<0.01);among women with pernicious placenta previa,the hysterectomy rate for traditional cesarean section was 41.7%,and the hysterectomy rate for interventional surgery was 0.0%,the difference between the two was statistically significant(P<0.05).5.The premature birth rate and transfer rate of newborns in groups A and C were higher than those in group B,birth weight is less than group B and the difference was statistically significant(P<0.05).6.The accuracy rates of B-ultrasound and MRI for the diagnosis of placenta previa were 73.1% and 84.6%,the difference was not statistically significant(P>0.05),the sensitivity for the diagnosis of placenta accreta was 54.9% and 86.7%,the difference was statistically significant(P<0.05).7.In the pernicious placenta previa surgery,the average bleeding volume of the group that quickly finds out and sutures the closed diverticulum is(710.00±194.94)ml,and the blood transfusion volume is(570.00±303.32)ml,which is less than the early unclosed diverticulum group,the difference was statistically significant(P<0.05).Conclusion: 1.The incidence of pernicious placenta previa continues to increase,and the severity of placental accreta and perioperative bleeding,blood transfusion,and hysterectomy are significantly higher than other types of placenta previa.2.The number of abortions is ≥3 times,the cesarean section is ≥2 times,and the anterior placenta is an independent risk factor for pernicious placenta previa.3.The application of interventional surgery reduces the rate of hysterectomy and provides more treatment options for pernicious placenta previa.4.B-ultrasound is the preferred method for diagnosing placenta previa,and MRI is of great value for the diagnosis of placenta accreta as an assisted diagnosis method.5.Quickly finding and closing the diverticula during the operation is an effective way to restore the anatomical structure and reduce the bleeding during the operation. |
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