Results
Our results showed that placental implantation occurred in 47.5% of
patients and the hysterectomy rate was 10.4%. The incidence of massive
bleeding and blood transfusion was 55.8% and 64%, respectively. The
women with placenta implantation predicted by both ultrasound and MRI
had higher blood loss than those diagnosed only by either one of the
examinations. Surprisingly, vascular occlusion had no effect on the
occurrence of severe hemorrhage and hysterectomy. The latter was even
higher in the vascular blocking group compared to that in the
non-blocking group (34.2% and 8.6%, respectively).
Conclusions: The pregnancies with pernicious placenta previa
and prior cesarean delivery, had a dramatically higher risk of placenta
implantation, hysterectomy and massive hemorrhage. MRI combined with
ultrasound examination presented high accuracy in predicting severe
outcomes in these patients. Vascular occlusion does not appear to be an
effective approach to prevent severe outcomes. Surgical hemostasis
should be the key goal in blocking massive bleeding, preserving the
uterus and improving the prognosis of the patients.
Funding statement: This study was supported by the Innovative
Team Program of Shaanxi Province (project N°: 2019TD-031).
Key words : cesarean section; pernicious placenta previa;
massive bleeding; placental implantation; hysterectomy, vascular
occlusion, severe outcomes