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Aim: This study aimed to investigate the association between placental implantation abnormalities (PIAs) and gestational hypertension‐preeclampsia (GH‐PE) in pregnant women. Methods: Patients were recruited from 2010 to 2019 into this retrospective study at the International Peace Maternity & Child Health Hospital. PIAs were classified as follows: placenta previa (PP), low‐lying placenta (LP), placenta accreta, and placenta adherence (PA). Logistic regression models were constructed to analyze the associations between placental abnormalities and GH‐PE. Propensity score matching (PSM) was conducted to reduce confounders. The relationship between PP with placenta accreta spectrum (PAS) and GH‐PE were assessed. Results: In total, 5527 women were recruited, and 2614 women had an abnormal placenta (992 with LP; 749 with PP 839 and PA; and 34 with placenta accreta). There were 296 patients with GH‐PE in those groups. After adjustments for confounding factors, women with PP had a lower risk of PE (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.19–0.86, p = 0.025) than those in the control group. Women with PA had a higher risk of GH‐PE (OR: 1.45; 95% CI: 1.05–1.99, p = 0.022). In addition, we categorized PP into marginal, complete, and partial PP and investigated these associations. We found a lower risk of PE in complete PP (OR: 0.09, 95% CI: 0.01–0.44, p = 0.020) than in marginal or partial PP. There was no significant difference regarding GH‐PE in the PP with PAS group (OR = 0.67, 95% CI: 0.82–2.34, p = 0.525). Conclusion: PP, especially complete PP, is associated with a lower risk of PE. PA is associated with higher risks of GH‐PE. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of prophylactic uterine artery embolization (UAE) during cesarean delivery for women with placenta previa complicated by placenta accreta.Methods: A retrospective analysis of women with placenta previa admitted to The Second Affiliated Hospital of Soochow University, Suzhou, China, for elective cesarean between February 2003 and July 2016. Postpartum estimated blood loss, blood transfusion, hysterectomy, disseminated intravascular coagulation (DIC) incidence, intensive care unit (ICU) duration, and postoperative stay were compared between control women who underwent cesarean delivery only and women who underwent prophylactic intraoperative UAE during cesarean.Results: There were 28 and 26 women in the UAE and control group, respectively. There were no differences in hysterectomy incidence (P=0.291), or duration of ICU stay (P=0.085), or postoperative hospitalization (P=0.668) between the groups; however, the incidence of DIC was lower in the UAE group (P=0.035). Mean estimated blood loss (P=0.018) and blood transfusion (P=0.011) were also lower in the UAE group. No serious complications were associated with the endovascular procedures.Conclusion: Prophylactic intraoperative UAE seemed to effectively reduce blood loss, need for blood transfusion, and incidence of DIC among women with placenta previa complicated by placenta accreta. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to identify the maternal and neonatal outcomes in women with placenta increta or placenta percreta in China.Materials and Methods: We retrospectively analyzed 2219 cases from 20 tertiary care centers in China between January 2011 and December 2015. All cases were diagnosed of placenta increta or placenta percreta, based on either intraoperative findings or histopathological findings.Results: The incidence of placenta increta and placenta percreta progressively increased from 0.18% in 2011 to 0.78% in 2015. Compared with the placenta increta, placenta percreta was strongly related to serious adverse outcomes: postpartum hemorrhage (65.9% versus 38.6%, p = .003), blood transfusion (86.2% versus 46.5%, p < .001), hysterectomy (43.3% versus 11.2%, p < .001), preterm birth (65.7% versus 49.9%, p < .001), and the need for neonatal intensive care unit (NICU) admission (54.5% versus 36.7%, p < .001).Conclusion: The incidence of placenta increta and placenta percreta is likely to increase in China. The depth of placenta implantation is associated with the severity of outcomes. Placenta percreta tends to have worse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of balloon occlusion of internal iliac arteries during cesarean hysterectomy in women with placenta previa accreta.Methods: Retrospective cohort study conducted using medical records of women with placenta previa and pathologically confirmed accreta taken from a single tertiary center in Chengdu, China, between January 1, 2012 and December 31, 2017. Baseline characteristics and pregnancy outcomes were compared between women with and without balloon occlusion of internal iliac arteries during cesarean delivery. The primary outcome was a composite outcome: estimated blood loss greater than or equal to 3.0 L, massive transfusion (transfusion of 10 or more units of packed red blood cells), and maternal intensive care unit admission.Results: There were 114 patients included in the study, 83 (72.8%) in the balloon group and 31 (27.2%) in the control group. Both propensity score analysis (18 [78.3%] vs 15 [65.2%], P=0.326) and multivariate logistic analysis (adjusted odds ratio 0.54, 95% confidence interval 0.20-1.45; P=0.221) showed that intraoperative balloon occlusion of internal iliac arteries was not associated with the primary outcome.Conclusion: Balloon occlusion of