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Manejo ambulatorio de la paciente con placenta previa revisión sistemática
Grillo-Ardila,Carlos Fernando;
Revista Colombiana de Obstetricia y Ginecología , 2007,
Abstract: placenta previa is an important obstetric complication in terms of maternal and foetal morbidity-mortality, having a high incidence in our population. many interventions have been proposed for managing this pathology to minimise risks, recourse to hospital stay being a usual preventative action. these problems, apart from being costly, cause patients to become subjected to permanent medical care and high emotional tension. objective: reviewing perinatal outcome and outpatient management cost effectiveness in placenta previa. materials and methods: an electronic search was performed to identify relevant literature. searched databases included medline, ebsco, scopus, scielo (1980 to 2006) and cochrane pregnancy and childbirth group (september 15th 2006). any controlled clinical trial which had assessed perinatal outcome in placenta previa outpatient management and any study regarding the cost-benefits of such intervention. results: one perinatal outcome trial was included. there was no difference in maternal or neonatal outcome, reduced length of stay in hospital being the only difference. two studies assessed the cost-benefits of outpatient management, demonstrating contrary results. conclusions: there is insufficient trial data to recommend any change in clinical practice. however, available data showed that outpatient management could be a safe and cost-benefit option for selected patients. outpatient management appeared to be a safe and cost-effective therapeutic option.
Manejo ambulatorio de la paciente con placenta previa revisión sistemática Outpatient management of placenta previa: Systematic review  [cached]
Carlos Fernando Grillo-Ardila
Revista Colombiana de Obstetricia y Ginecología , 2007,
Abstract: La placenta previa constituye una complicación obstétrica ostensible en términos de morbimortalidad materno-fetal, con una incidencia importante dentro de nuestra población. Múltiples intervenciones han sido puestas en marcha para minimizar los riesgos inherentes a esta patología, dentro de los cuales se encuentra la vigilancia intrahospitalaria de esta entidad como medida preventiva. Esta opción terapéutica genera gran costo dentro de los sistemas de salud, somete a nuestras pacientes a una estancia hospitalaria prolongada y a niveles altos de tensión emocional durante su manejo. Objetivo: revisar el resultado perinatal y la costo-efectividad del manejo ambulatorio frente al hospitalario en la paciente con placenta previa. Materiales y métodos: se realizó una búsqueda electrónica para identificar literatura relevante en Medline, EBSCO, Scopus, SciELO (1980 al 2006) y Cochrane Pregnancy and Childbirth Group (septiembre 15 del 2006).Se eligieron ensayos clínicos controlados que evalúen el resultado perinatal del manejo ambulatorio en la paciente con placenta previa, así como estudios que evalúen la costo-efectividad de esta intervención. Resultados: se encontró un ensayo clínico controlado que evaluaba el resultado perinatal. No se encontró diferencia en la morbimortalidad materna o neonatal; la única diferencia fue la estancia hospitalaria. Dos estudios que evaluaron los costos del manejo ambulatorio mostraron resultados contradictorios. Conclusiones: existen datos insuficientes a partir de los ensayos para recomendar alguna variación en el ejercicio clínico. Sin embargo, la información disponible muestra que en pacientes seleccionadas, el manejo ambulatorio parece ser una opción terapéutica segura y costo-efectiva. Placenta previa is an important obstetric complication in terms of maternal and foetal morbidity-mortality, having a high incidence in our population. Many interventions have been proposed for managing this pathology to minimise risks, recourse to hospital stay being a usual preventative action. These problems, apart from being costly, cause patients to become subjected to permanent medical care and high emotional tension. Objective: reviewing perinatal outcome and outpatient management cost effectiveness in placenta previa. Materials and methods: an electronic search was performed to identify relevant literature. Searched databases included MEDLINE, EBSCO, SCOPUS, SciELO (1980 to 2006) and Cochrane Pregnancy and Childbirth Group (September 15th 2006). Any controlled clinical trial which had assessed perinatal outcome in placenta previa outp
Maternal and fetal death due to placenta previa/accreta ina concealed pregnancy - a case report  [PDF]
Jovanovi? Bo?idar,?or?evi? Mom?ilo
Medicinski Pregled , 2006, DOI: 10.2298/mpns0606277j
Abstract: Introduction. This is a case report of maternal and fetal death due to major hemorrhage of a patients with placenta previa/accreta in a concealed pregnancy. Bleeding is the leading cause of maternal mortality in obstetrics. Postpartum hemorrhage is the most important cause of maternal death. Placenta accreta is a severe complication involving an abnormal attachment to the uterine wall so that it cannot be easily separated from the uterus. Case report. Due to the fact that one part of the placenta is partially detached, while the other part has grown into the uterus, postpartum hemorrhage may occur with lethal outcome, unless the mother is hospitalized. Fetal death was caused by severe meconium aspiration. One way to prevent such complications is to support legal abortions. .
