Relation between Birth Weight and Intraoperative Hemorrhage during Cesarean Section in Pregnancy with Placenta Previa

Balloon displacement during caesarean section with pernicious placenta previa: A case report

BACKGROUND

For the past few years, preventive interventional therapy has been widely used domestically and overseas, bringing great benefits to pregnant women at high-risk for complications, such as pernicious placenta previa (PPP) and placenta accreta. Nevertheless, there are still few reports on surgical complications related to interventional therapy, and its safety should be a concern.

CASE SUMMARY

We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section. However, the balloon shifted during the operation, which damaged the arterial vessels after filling, resulting in severe postpartum haemorrhage in the patient. Fortunately, after emergency interventional stent implantation, the patient was successfully relieved of the massive haemorrhage crisis.

CONCLUSION

It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases, but surgical complications related to intervention therapy can also cause adverse consequences. It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.

Effect of carboprost tromethamine injection combined with modified B-lynch suture and carboprost methylate suppositories in parturients with placenta previa

OBJECTIVE

To investigate the clinical value of carboprost tromethamine injection combined with modified B-lynch suture and carboprost methylate suppositories in the treatment of placenta previa parturients with postpartum hemorrhage after cesarean section.

METHODS

A total of 102 parturients with placenta previa and postpartum hemorrhage after cesarean section in our hospital were selected as the study subjects, and they were divided into Group A (carboprost tromethamine injection combined with modified B-lynch suture, n=35), Group B (carboprost methylate suppositories, n=34), and Group C (carboprost tromethamine injection, n=33) in accordance with a random number table. The amounts of hemorrhaging and clinical indices in the three groups were recorded, and the rescue effects were compared among the three groups.

RESULTS

The amount of hemorrhaging in Group A was significantly lower than that in Groups B and C during surgery and 24 h after surgery (P < 0.05). There were markedly improved clinical indices in Groups A, B and C, showing statistical significance (P < 0.05). There were statistically significant differences in hemostatic failure rate, hysterectomy, postoperative abdominal pain and puerperal infection between Groups A and B (P < 0.05). The intraoperative indices, postoperative infection, effective hemostasis rate and rate of advanced postpartum hemorrhage in Group A were remarkably higher than those in Groups B and C (P < 0.05), showing statistical significance (P < 0.05). There were statistically significant differences in blood oxygen saturation and pulse among the three groups before surgery and 2 h after surgery (P < 0.05).

CONCLUSION

Carboprost tromethamine injection combined with modified B-lynch suture and carboprost methylate suppositories can reduce the amount of hemorrhaging and the risk of postoperative infection in placenta previa patients with postpartum hemorrhage after cesarean section.

Low Birth Weight, and Low Ponderal Index Mediates the Association between Preeclampsia, Placenta Previa, and Neonatal Mortality

BACKGROUND

A retrospective study was conducted to assess the mediation role of low birth weight, and low ponderal index between the preeclampsia, placenta previa, and neonatal mortality in the tertiary hospital of Hubei Province, China.

METHODS

A total of 12772 neonatal births were included for data analysis. Birth weight, birth length, and neonatal mortality were recorded after birth. Sobel test based on mediation regression was used to evaluate the effect of mediator variables.

RESULTS

Approximately, 383 (3%) and 409 (3.2%) women experienced preeclampsia and placenta previa respectively. After adjusting for covariates, the indirect effect of preeclampsia on neonatal mortality mediated by low birth weight and low ponderal index was [β 2.59 (95% CI: 0.74 - 4.44)], and [β 3.94 (95% CI: 1.50 - 6.38)] respectively. Moreover, the indirect effect of placenta previa on neonatal mortality mediated by the low birth weight was [β 1.74 (95% CI: 0.16 - 3.31)], and low ponderal index was [β 3.21 (95% CI: 0.95 - 5.48)]. The estimated mediation proportion between the preeclampsia and neonatal mortality accounting for possible mediation by low birth weight and low ponderal index was 44.5% and 34.5% respectively. Furthermore, 47.9% by low birth weight and 33.2% by low ponderal index mediate the association between placenta previa and neonatal mortality.

CONCLUSION

Low birth weight, and low ponderal index partially mediates the association between preeclampsia, placenta previa and neonatal mortality.

Association between birth weight and massive haemorrhage in pregnancy with a low-lying placenta: a 9-year single-centre retrospective cohort study in Japan

A low-lying placenta is a well-known cause of a massive intrapartum haemorrhage. We aimed to evaluate whether neonatal birth weight deviation from the nationwide average could predict a massive haemorrhage during a delivery in the women with a low-lying placenta. This study included 40 women. The main outcomes were a massive haemorrhage and a neonatal birth weight deviation. We used a receiver operating characteristic curve analysis to determine the optimal birth weight deviation cut-off for predicting a massive haemorrhage. A multiple logistic regression model was used to identify the variables significantly associated with a massive haemorrhage. The best cut-off for predicting a massive haemorrhage was a birth weight deviation of +0.51 standard deviations (SDs) from the nationwide average. A birth weight deviation of ≥ +0.51 SDs was significantly associated with an increased massive haemorrhage risk. Impact statement What is already known on this subject? A low-lying placenta is a well-known cause of a massive intrapartum haemorrhage. Therefore, when managing pregnancies with a low-lying placenta, the possibility of severe perinatal bleeding should be considered, and it is desirable to determine reliable predictors of a haemorrhage. However, few studies have reported the predictive factors of a massive haemorrhage in patients with a low-lying placenta. What do the results of this study add? We demonstrated that a birth weight deviation from the nationwide average was significantly associated with a massive intrapartum haemorrhage in patients with a low-lying placenta. To our knowledge, this is the first study to clarify the association between a neonatal birth weight and a massive intrapartum haemorrhage incidence and to determine the optimal birth weight deviation cut-off for predicting a massive haemorrhage in patients with a low-lying placenta. What are the implications of these findings for clinical practice and/or further research? An accurate risk stratification using the foetal weight as a marker for a predicting massive intrapartum haemorrhage may help in the management of patients with a low-lying placenta. Studies with a larger sample size are required to confirm our findings.