internal iliac arteries during cesarean hysterectomy in women with placenta previa accreta was not associated with improved maternal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine whether surgical treatment of cesarean scar diverticulum (CSD) reduced adverse outcomes during the subsequent pregnancy.Methods: A retrospective observational study was conducted using the medical records of pregnant women with CSD who attended a single hospital in Hangzhou, China, between January 1, 2014, and December 31, 2016. Baseline characteristics and pregnancy outcomes were compared between the surgery group and the no surgery group.Results: There were 106 patients included in the study, 83 in the surgery group and 23 in the no surgery group. The CSD size was greater in all dimensions for the surgery group versus the no surgery group: length (P<0.001), width (P=0.001), and depth (P=0.030). The remaining myometrium was thinner among women in the surgery group than those in the no surgery group (P=0.011). In all, 76 (91.6%) women in the surgery group were symptomatic. The incidence of live delivery pregnancy was higher (P=0.033) and the incidence of cesarean scar pregnancy was lower (P=0.019) in the surgery group versus the no surgery group. Surgery increased the thickness of the lower uterine segment (P<0.001); however, it did not reduce the risks of placenta previa or placenta accreta (P=0.683) and uterine dehiscence or uterine rupture (P=0.458).Conclusion: Surgical intervention reduced the incidence of cesarean scar pregnancy and increased the number of live deliveries. [ABSTRACT FROM AUTHOR]

Objective: To identify both the trends in placenta accreta spectrum (PAS) disorders in the context of the universal two-child policy in China and risk factors for hysterectomy.Methods: The present retrospective analysis included confirmed PAS disorders during cesarean delivery at a tertiary hospital in Changsha, Hunan, China, from January 1, 2007, to December 31, 2016. Multivariable logistic regression was used to estimate the risk of hysterectomy.Results: During the 10-year study period, the overall incidence of cesarean delivery was 51.6% (13 530/26 214) and that of PAS disorders was 1.2% (302/26 214). The PAS rate increased from 0.1% (5/4617) in 2007-2008 to 2.1% (133/6351) in 2015-2016, alongside a rise in elective repeat cesarean delivery from 5.0% (106/2124) to 38.4% (1385/3603). Previous cesarean delivery greatly increased the likelihood of PAS disorders (odds ratio [OR] 97.4; P<0.001). Invasive depth (OR 92.0; P<0.001), inter-cesarean interval less than 36 months (OR 7.0; P=0.002), rural residence (OR 5.3; P=0.018), and advanced maternal age (OR 3.0; P=0.045) were independent risk factors for hysterectomy among women with PAS disorders.Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objective: Online-to-offline is a new model for emergent medical service with the ability to connect care providers with patients on instant basis. This study aims to evaluate maternal and neonatal outcomes in patients with placenta accreta spectrum managed by an online-to-offline care model.Methods: Starting from January 1, 2015, management of patients with placenta accreta spectrum was changed from standard care model into an online-to-offline care model through "Wechat" in Guangzhou Medical Centre for Critical Obstetrical Care. This study compared maternal and neonatal outcomes in patients affected by placenta accreta spectrum between 2015 (online-to-offline model) and 2014 (standard care model).Results: A total of 209 cases of placenta accrete spectrum were treated in our center in 2015 and 218 such cases were treated in 2014. Patients treated in 2015 had lower rate of hysterectomy (14.83% versus 20.64%) and shorter hospital stay (7 days versus 8 days). The average interval from admission to emergency cesarean section for critically ill patients was 38.5 min in 2015 versus 50.7 min in 2014.Conclusion: Patients affected by placenta accreta spectrum managed by online-to-offline care model have reduced risk of hysterectomy, shorter hospital stay, and shorter response time from admission to emergency cesarean section. [ABSTRACT FROM AUTHOR]

Objective. This paper is aimed at investigating the role and value of the timing of balloon occlusion of the abdominal aorta during caesarean section in patients with pernicious placenta previa complicated with placenta accreta. Methods. 79 cases admitted to the Second Affiliated Hospital of Zhengzhou University from September 2015 to December 2016 were treated with ultrasound mediated abdominal aortic balloon occlusion. Among them, 42 cases, whose balloon occlusion time was selected before the delivery and transverse incision was taken, were group A. The other 37 cases were group B, whose timing of balloon occlusion was selected after the delivery and the uterine incision made trying to avoid the placenta or double incisions. The intraoperative blood loss, utilization of blood, and other indicators were compared between the two groups. Results. The intraoperative blood loss in groups A and B was 413.8 ± 105.9 ml and 810.3 ± 180.3 ml, and the utilization of blood products in groups A and B was 30.23% and 89.2%. The total hysterectomy rate was 2.53% (2/79), with no hysterectomies in groups A and 2 cases in group B. Conclusion. The balloon occlusion of the abdominal aorta before the delivery combined with a transverse incision is more effective. