| Background and aimsPernicious placenta previa was earliest put forward by Chatto-padhyay, and is defined as:a previous history of cesarean section, the pregnancy placenta previa and placenta attached to the the original uterine scar, often accompanied by placenta accreta. It was also known as cesarean scar pregnancy, which refers to a fertilized egg, trophoblast cells were grown in the last minute after cesarean section, incision scar gap,they were enveloped by uterine smooth muscle fibers and scar fibrous tissue, belonging to a rare ectopic pregnancy.It can occur on placent increta,uterine rupture, hemorrhagic shock, and even endanger the lives of the patients.In recent years,with the increase rate of cesarean section,Its incidence is increasing year by year,0.04%of the the placenta accreta incidence of normal pregnancy, placenta previa with placenta accreta was10%,up to38.2%, while the incidence of dangerous placenta previa, no history of cesarean section was35times as high as59.2%of cesarean section. Dangerous placenta previa is a serious obstetric complications in early pregnancy, it may cause perforation of the uterus, uterine rupture, bleeding, if not timely treatment, it can cause beneath hemorrhagic shock, the risk of death.If complicated with placenta accreta, it can unpredictable bleeding during the production, makes the risk of hysterectomy increase greatly. It can cause maternal and (or) perinatal deaths if the diagnosis and treatment delayed or not timely treated. Childbirth unpredictable bleeding can occur, greatly increased the risk of hysterectomy. If the diagnosis and treatment delayed or not timely treatment can cause maternal and (or) perinatal deaths. Once discovered, reasonable and effective measures should be taken to reduce the rate of hysterectomy and perinatal mortality, to improve the prognosis of the patients.MethodsRetrospective analysis of48cases with a previous history of cesarean section from February2006to February2012in the first affiliated hospital of zhengzhou University, of them there were392cases with placenta previa,48cases with pernicious placenta previa. Of the48patientes,16cases with placenta accreta, the incidence rate was33.33%; aged24to42years old, an average of33.26±3.68years; gestational age of28to39weeks, an average of33.73±3.56weeks, previous cesarean section, producing3times the six cases,14cases,28cases; the past abortion five times three cases, four times in two cases, three times in18cases,2times in8patients,1in9patients, no abortion history in8cases.48cases underwent color Doppler ultrasound examination,of which16cases parallel MRI examination.Results1. There were2cases of misdiagnosis and missed four cases by Separate line color Doppler ultrasound to diagnose placenta accreta,The sensitivity was58.3%and the specificity was95.0%;There were1cases of misdiagnosis and missed two cases by line color Doppler ultrasound unite MRI,The sensitivity was60.0%and the specificity was90.9%.Both the sensitivity and specificity of the difference was not statistically significant.(χ2=1.229,P=0.268; χ2=0.083, P=0.774)2. Emergency surgery group and elective surgery group in the production and the amount of bleeding and hysterectomy rate difference was statistically significant.(t=7.422, P=0.015;χ2=9.707, P=0.002)3. The placenta accreta group and non-placenta accreta group intrapartum bleeding and hysterectomy rate difference was statistically significant.(t=19.744, P=0.000;χ2=8.532,P=0.002)ConclusionThe examination of ultrasonography and MRI is not increase the sensitivity and specificity significantly for the diagnosis of placenta accreta;expecting the treatment to a certain gestational age after miscarriage treatment can increase the bleeding risk during pregnancy, thereby increasing the rate of emergency surgery, and greatly increased intraoperative bleeding and the risk of hysterectomy; Complicated by placenta accreta can significantly increase the amount of blood loss and improve the rate of hysterectomy. |
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