Placenta previa with posterior extrauterine adhesion: clinical features and management practice

• Published in: BMC surgery Vol. 21; no. 1; p. 10
• Main Authors: Nagase, Yoshikazu, Matsuzaki, Shinya, Endo, Masayuki, Hara, Takeya, Okada, Aiko, Mimura, Kazuya, Hiramatsu, Kosuke, Kakigano, Aiko, Nakatsuka, Erika, Miyake, Tatsuya, Takiuchi, Tsuyoshi, Ueda, Yutaka, Tomimatsu, Takuji, Kimura, Tadashi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.01.2021; BioMed Central; BMC
• Subjects: Adhesion; Adult; Age; Bakri balloon; Balloon treatment; Bleeding; Blood; Blood Loss, Surgical; Body mass index; Catheters; Cervix; Cesarean Section; Diagnostic systems; Disease management; Endometriosis; Experimental methods; Female; Hemorrhage; Humans; Hysterectomy; In vitro fertilization; Infant, Newborn; Magnetic resonance imaging; Matching; Medical research; Medicine, Experimental; Middle Aged; Multivariate analysis; Patients; Placenta; Placenta previa; Placenta Previa - diagnostic imaging; Placenta Previa - surgery; Postpartum Hemorrhage; Pregnancy; Pregnancy complications; Premature Birth; Regression analysis; Retrospective Studies; Risk analysis; Risk factors; Strategic planning (Business); Surgical outcomes; Sutures; Ultrasonic imaging; Uterus; United States > US; Endometriosis; Placenta previa; Magnetic resonance imaging; Bakri balloon; Adhesion
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-020-01027-9

A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.