Placenta previa with posterior extrauterine adhesion: clinical features and management practice
Open accessAbstract
Background: 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. Methods: 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. Results: 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). Conclusions: 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.
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Patients with DIE and placenta praevia have greater blood loss during CD than patients without DIE.
“In particular, patients with DIE and placenta praevia have been shown to have greater blood loss during CD than patients without DIE [17].”
From Women with Endometriosis—Who Is at Risk for Complications Associated with Pregnancy and Childbirth? A Retrospective Case–Control Study (2024) · cites this paper as [17]
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“Statistical consideration A quasi-experimental method was used to assess the relationship between changes in practice and the surgical outcomes, by examining the difference-in-difference before (the pre group) and after (the post group) the changes in practice were implemented [21].”
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- Authors
- Nagase, Y., Matsuzaki, S., Endo, M., Hara, T., Okada, A., Mimura, K., Hiramatsu, K., Kakigano, A., Nakatsuka, E., Miyake, T., Takiuchi, T., Ueda, Y., Tomimatsu, T., & Kimura, T.
- Affiliations
- The University of Osaka (JP)
- University of Southern California (US)
- National Cerebral and Cardiovascular Center (JP)
- Corresponding author
- Matsuzaki, Shinya
- ORCID
- Venue
- BMC Surgery
- Published
- 2021-01-06
- Volume
- 21
- Issue
- 1
- Pages
- 10-10
- ISSN
- 1471-2482 (ISSN-L)
- PMC
- PMC7789541
- OpenAlex
- W3119267863
- Cited by
- 14
- References
- 37
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 1
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Surgery (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Japan Society for the Promotion of Science (21K09447)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- placenta previa, cesarean section, intraoperative blood loss, Bakri balloon, Nelaton catheter, posterior placenta, MRI diagnosis, surgical outcomes, propensity score matching
- MeSH terms
- Adult, Cesarean Section, Female, Postpartum Hemorrhage, Humans, Infant, Newborn, Middle Aged, Placenta Previa, Pregnancy, Retrospective Studies, Blood Loss, Surgical, Premature Birth
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