EVALUATE THE OUTCOME OF PLACENTA PREVIA PREGNANCY DR

EVALUATE THE OUTCOME OF PLACENTA PREVIA PREGNANCY DR NGUYỄN HẢI LONG PHỤ SẢN HOSPITAL

DEFINITION Ø Placenta praevia is an obstetric complication in which the placenta is inserted partially or wholly in the lower uterine segment. [1] It is a leading cause of antepartum hemorrhage (vaginal bleeding). It affects approximately 0. 4 -0. 5% of all labors

OBJECTIF: Evaluation the treatment of placenta previa pregnancies TARGETS: The women with gestational age of 28 weeks or more, in treatment and delivery at Hai Phong Obstetrics Hospital, were diagnosed after delivery, after RT operation. Medical records are full of research information.

METHOD: Restrospective 116 cases. Collect data from the medical records. Data processing and manipulation by SPSS 16. 0

VARIANTES Medical treatment The term of termination of pregnancy Cesarean section indication The method of hemostatic using in surgery The amount of blood transmitted Neonatal status: Apgar, weight.

INCIDENCE n ratio Tỷ lệ RTĐ so với tổng số đẻ Placenta previa 116 Number of birth 12 805 0, 9% Trần Ngọc Can, 1963, “RTĐ năm 1962 tại BV C”, Nội san sản phụ khoa, tỷ lệ 1, 15%. Đặng Trần Anh, “RTĐ tại BVPSHP, 2008 -2009”, 1, 47%.

METRORRAGIE 35, 3% 38, 8% 40% 35% 30% 25% 20% 15% 10% 5% 0% 12, 1% 7, 8% Không ra máu 1 đợt 2 đợt 3 đợt 6, 0% 4 đợt Ra máu tái phát: 25, 9%. Trần Băng Huyền, BVPSTW 2012: ra máu 1 đợt 41, 2%, ra máu tái phát 38, 3%.

MEDICAL TREATMENT Tocolytic Cortico therapy n % yes 41 35, 3 no 75 64, 7 yes 22 19, 0 no 94 81, 0 Đặng Trần Anh, BVPSHP 2008 -2009: 33, 5% được điều trị giảm co.

ULTRASOUND DIAGNOSTIC Low Marginal Placenta segment placenta previa minor major placenta n % n % n Correct 16 84, 2 24 85, 7 3 100 66 Not correct 3 15, 8 4 14, 3 0 0 0 Total 19 100 28 100 3 100 66 CĐ đúng RTĐ: 97, 4%, CĐ đúng thể: 93, 9%. Phù hợp NC Đặng Trần Anh. % Tổng n % 100 109 93, 9 0 7 6, 1 100 116 100

METHOD OF INTERRUPTION Term (weeks) 28 – 32 33 – 36 n % n % Vaginal birth 0 0 0 0 Cesarean 7 100 13 100 96 100 116 100 Total 7 100 13 100 96 100 116 100 methods ≥ 37 Total Tỷ lệ mổ lấy thai theo Đặng Trần Anh (BVPSHP, 2008 -2009) và Bùi Thị Hồng Giang (BVPSHN, 2003 -2004) là 100%.

INDICATION OF CESAREAN 28 – 32 33 – 36 n % n % Emergency 7 100 12 92, 3 28 29, 2 47 40, 5 Programmed 0 0 1 7, 7 68 70, 8 69 59, 5 Total 7 100 13 100 96 100 116 100 Term (week) Indication P P < 0, 05 ≥ 37 Tổng số

INDICATION OF CESAREAN N % 43 91, 6 2 4, 2 Old cesarean scar 13 18, 8 Placenta percreta 4 5, 8 Metrorragie abondante Fetal distress

HEMOSTATIC METHOD Hemostatic N % Suture location 23 74, 2 Uterine artery 1 3, 2 7 22, 6 method 31/116 trường hợp phải cầm máu, chiếm 26, 7%. ligation Hysterectomy subtotal

TRUYỀN MÁU Unit of Low segment blood transmitted Marginal placenta Placenta Tổng previa minor previa major n % n % n % 0 18 94, 7 24 85, 7 2 66, 7 44 66, 7 88 75, 9 1 1 5, 3 2 7, 1 1 33, 3 3 4, 5 6 5, 2 2 0 0 1 3, 6 0 0 11 16, 7 13 11, 2 ≥ 3 0 0 1 3, 6 0 0 8 12, 1 9 7, 7 Tổng 19 100 28 100 3 100 66 100 116 100 Maximum : 5 units Tỷ lệ phải truyền máu: 24, 1%. RTĐTT: 22/66 tương ứng với 33, 3% trường hợp phải truyền máu.

TERM OF INTERRUPTION 100% 82, 8% 80% 60% 40% 20% 6, 0% 11, 2% 0% 28 - 32 tuần 33 - 36 tuần ≥ 37 tuần Sơ sinh non tháng: 17, 2%. Theo Vương Tiến Hòa, BVPSTW 2001 -2002, tỷ lệ đẻ non là 38, 8% và Bùi Thị Hồng Giang, BVPSHN 2003 -2004 tỷ lệ này là 36, 3%.

OUTCOME OF NEONATAL Apgar score Weight n % ≥ 7 109 93, 1 < 7 7 6, 9 Mortality 0 0 < 2500 gr 29 25, 0 2500 – 3400 gr 76 65, 5 3500 – 3900 gr 11 9, 5 ≥ 4000 gr 0 0 Nguyễn Thị Phương Chi, BVPSTW 2003, tỷ lệ sơ sinh bị ngạt là 6, 1%. Vương Tiến Hòa, BVPSTW 2001 -2002, tỷ lệ sơ sinh < 2500 gr là 27, 8%.

CONCLUSION 1. Placenta previa incidence PP ratio 0, 9%. 2. Signs and symptom: Metrorrhagia : 64, 7% Diagnostic ultrasonographical : 97, 4%

CONCLUSION 3. TREATMENT AND OUTCOME Medical treatment : 34, 3% tocolytic. Surgery: 100% cesarean. programmed 59, 5%, emergency: 40, 5%. 26, 7% have hemostatic procedure: + suture hemostatic local: 74, 2%. + Uterine artery ligation: 3, 2%. + 7 cases hysterectomy (22, 6%), including 4 placenta percreta.

CONCLUSION Blood transfusion 24, 1%. Neonatal outcome: + premature: 17, 2%. + fetal distress: 6, 9%. + weight less than 2500 gr: 25%. + no mortality.

PROPOSAL Image diagnostic: abdominal ultrasound, vaginal ultrasound, trans perineal ultrasound, MRI. Tocography by monitoring, medical treatment, corticoid therapy, surveillance until 37 weeks. Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.

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