Prediction of maternal near-miss in placenta previa: a retrospective analysis from a tertiary center in Ankara, Turkey

Hypogastric artery ligation in postpartum haemorrhage: a ten-year experience at a tertiary care centre

This study investigated patients who underwent bilateral hypogastric artery ligation (BHAL) due to postpartum haemorrhage (PPH). Patients who underwent BHAL because of PPH following a conservative treatment were included in this study. Placental abnormalities were referred to as placenta accreta. A total of 130 BHAL procedures took place at the study hospital as a result of PPH. Of these, 39 (30%) were referred to the hospital. The rate of BHAL requirement was 62 out of 10,000 births. Among the 130 patients, the most frequent indication for BHAL was placenta accreta (58.5%). Haematological parameters were poorer among the referral patients. Four of the exitus patients (80%) were referral patients. The mortality rate among the referral patients was 10.25%, whereas this rate was only 1.01% among the patients who gave birth at the hospital. PPH is a life-threatening condition that requires immediate medical attention. BHAL, with its fertility-preserving features, is a good option that can be employed in all PPH patients. BHAL not only preserves patients' fertility, but it also gives them a higher chance of survival.IMPACT STATEMENTWhat is already known on this subject? PPH is a life-threatening condition. Due to the worldwide increase in caesarean sections, placenta accreta has also increased. BHAL is a vital treatment method for PPH.What do the results of this study add? Placenta accreta is one of the most common causes of PPH. Traditional hysterectomy rates can be reduced by replacing this treatment with BHAL in this group of patients. Without early intervention in PPH, a patient's mortality risk can increase by up to 10 times. As research and surgeons' experience grows, PPH can be controlled with treatments with less complex modalities without the need for BHAL.What are the implications of these findings for clinical practice and/or further research? The need for BHAL should be kept in mind when addressing PPH, especially in cases of placenta accreta. The need for hypogastric artery ligation, which is a more aggressive treatment for the surgical correction of the pathology, can be reduced as surgeons' experience increases. Early intervention and/or referral in cases of PPH is of great importance.

Planned versus urgent deliveries in placenta previa: maternal, surgical and neonatal results

PURPOSE

Placenta previa is abnormal localization of the placenta, associated with high rates of maternal-fetal morbidity and mortality. This abnormal implantation may also be in the form of invasion to surroundings defined as placenta accreta spectrum (PAS). The increasing rates of cesarean section raise the frequency of placenta previa and PAS in recent years. Although there are some recommendations, the optimal timing of caesarean delivery concerning fetal and maternal benefits is still unclear. The aim of this study is to compare maternal, surgical and perinatal outcomes of placenta previa cases who underwent emergency or planned surgery.

METHODS

The women who underwent cesarean section for placenta previa between October 2013 and February 2019 at a tertiary care center were retrospectively analyzed. They were divided into two main groups as planned and urgent, and into two subgroups as complicated (PAS) and uncomplicated (non-PAS).

RESULTS

Of the 313 women who met the inclusion criteria, 176 were planned and 137 were urgent cesarean sections. In the urgent group, gestational age, duration of surgery, maternal preoperative and pre-discharge hemoglobin levels, requirement of blood and blood product, additional surgical interventions, length of maternal postoperative intensive care unit and hospital stay, neonatal birthweight, Apgar scores, length of the follow-up in neonatal intensive care unit, invasive and non-invasive mechanical ventilation were significantly different.

CONCLUSIONS

Maternal complication rates are increased in women who are operated on emergency conditions due to placenta previa. Perinatal outcomes are better in women who underwent planned surgery and in those with gestational age greater than 37 weeks.

Risk factors for severe postpartum haemorrhage during caesarean section for placenta praevia

The objective of this study was to evaluate the value of clinical and ultrasound risk factors in predicting severe postpartum haemorrhage (PPH) (≥1.5 L) in pregnancies undergoing caesarean section for placenta praevia. This cohort consists of all cases of placenta praevia undergoing caesarean delivery over a period of 5 years in a service unit. Patients and their delivery data were retrieved from an obstetric database. Ultrasound features were prospectively recorded before caesarean section. The incidence of caesarean section for placenta praevia was 0.98% (n = 215). Of these, 12.1% (n = 26) had severe PPH. A logistic regression model showed that major praevia, antepartum haemorrhage before delivery and anterior placenta remained significant factors associated with severe PPH. The sensitivity/specificity and positive/negative predictive value of the model are 96.2%, 59.8%, 24.8% and 99.1%, respectively. Our model had high sensitivity and negative predictive value for severe PPH during caesarean section for placenta praevia.Impact statementWhat is already known on this subject? Placenta praevia is known to be one of the leading causes of severe PPH. Many risk factors have been associated with severe bleeding during caesarean section for placenta praevia. However, the importance of individual factors in predicting pregnancy outcome remains controversial.What the results of this study add? Our model includes only three simple parameters, namely the presence of significant antepartum haemorrhage (APH) from the history, and anterior or posterior placenta and major or minor praevia from ultrasound findings, but could predict up to 96.2% of all severe PPH. More importantly, the absence of APH, a posterior minor praevia, was associated with a negative predictive value of 99.1% of severe PPH, implying that such cases could be treated as 'normal' low risk caesarean sections.What the implications are of these findings for clinical practice and/or further research? This simple model would allow differential pre-operative counselling of patients on risks and complications, planning and preparation of operation, allocation of staff as well as in contingency measures to be taken during operation. The establishment of a differential protocol for placenta praevia based on these simple risks factors and a prospective trial of such a protocol is suggested.