Background: We aimed to compare the hemostatic effect and perioperative outcomes between internal iliac artery (IIA) and abdominal aorta (AA) balloon occlusions in pernicious placenta previa patients complicated with placenta accrete and underwent cesarean delivery. Methods: One hundred and twenty-three pernicious placenta previa patients complicated with placenta accrete were retrospectively reviewed. Patients who received IIA or AA occlusions were subsequently divided into the IIA group (n = 71) and AA group (n = 52). Estimated blood loss (EBL) and blood transferring volume were evaluated. Results: No difference was observed in EBL during cesarean delivery, EBL within 24 h or blood transferring volume between IIA and AA groups. Subgroup analysis disclosed that AA occlusion presented lower EBL during cesarean delivery and EBL within 24 h compared to IIA occlusion in placenta percreta subgroup. For secondary outcomes, IIA occlusion caused better Apgar score at 1 min but higher rates of IIA ligation and iodoform gauze packing of the uterine cavity compared to AA occlusion. Multivariate linear analysis revealed that invasion depth independently predicted worse EBL. Conclusion: IIA and AA occlusions have similar hemostatic effects in pernicious placenta previa patients with placenta accrete underwent cesarean delivery, while AA occlusion is more effective in reducing EBL in placenta percreta subgroup.
Objective
To explore the risk factors including the difference between mean gestational sac diameter and crown-rump length for missed abortion.
Methods
Hospitalized patients with missed abortion and patients with continuing pregnancy to the second trimester from Chengdu Women's and Children's Central Hospital from June 2018 to June 2021 were retrospectively analyzed. The best cut-off value for age and difference between mean gestational sac diameter and crown-rump length (mGSD-CRL) were obtained by x-tile software. Univariate and multivariate logistic regression analysis were adopted to identify the possible risk factors for missed abortion.
Results
Age, gravidity, parity, history of cesarean section, history of recurrent abortion (≥ 3 spontaneous abortions), history of ectopic pregnancy and overweight or obesity (BMI > 24 kg/m2) were related to missed abortion in univariate analysis. However, only age (≥ 30 vs < 30 years: OR = 1.683, 95%CI = 1.017–2.785, P = 0.043, power = 54.4%), BMI (> 24 vs ≤ 24 kg/m2: OR = 2.073, 95%CI = 1.056–4.068, P = 0.034, power = 81.3%) and mGSD-CRL (> 20.0vs ≤ 11.7 mm: OR = 2.960, 95% CI = 1.397–6.273, P = 0.005, power = 98.9%; 11.7 < mGSD-CRL ≤ 20.0vs > 20.0 mm: OR = 0.341, 95%CI = 0.172–0.676, P = 0.002, power = 84.8%) were identified as independent risk factors for missed abortion in multivariate analysis.
Conclusion
Patients with age ≥ 30 years, BMI > 24 kg/m2 or mGSD-CRL > 20 mm had increasing risk for missed abortion, who should be more closely monitored and facilitated with necessary interventions at first trimester or even before conception to reduce the occurrence of missed abortion to have better clinical outcomes.
LNG-IUS post-abortion shows better bleeding patterns, and reduced dysmenorrhea and bleeding amount, but with a similar safety profile compared with Cu-IUD. ClinicalTrials.gov identifier: NCT01958684.
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