Termination Of Pregnancy Complicated By Placenta Previa And Placenta Accreta In Midtrimester With History Of Cesarean Section

Objective:To investigate the interest of injecting potassium chloride into fetus's heart before labor induction when second-trimester termination of pregnancy(TOP)is associated with the history of cesarean section,placenta previa and accreta.Methods:From 2012 to 2017 January,the databases of Qilu Hospital of Shandong University were reviewed.We identified 29 cases.They were divided into two group for their wishes.Observation group undergoing KCL fetal heart injection was a total of 14 cases;the control group directly undergoing cesarean section was a total of 15 cases.After KCL injection,if placenta accreta was slightly,it could spontaneously launch the contraction or given misoprostol to finish viginal delivery.If placenta was tightly adhere to the uterus,patients could go back home after the stillbirth confirmed.The placental blood flow and ?-HCG levels were regularly reviewed.We performed placenta clamps guided by ultrasound after KCL when placental dysfunction suggested.The clinical data of two groups were observed.Results:1.General situation of the two groups:the difference of age,gestational age,previous pregnancy times,number of previous cesarean delivery and abortion times were not statistically significant(P>0.05).2.Comparison of the outcomes of the two groups:the mean blood loss of observation group is 902.14±1060.3ml,red blood cell volume is 3.89±3.28U.The control group had an average blood loss of 2546.7± 1686.9 ml,red blood cell volume of 10.93±6.84U.The difference between the two groups was statistically significant.The amount of blood loss and red blood cell transfusion in KCL group was significantly lower than that in directly cesarean section.There was no significant difference in the cost of hospitalization between the two groups(P>0.05).The number of hospital days was statistically significant(P<0.05).The number of hospitalizations of KCL patients was longer than that of directly cesarean section.There was no difference in hysterectomy rate,infection rate and ICU rate.Two groups had no serious infection and severe coagulation dysfunction.4.Comparison of the observation group:according to pregnancy outcome,observation group can be divided into three groups:viginal delivery after KCL(n=5),placenta clamps guided by ultrasound after KCL(n=4),cesarean after KCL(n=5).There was no significant difference in age,gestational age,bleeding volume and blood transfusion between the three groups.After the injection of KCL,placenta accreta and placenta increta were more likely to automatically launch uterine contractions to achieve viginal labor.Since KCL injection to the average days of vaginal delivery was 12 days(2?21 days).It took 108 days on average(86?152 days)from KCL injection to placenta clamps guided by ultrasound.The reduction of ?-HCG down to normal level in placenta percreta took 116.5 days on average(89?134 days).5.Comparison of cesarean section after and without KCL injection:there was no significant difference(P>0.05).6.Follow-up:most of the patients were normal menstrual cramps.Conclusions:1.Fetal heart cavity injection of KCL can be a feasible induction method for people who not want to re-surgery in second-trimester termination of pregnancy(TOP)associated with the history of cesarean section,placenta previa and accreta.2.Stillbirth caused by KCL injection no more than 3 to 4 months may not cause coagulant dysfunction.