ABSTRACT
Objective:To analyze the outcome of vaginal trial labor of pregnant women with low-lying placenta detected by translabial ultrasonography, and to explore the influencing factors of vaginal trial delivery and the risk factors of postpartum hemorrhage (PPH).Methods:A total of 80 pregnant women who were diagnosed by translabial ultrasonography with low-lying placenta and underwent vaginal trial delivery in Women′s Hospital, School of Medicine Zhejiang University were collected. Based on the distance of placenta lower edge to cervical internal os (IOD) 1 cm, and the general characteristics and pregnancy outcomes of pregnant women with IOD≤1 cm and 1-2 cm were compared and the related factors of PPH were analyzed by binary logistic regression analysis.Results:Among the 80 pregnant women with low-lying placenta, 41 cases with IOD≤1 cm and 39 cases with IOD 1-2 cm, respectively. The rate of cesarean section in the two groups were 15% (6/41) and 15% (6/39), respectively. The birth weight of newborns were (3 334±360) and (3 460±365) g, respectively. PPH rates were 24% (10/41) and 26% (10/39), respectively, and the differences were not statistically significant (all P>0.05). Among the 80 pregnant women with low-lying placenta, 60 cases did not have PPH, and 20 cases did. The rates of placenta manual removal were 2% (1/60) and 20% (4/20), respectively. The birth weight of newborns were (3 330±368) and (3 591±284) g, respectively. The differences were statistically significant (all P<0.05). Binary logistic regression analysis suggested that placenta manual removal was a risk factor for PPH in pregnant women with low-lying placenta ( OR=30.448, P=0.029). Conclusions:The results of vaginal trial labor in women with IOD≤1 cm and 1-2 cm are comparable, and vaginal trial labor could be attempted in those without contraindications of vaginal delivery. The main adverse complication of vaginal trial labor is PPH, and those with placenta manual removal need to make corresponding plans.
ABSTRACT
Objective:To investigate the safety, efficacy and application indication of intra-operative cell salvage (IOCS) in cesarean section.Methods:A total of 1 265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into <1 500 ml group (796 cases) and ≥1 500 ml group (469 cases) according to the amount of blood loss during cesarean section. The general clinical data, ultrasonic imaging data, perinatal and puerperium indicators were analyzed retrospectively. The risk factors of intraoperative blood loss ≥1 500 mL using IOCS transfusion were analyzed by logistic multivariate regression.Results:(1) A total of 848 001 ml of blood was recovered and a total of 418 649 ml of blood was transfused in 1 265 pregnant women who received IOCS transfusions, which was equivalent to 23 258 U red blood cell suspension, greatly saving medical resources. The intraoperative blood loss in <1 500 ml group and ≥1 500 ml group was 800 ml (300-1 453 ml) and 2 335 ml (1 500-20 000 ml), respectively. No amniotic fluid embolism, severe adverse reactions, shock and death occurred in the two groups. (3) Multivariate regression analysis showed that age ≥35 years ( OR=1.5, 95% CI: 1.1-1.9), prenatal hemoglobin level <110 g/L ( OR=1.7, 95% CI: 1.3-2.2), history of uterine surgery ( OR=1.8, 95% CI: 1.3-2.6), placenta previa ( OR=1.9, 95% CI: 1.1-3.1), placenta accreta ( OR=2.6, 95% CI: 1.8-3.9), blood pool in the placenta ( OR=1.6, 95% CI: 1.1-2.3), abnormal posterior placenta muscle wall ( OR=1.8, 95% CI: 1.2-2.6), placenta projecting to the anterior uterine wall ( OR=3.0, 95% CI: 1.3-7.0) were risk factors for blood loss ≥1 500 ml in obstetric transfusion using IOCS technique, with statistical significance (all P<0.05). Conclusion:IOCS is safe and effective in cesarean section, which could save the medical resources and reduces medical expenses, however, it is necessary to strictly master the application indication.