Effect of an emergency/planned cesarean section on the perinatal outcomes of pregnant women with placenta accreta spectrum and their neonates: a retrospective study cohort.

IF 1.6 4区 医学 Q2 SURGERY
Frontiers in Surgery Pub Date : 2025-08-20 eCollection Date: 2025-01-01 DOI:10.3389/fsurg.2025.1603425
Duan Duan, Sumei Wei, Dongmei Tang, Shimao Zhang, Jinzhu Fu, Linbo Cheng, Mi Su, Wenyi Lin, Wen Xiong
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引用次数: 0

Abstract

Background: Placenta accreta spectrum (PAS) is an obstetric condition. This study analyzes the outcomes of PAS parturients and their newborns undergoing emergency cesarean sections as opposed to planned cesarean sections.

Methods: In this research, we conduct a thorough retrospective analysis of 345 patients with placenta accreta at a single medical center. The patients were systematically categorized into two groups based on the type of surgical procedure: emergency cesarean sections and planned cesarean sections. A univariate analysis was performed to compare the outcomes associated with each approach. Furthermore, a logistic regression analysis was used to identify independent risk factors related to emergency surgeries. To further enhance our understanding, a multiple linear regression analysis was employed to determine the key factors influencing intraoperative bleeding. The selection of covariates for the regression analyses was carefully guided by previously reported influencing factors, as well as the significant differences highlighted in the univariate analysis. Missing data were addressed using multiple imputation based on chained equations to reduce potential bias and preserve analytical integrity. The study enrolled all women with PAS between August 2019 and February 2022. Ethical approval for this study was obtained from the Ethics Committee of Chengdu Women's and Children's Center Hospital (Ethics DOI: 201830). All participants provided written informed consent.

Results: The amount of bleeding and allogeneic blood transfusion in mothers in the emergency group was higher than that in the planned group. In the newborns in the emergency group, birth weight, length, and gestational age were lower than those in the planned group. The analysis found that the operation mode (B = 158.174, P = 0.043, 95% CI: 4.99-311.358) and the duration of operation (min) (B = 13.348, P < 0.001, 95% CI: 11.878-14.817) significantly affected the amount of intraoperative bleeding.

Conclusions: The perinatal outcomes and perinatal infant outcomes in the emergency group were worse than those in the planned group, as exemplified by a lower neonatal birth weight, shorter body length, smaller gestational age at birth, and higher incidence of severe neonatal asphyxia. An emergency cesarean section may increase the amount of bleeding during a cesarean section in patients with PAS. A multidisciplinary team managing such patients can achieve favorable outcomes.

Clinical trial registration: identifier (ChiCTR2100054068).

Abstract Image

急诊/计划剖宫产对伴有胎盘增生的孕妇及其新生儿围产儿结局的影响:一项回顾性队列研究
背景:胎盘增生谱(PAS)是一种产科疾病。本研究分析PAS产妇及其新生儿接受紧急剖宫产与计划剖宫产的结果。方法:在本研究中,我们对同一医疗中心的345例胎盘增生患者进行了全面的回顾性分析。根据手术类型将患者系统地分为两组:紧急剖宫产和计划剖宫产。进行单变量分析,比较与每种方法相关的结果。此外,采用logistic回归分析确定与急诊手术相关的独立危险因素。为了进一步加深我们的认识,我们采用多元线性回归分析来确定影响术中出血的关键因素。回归分析协变量的选择受到先前报道的影响因素以及单变量分析中突出的显著差异的仔细指导。使用基于链式方程的多重输入来解决缺失数据,以减少潜在的偏差并保持分析的完整性。该研究招募了2019年8月至2022年2月期间患有PAS的所有女性。本研究已获得成都市妇女儿童中心医院伦理委员会的伦理批准(伦理DOI: 201830)。所有参与者均提供书面知情同意书。结果:急诊组母亲的出血量和输血量均高于计划组。急诊组新生儿出生体重、体长、胎龄均低于计划生育组。分析发现,手术方式(B = 158.174, P = 0.043, 95% CI: 4.99 ~ 311.358)和手术时间(B = 13.348, P)的差异有统计学意义。结论:急诊组围产儿结局及围产儿结局均较计划分娩组差,新生儿体重较低,体长较短,出生时胎龄较小,新生儿重度窒息发生率较高。紧急剖宫产可能会增加PAS患者剖宫产时的出血量。一个多学科的团队管理这样的病人可以取得良好的结果。临床试验注册:标识符(ChiCTR2100054068)。
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来源期刊
Frontiers in Surgery
Frontiers in Surgery Medicine-Surgery
CiteScore
1.90
自引率
11.10%
发文量
1872
审稿时长
12 weeks
期刊介绍: Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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