Obstetric Outcome of Teenage Pregnancy  [PDF]
S Kayastha,A Pradhan
Nepal Journal of Obstetrics and Gynaecology , 2012, DOI: 10.3126/njog.v7i2.11139
Abstract: Aims: To assess the prevalence of teenage pregnancies and to compare the obstetric performance of teenage pregnant woman with that of adult pregnant woman. Methods: A prospective study was conducted in Nepal Medical College Teaching Hospital from August, 2010 to February, 2012 (one and half year duration). All the teenage pregnancies were included and outcomes were compared with adult (20-24 years) pregnancies, selected randomly who had delivered during the same period of time. The patient characteristics (age, gravidity, parity, gestation age) and obstetric outcome (medical and obstetrical complications, mode of delivery, complications during delivery, fetal outcome, birth weight) were compared between the two groups. Statistical analysis was preformed using PHSTATZ and Z test for proportion. Results: There were total 2708 deliveries during the study period, out of which teenage pregnancy was 264 (9.7%). There were 69(26.1%0) teenage mothers of age 16 to 17 years and 195(73.9%) of age group 18 to 19 years. As expected, maximum patients in the test group i.e. teenagers were primigravida as compared to control group. (90.1% vs. 68.5%). As for mode of delivery, normal delivery in test and control was 82.9% vs 81.1% (p=0.56) and rate of cesarean delivery was similar 10.2% and 10.7%, (p=0.84) in both the groups. The incidence of instrumental delivery was more in control group although it was not statistically significant( 0.7% vs 2.2%, p=0.16). Preterm delivery was 3.0% in teenage as compared to control which is 2.2%. The percentage of intrauterine fetal death was 0.7% vs 0% in test and control group (p=0.15). Proportion of low birth weight babies in test and control group was 7.2% vs 5.9% (p=0.55). Similarly pregnancy related complications were also compared in teenage and control groups. It was found that postpartum hemorrhage occurred more in teenage pregnancy 1.8% vs 0.7% (p=0.84) but statistically not significant. Incidence of hypertensive disorders was 6.4% and 5.6% (p=0.66) in test and control group. Proportion of babies with intrauterine growth restriction was 3.0% in test and 1.1% (p=0.009) in control, the only parameter that is statistically significant. Fetal congenital anomaly was 0.7% vs 0.4% (p=0.54) Conclusions: Teenage pregnancy can have an equally good outcome if we give good obstetric care and encourage institutional delivery. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11139 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 29-32
Selected Pregnancy Variables in Women with Placenta Previa
Sohrabi Davood,Parivar Kazem,Ebrahimi Sepideh
Research Journal of Obstetrics and Gynecology , 2008,
Abstract: The aim of this study was to investigate risk factors and perinatal outcomes of pregnancies complicated by placenta previa. Birth records of 93 cases with placenta previa and 940 randomly selected controls were reviewed retrospectively. Statistical analysis was performed using Pearson`s Chi-Square method. Placenta previa complicated 0.73% (n = 93) of all deliveries included in the study (n = 12834). Multiparity was more common in patients with placenta previa (78.5%, p<0.001). Placenta previa occurred in male infants in 62 cases (76.6%). Fetuses with placenta previa had lower fetal weight ; particularly, fetal weight less than 2500 g was a significant (40.9.%, p<0.0001). We also found that previous abortion (OR = 0.7; 95% CI = 0.57-0.83), previous placenta previa (OR = 5.17; 95%, CI = 5.61-7.62) and previous cesarean section (OR = 11.5; 95% CI = 3.91-33.41) were risk factors for placenta previa. The newborns that were delivered after placenta previa graded lower Apgar scores less than 7 at 5 min (24.7%, p<0.0001). Multiparity, previous placenta previa, previous abortion and previous cesarean section are risk factors for placenta previa.