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta (PA), a severe complication during delivery, is closely linked with massive hemorrhage which could endanger the lives of both mother and baby. Moreover, the incidence of PA has increased dramatically with the increasing rate of cesarean deliveries in the past few decades. Therefore, studies evaluating the effects of different perioperative managements based on different modalities in the treatment of PA are necessary. Among the numerous treatment measures, prophylactic abdominal aortic balloon occlusion (AABO) in combination with cesarean section for PA seems to be more advantageous than others. However, up to now, all studies on AABO were almost retrospective. Current evidence is insufficient to recommend for or against routinely using the AABO technology for control intraoperative hemorrhage in patients with PA. Thus, we hope to carry out a prospective, randomized controlled trial (RCT) study to confirm the effectiveness of the AABO technology in patients with PA.Methods/design: This trial is an investigator-initiated, prospective RCT that will test the superiority of AABO in combination with cesarean section compared to the traditional hysterectomy following cesarean section for parturients with PA. A total of 170 parturients with PA undergoing cesarean section will be randomized to receive either AABO in combination with cesarean section or the traditional hysterectomy following cesarean section. The primary outcome is estimated blood loss. The most important secondary outcome is the occurrence of cesarean hysterectomy during delivery; others include blood transfusion volume, operating time, neonate's Apgar scores (collected at 1, 5 and 10 min), length of stay in intensive care unit, total hospital stay, and balloon occlusion-relative data.Discussion: This prospective trial will test the superiority of AABO in combination with cesarean section compared to the traditional hysterectomy following cesarean section for parturients with PA. It may provide strong evidence about the benefits and risks of AABO in combination with cesarean section for parturients with PA.Trial Registration: Chinese Clinical Trial Registry, ChiCTR-INR-16008842 . Registered on 14 July 2016. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical characteristics of mirror syndrome. Methods: Retrospective analysis of cases with mirror syndrome. Data of clinical manifestations, laboratory examinations, placental morphology, treatment and prognosis of these patients were obtained and studied. Results: Five cases satisfying the inclusion criteria for mirror syndrome were identified from our hospital database. The incidence of the condition was 0.0154% in China. Mirror syndrome was associated with Rhesus isoimmunization, intrauterine parvovirus B19 infection, fetal neuroblastoma, fetal heart malformation and unknown cause respectively. Fetal symptoms were multi-hydrocele and fetal heart failure complicating fetal hydrops. All of the cases manifested maternal hydrops and hemodilution, the other most common symptoms included hypertension, proteinuria, hypoalbuminemia, anemia, thrombocytopenia and elevated uric acid levels. Fetal outcomes in this study were poor with a perinatal mortality rate of 100%. Placentomegaly was observed in most cases and placental morphology showed villous edema, increased intervillous fibrin deposition and one rare case of fetal adrenal neuroblastoma. Resolution of maternal symptoms was noted within 3-30 days after delivery. Conclusion: Mirror syndrome is associated with a substantially increased risk of fetal death and severe maternal complications. Early diagnosis of this condition during pregnancy is crucial for providing proper treatments and achieving better clinical outcomes. [ABSTRACT FROM AUTHOR]

The investigation at 19 hospitals in 18 cities showed that the incidence of premature and low-birth-weight (LBW) infant in live births was 4.9% and 5.1% respectively. The mortality rate was as high as 85.5/1000 and 97.7/1000 and the deaths accounted for 45.9% and 54.5% of total neonatal deaths respectively. The male infant's mortality rate was higher than the female; the twins' and triplets' was higher than the single births'. The mortality was mainly attributed to the preterm, LBW and related diseases. The first six causes of deaths were respiratory diseases, prenatal asphyxia, infection, scleredema congenital malformation and intracranial hemorrhage. The approaches for reducing the mortality rate of premature and LBW infants were discussed.

The risk factors of low birth weight infant (LBW) were prospectively studied in 26,941 pregnant women. Investigations included sociodemographic risks, environmental behavioural conditions, medical diseases before pregnancy and current pregnancy complications. The adjusted odds ratios for various risk factors were calculated from multiple logistic regression model. In this analysis, placenta abnormalities uterine malformations and pregnancy-induced hypertension were shown to be the main risk factors. Preterm delivery occurred more frequently in women with diabetes and injuries in the third trimester. Term SGA babies were usually seen in women who had inadequate diet during pregnancy or in women with maternal heart disease. The risk factors of maternal age, educational background, parental smoking etc were less important than maternal diseases or pregnancy complications. The present study indicated prenatal care, started early with regular check-ups was mast important in preventing prematurity and LBW infant in China.