Clinical Analysis Of 57 Cases Of Caesarean Sections Of Uterus With Scar Combined With Placenta Previa

Objective: To explore the managements for caesarean sections of uterus with scar combined with placenta previa and the influences of women and neonates .Methods: The managements of caesarean sections and the influences of women and neonates for 57 cases of caesarean sections of uterus with scar combined with placenta previa from January .2009 to January .2001 were reviewed retrospectively.Results:1.There were 57 cases of caesarean sections. 2.There were 18 cases of gestation less than 37 weeks'cesarean sections .Because of the hemorrhage of vagina,4 patients had to do the obstetric emergent caesarean sections . The other 14 patients had conservative expectant treatments for blood loss smaller or lacks of gestational weeks ,then the conservative expectant treatments without action ,they had cesarean sections . There were 39 cases of cesarean sections for the time of gestational weeks after 37.Because of the hemorrhage of vagina,2 patients had to do the obstetric emergent caesarean sections .Another 15 patients had conservative expectant treatments for blood loss smaller or lacks of gestational weeks ,then the conservative expectant treatments with action ,they had planned elective cesarean sections after 37 weeks .The last 22 patients had planned elective cesarean sections after 37 weeks smoothly during pregnancy. 3. There were 23 cases of central placenta previa with blood loss more than 1000ml in operation .11 patients had the placentas attaching to the anterior wall of the uterus , another 6 patients had the placentas attaching to the posterior wall of the uterus .The last one attached to the lateral wall of the uterus .Central placenta previa with blood loss more than 1000ml in operation was easier ,especially the placentas attaching to the anterior wall of the uterus. 4.When the blood loss less than 1000ml in operation it would use the haemostasis①,②and②.When the blood loss from 1000ml-3000ml in operation it would use the haemostasis③.When the blood loss from 3000ml-5000ml in operation it would use the haemostasis②.When the blood loss more than 5000ml in operation it would use the haemostasis⑤. 5. The patients:1 case of postpartum intestinal obstruction .3 cases of cesarean hysterectomy: there were 1 case of renal failure and 2 cases of DIC for blood loss large in operation .Neonate : all of the 57 cases were survival .Premature children were 19. Full-term infants were 38. Low birth weight children were 2;one of them gestational weeks was 35+4 ,the other was 37+4.Conclusion :1. Caesarean section was the main method to treat the uterus with scar combined with placenta previa , it made the pregnant and parturient women and the newborn security. 2 .When could terminate the pregnancy of the uterus with scar combined with placenta previa ,it had a relationship with gestational weeks and vaginal blood loss .It had to make cesarean sections for the hemorrhage of vagina .The patients had conservative expectant treatments for blood loss smaller or lacks of gestational weeks in case of maternal security ,then they had planned elective cesarean sections after 37 weeks .They had cesarean sections when the conservative expectant treatments without action .Patients had planned elective cesarean sections after 37 weeks smoothly during pregnancy. 3 .It was the most dangerous that the placentas attached to the anterior wall of the uterus belong to uterus with scar combined with placenta previa .4. Haemostasis in operation is variety ,it could use joint methods of haemostasis flexibly according to circumstances in operation to reduce the blood loss. 5.Uterus with scar combined with placenta previa did great harms to the pregnant and parturient women and the newborn ,especially it could be a threat to life and quality of life.