PLACENTA PREVIA
ZOONA SAEED
The Professional Medical Journal , 2009,
Abstract: Objectives: To analyze the causative factors and short term complications in cases of placenta previa. Design and Settings: A retrospective study carried out in Obstetrics and Gynecology Department of Sheikh Zayed Post Graduate Institute Lahore. Period: From June 2004 to June 2007.Subject: Fifty patients with placenta previa. Main outcome measures: Age, parity, previous cesarean section, previous history of evacuation/myomectomy, average hospital stay, need for blood transfusions, emergency/elective LSCS, associated maternal and fetal morbidity and mortality. Results: There were 50 cases of placenta previa over the period of 3 years. Most frequently occurring intra operative complication was postpartum hemorrhage in 19 patients (38%). Highest morbidity was due to anemia which was in 23 patients (46%). Maternal mortality was 2%, while neonatal mortality was 14%. Conclusion: Placenta previa is a multifactorial disease. No doubt that the rising incidence of cesarean section is increasing the intraoperative complication associated with the condition but other risk factors are also important like age, parity, history of evacuation etc.
Maternal Outcome of Cases of Placenta Previa with and without Morbidly Adherent Placenta at King Abdul-Aziz University Hospital, Saudi Arabia  [PDF]
Ashraf Radwan, Abdel Magid Abdou, Sausan Kafy, Mamdouh Sheba, Hassan Allam, Moaz Bokhari, Majed Almutairi
Open Journal of Obstetrics and Gynecology (OJOG) , 2018, DOI: 10.4236/ojog.2018.813142
Abstract: Introduction:Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent placenta. This morbidly adherent placenta constitutes a serious and possibly a life threatening complication. An efficient team capable for managing possible complicated situations will be able to reduce mortality and morbidity. Objectives: The aim of our study was to evaluate maternal outcome in cases of Placenta Previa with and without morbidly adherent placenta. Methods: Analysis of all pregnancies complicated by antepartum hemorrhage during the period from January 2013 to September 2017 at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA) was done. Cases of Placenta Previa with gestational age > 28 weeks were included. They were classified into 2 groups; Group (A) included Placenta Previa cases without morbidly adherent placenta and Group (B) included cases with morbidly adherent placenta
Predictors of Perinatal Mortality Associated with Placenta Previa and Placental Abruption: An Experience from a Low Income Country  [PDF]
Yifru Berhan
Journal of Pregnancy , 2014, DOI: 10.1155/2014/307043
Abstract: A retrospective cohort study design was used to assess predictors of perinatal mortality in women with placenta previa and abruption between January 2006 and December 2011. Four hundred thirty-two women (253 with placenta previa and 179 with placental abruption) were eligible for analysis. Binary logistic regression, Kaplan-Meier survival curve, and receiver operating characteristic (ROC) curve were used. On admission, 77% of the women were anaemic (<12?gm/dL) with mean haemoglobin level of 9.0?±?3.0?gm/dL. The proportion of overall severe anaemia increased from about 28% on admission to 41% at discharge. There were 50% perinatal deaths (neonatal deaths of less than seven days of age and fetal deaths after 28 weeks of gestation). In the adjusted odds ratios, lengthy delay in accessing hospital care, prematurity, anaemia in the mothers, and male foetuses were independent predictors of perinatal mortality. The haemoglobin level at admission was more sensitive and more specific than prematurity in the prediction of perinatal mortality. The proportion of severe anaemia and perinatal mortality was probably one of the highest in the world. 