Diagnosis And Treatment Strategy Of Pernicious Placenta Previa

With the development of perinatal medicine，the cesarean section rate increases yearby year in our country. Pernicious placenta previa, that has a history of cesarean sectionand this pregnancy with placenta previa, is the most serious complications. It is a seriousthreat to the maternal and perinatal health. Pernicious placenta previa can lead to seriouscomplications such as maternal uncontrolled hemorrhagic， shock， disseminatedintravascular coagulation (DIC)，premature birth, hysterectomy, and infection. It is closelyrelated to the incidence and mortality of maternal and perinatal infant. It is also closelyrelated to the bladder repair, ureteral injury and increases the incidence of pulmonaryembolism and so on. The key point is that there are no unified and effective diagnosticstandard and treatment principles to pernicious placenta previa both at home and abroad.This brings to the clinical treatment of great distress. So analysis the clinicalcharacteristics of pernicious placenta previa and take effective prevention, setting cleardiagnostic criteria and treatment are the major problems to be solved.Studies show that multiple pregnancies and abortion history and the history ofcesarean section can significantly increase many times of endometrial lesions. This is oneof the dangerous and risk factors of placenta previa in this pregnancy. The fertilized eggimplantation site is the main factor influencing the pregnancy outcome after cesareansection. Endometrial damage after cesarean section incision, the lining layer growth ispoorer, muscular layer is weak, pregnant bursa once implantation in here, the bottom ofdecidual formation, hairs easily into myometrium serous membrane layer, even formplacenta increta. So the rate of placenta increta in pernicious placenta previa is as high as20%~50%, and its incidence increases with the increase of cesarean section. Then, what factors is related to the occurrence of pernicious placenta previa? Whatis the dangerous of pernicious placenta previa? As the incidence of pernicious placentaprevia increasing, the risk of placenta increta also increased. The medical workers willface more and more clinical trial, so how can we effectively rescue such patients in clinic?These questions will help us fully aware of the harmfulness of pernicious placentaprevia in clinic. So some works have been done:1) Designed the "patients with previouscesarean section investigation registration form", improve the comprehensiveness andfeasibility of the questionnaires through repeated discussion, modified and registration;2)According to our hospital medical experience, the patients with pernicious placenta previa,previous cesarean section patients and patients with placenta previa were divided intoexperimental group and control group. Through the epidemiological investigation andanalysis, the incidence of pernicious placenta previa, statistical comparison betweengroups of patients with general condition, the types of placenta previa, prenatal vaginalbleeding, intraoperative situation and neonatal outcome, ultrasound diagnosis of placentaprevia, ultrasonic combined MRI in the diagnosis of placenta increta and patients withpostoperative follow-up;3) A summary of the statistical data analysis;4) Sum up theclinical diagnosis principles of pernicious placenta previa;5) Sum up the clinical treatmentexperiences of pernicious placenta previa.Some results have been obtained：1) From May2008to February2014, ourhospital treated65cases of pernicious placenta previa, its incidence is0.51%, occupies5.38%of the history of cesarean section cases, accounting for15.40%of the total numberof placenta previa.2) The experimental group and control group in pernicious placentaprevia, placenta previa and previous cesarean section has no difference in maternal age;compared to patients with placenta previa and previous cesarean section, the gravidity,parity and previous abortive times of pernicious placenta previa were significantlyincreased;3) With the increase of the patients age, gravidity, parity and previous abortivetimes, risk of placenta increta also increased;4) The type of placenta previa has nothing todo with a history of previous cesarean section; placental location of the abnormal adhesionmay be associated with the damage level of the endometrium;5) Pernicious placentaprevia and placenta previa patients is close to have vaginal bleeding for the first time; prenatal vaginal haemorrhage is no significantly difference;6) The placenta increta withpernicious placenta previa are a total of24cases, the incidence is36.92%; Experimentalgroup and control group in pernicious placenta previa, the rate of placenta increta, theintraoperative blood loss, blood transfusion and transfusion volume were significantlyhigher than the previous cesarean section and placenta previa;7) Since2013, the patientsof pernicious placenta previa after effective solution treatment has significantly reducedthe uterus resection from2013years ago;8) More than twice cesarean section cansignificantly increase the patient’s uterus resection;9) Compared between theexperimental group and control group, the birth weight and Apgar score had no difference;10) Abdominal ultrasound in the diagnosis of three types of placenta previa, the clinicaldiagnostic coincidence rate of complete placenta previa up to96.0%;11) In the diagnosisof placenta increta, the experimental group adopts ultrasound combined MRI diagnosis,and clinical pathological diagnosis coincidence rate is higher than the control group;12)The core idea of management strategy in previous placenta previa is: optimize the referralprocess, treatment of reasonable expectation, attaches great importance to theperioperative treatment and the rescue of postpartum hemorrhage.In conclusion，this study we analysis of the clinical features of previous placentaprevia and its harmfulness of maternal and perinatal. We also analyzed and summarized aseries of treatment in patients with previous placenta previa, has been clear about thediagnosis of previous placenta previa, formulate the treatment process of previous placentaprevia, thus provide effective help and effective basis for clinical treatment of previousplacenta previa.