The increasing incidence of elective repeat cesarean delivery combined with a high overall rate of cesarean delivery implies a high prevalence of PAS disorders within the context of the universal two-child policy in China. The main predictor of hysterectomy was invasive depth.

Background:Placenta increta/percreta is an increasingly common and life-threatening obstetric complication. It poses a management challenge to clinicians. The present study aimed to evaluate efficacy and safety of preoperative placement of infrarenal abdominal aorta balloon catheter (IAABC) alone or combined with Bakri tamponade for the management of cases with placenta increta/percreta.Methods:We retrospectively analyzed all cases with placenta increta/percreta at a tertiary referral teaching hospital in China between the year 2014 and 2017. Statistical analysis considered the individual subgroups: IAABC placed group and control group (without IAABC), and compared their maternal–fetal outcomes.Results:The study covered 86 cases with placenta increta. For cases in the IAABC placed group (n = 48), significant reductions were noted in maternal morbidity including estimated blood loss (EBL), EBL ≥ 2000 mL, blood products transfusions, postpartum hemorrhage, operative time, intensive care unit admission, and postoperative days (P < .05 for all). The overall rate of hysterectomy was much lower (4.2%vs 23.7%, P = .018), compared with those in the control group (n = 38). Furthermore, in the IAABC placed group, hysterectomy was avoided in a further 17 cases combined with Bakri tamponade. In the control group, 10 cases were successful in preserving uterus by Bakri tamponade. Four cases failed and needed reoperation (3 uterine arterial embolism, 1 hysterectomy). There were no differences in fetal outcomes between the 2 groups. Eighteen cases were diagnosed with placenta percreta. Almost all the cases (17/18) inevitably underwent caesarean hysterectomy. Only 1 case was treated with a combination of IAABC and Bakri tamponade, and successfully reserved uterus. No differences were observed in any other outcomes, except for a significant less mean operative time (P = .017) in cases with IAABC placed (n = 10), compared with those without IAABC (n = 8). Only 1 case had a femoral artery thrombosis directly related to IAABC placement and recovered after conservative treatment. There was no maternal or neonatal death in this study.Conclusion:Prophylactic insertion of IAABC alone or combined with Bakri tamponade should be safe and effective in controlling intraoperative bleeding due to placenta increta, thus hysterectomy could be avoided. It seems to be less beneficial to women with placenta percreta. Bakri tamponade can be a good choice in the management of placenta increta/percreta before more aggressive surgeries.

Objective To determine the effect of mid‐trimester emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes, and to identify risk factors predicting spontaneous preterm birth (sPTB) before 28 weeks, after cerclage. Methods Retrospective analysis of twin gestations with cervical dilation and prolapsed membranes treated with emergency cerclage or expectant management (2015–2020). The primary outcomes were the rate of sPTB before 28 weeks and the gestational latency. Multiple logistic regression analysis was used to determine the factors associated with sPTB before 28 weeks, after cerclage. Results Ninety‐seven women were included, cerclage (n = 58) or no cerclage (n = 39). Cerclage placement was associated with significantly lower incidence of sPTB before 28 weeks of pregnancy (34.5% vs 82.1%) and prolongation of the gestational latency (46.71 ± 27.52 vs 10.95 ± 11.71 days). Positive cervical culture (odds ratio [OR] 10.69, 95% confidence interval [CI] 1.82–62.95), pregnancy duration at diagnosis less than 22 weeks (OR 9.42; 95% CI 1.69–52.69) and cervical dilation at least 4 cm (OR 7.92; 95% CI 1.40–44.71) were found to be independent risk factors for sPTB before 28 weeks, after cerclage. Conclusion Emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes was associated with an overall 40% decrease in sPTB before 28 weeks and a prolongation of latency by 5 weeks. The strongest predictor of sPTB before 28 weeks after cerclage was a positive cervical culture.