1. Introduction Placenta previa (placenta implanted over the internal cervical os) and placental abruption (premature separation of normally implanted placenta) are the major causes of antepartum haemorrhage in the third trimester of pregnancies and major contributors of obstetric haemorrhage in general [1]. Each of these conditions has a prevalence rate of 0.5% to 2% in most parts of the world [2–4]. Because of the changes in the lower uterine segment length and placental migration as the pregnancy advances, the prevalence of placenta previa has an inverse relation to the gestational age [5]. In other words, it is suggested that reporting of placenta previa in early gestation is likely to overestimate its actual prevalence at term. Placenta previa and placental abruption have long been recognized as major obstetric complications that result in maternal and fetal mortality as well as morbidity. The effect of these two bloody obstetric complications on perinatal health is multifactorial: blood loss, premature delivery, intrauterine growth restriction, the risk of perinatal asphyxia, the risk of sepsis, and hyperbilirubinemia [2, 6–8]. A Danish national cohort study was associated with an increased risk of neonatal mortality, prematurity, low Apgar scores, low birthweight, and transfer to a neonatal intensive care unit [9]. Several other studies from developing countries have also shown that pregnant women complicated by
Placenta previa percreta left in situ - management by delayed hysterectomy: a case report
Minna Tikkanen, Vedran Stefanovic, Jorma Paavonen
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-418
Abstract: We present the case of a 30-year-old African woman, gravida 7, para 5, with placenta percreta managed by an alternative approach: the placenta was left in situ, methotrexate was administered, and a delayed hysterectomy was successfully performed.Further studies are needed to develop the most appropriate management option for the most severe cases of abnormal placentation. Delayed hysterectomy may be a reasonable strategy in the most severe cases.Placenta accreta (PA) is characterized by abnormal invasion of the placenta into the myometrium. PA is defined as superficial invasion, placenta increta as middle layer invasion and placenta percreta as deep invasion, which is the most severe form of PA with an incidence of one in 7000. All three types are collectively known as placenta accreta. The incidence of PA has dramatically increased due to increasing Caesarean section rates [1,2]. Although rare, PA is one of the most severe pregnancy complications. Maternal morbidity and mortality associated with PA is mainly caused by massive obstetric hemorrhage or emergency hysterectomy, and PA is often diagnosed during delivery or immediately post-partum leading to an obstetric emergency [1,3,4]. Studies suggest that antenatal diagnosis may reduce obstetric hemorrhage-related morbidity [5,6]. Furthermore, in some cases a morbidly adherent PA can be left in situ [7,8]. Such conservative management may allow delayed removal of the placenta to avoid massive hemorrhage during an attempted forced removal of the adherent placenta. We describe a case in which placenta percreta was left in situ. Subsequent post-partum hemorrhage was successfully managed by delayed hysterectomy.Our patient was a 30-year-old African woman, gravida 7, para 5. Her second screening ultrasound at 21 weeks of gestation showed normal fetal anatomy and placenta previa. She was referred in her 28th gestational week from her antenatal clinic to the University Hospital Outpatients Maternity Clinic because of anemia
Placenta previa and percreta with massive genital bleeding in the first trimester of pregnancy: A case report  [PDF]
Masayuki Yamaguchi, Kunihiko Yoshida, Toru Takano, Takayuki Enomoto, Koichi Takakuwa
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.39127
Abstract:

A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation; she was treated with red cell concentrate and fresh frozen plasma transfusion. She was admitted to our hospital at the 11th week of gestation for continuous genital hemorrhage and cervical shortening (20 mm). Ultrasonography revealed placenta previa totalis. A lowlying gestational sac in early pregnancy, vascular lacunae, and an obscured retroplacental sonolucent zone indicated placenta percreta; magnetic resonance imaging showed similar findings. Owing to placenta percreta, uterus preservation was considered impossible. Elective cesarean section followed by total hysterectomy was performed at the 37th week of gestation, with bilateral internal iliac artery balloon catheter occlusion for reducing blood loss. The perioperative blood loss was 2,835 mL, for which the patient received blood transfusion. The postoperative course was uncomplicated.

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