Trial of Labor Compared With Elective Cesarean Delivery for Low-Lying Placenta
| Autor: | Alizée Froeliger, Hugo Madar, Pauline Jeanneteau, Vanessa Ruiz, Maela Le Lous, Franck Perrotin, Norbert Winer, Michel Dreyfus, Philippe Merviel, Aurélien Mattuizzi, Eric Jauniaux, Loïc Sentilhes |
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| Přispěvatelé: | Université de Bordeaux (UB), CHU Bordeaux [Bordeaux], Reseau de perinatalite des Pays de La Loire, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Physiopathologie des Adaptations Nutritionnelles (PhAN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Institut Fédératif de Recherche 148 Brest - Sciences et Ingénierie en Biologie Santé (IFR 148 Brest), Sciences et ingénierie en biologie santé (SCINBIOS), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Institute for Women's Health [London], University College London Hospitals (UCLH), Centre Hospitalier Universitaire de Bordeaux (CHU de Bordeaux) |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Male
Labor Obstetric Cesarean Section GYNECOLOGISTS Placenta VAGINAL DELIVERY FRENCH COLLEGE [SDV]Life Sciences [q-bio] Postpartum Hemorrhage Infant Newborn Obstetrics and Gynecology TRANEXAMIC ACID Delivery Obstetric OBSTETRICIANS Trial of Labor INTERNAL OS DISTANCE PROPENSITY SCORE BLOOD-LOSS Pregnancy CLINICAL-PRACTICE EDGE Humans Female Retrospective Studies |
| Zdroj: | Clinical and experimental obstetrics & gynecology Clinical and experimental obstetrics & gynecology, 2022, 140 (3), pp.429-438. ⟨10.1097/AOG.0000000000004890⟩ |
| ISSN: | 0390-6663 |
| Popis: | International audience; OBJECTIVE: To compare outcomes of women with low-lying placenta by planned mode of delivery and distance from the internal os distance. METHODS: Six tertiary maternity hospitals in France participated in this retrospective multicenter study of births from 2007-2012. Women with low-lying placenta, defined as an internal os distance of 20 mm or less, who gave birth after 35 weeks of gestation were included and classified in the planned trial-of-labor or elective cesarean delivery groups. The primary endpoint was severe postpartum hemorrhage (PPH) defined as blood loss exceeding 1,000 mL. Secondary outcomes were composite variables of severe maternal and neonatal morbidity. We used multivariable logistic regression and propensity scores to compare outcomes by planned mode of delivery. RESULTS: Among 128,233 births during the study period, 171 (0.13%) women had low-lying placenta: 70 (40.9%) in the trial-of-labor group and 101 (59.1%) who underwent elective cesarean delivery. The rate of severe PPH was 22.9% (16/70, 95% CI 13.7-34.4) for the trial-of-labor group and 23.0% (23/101, 95% CI 15.2-32.5) for the cesarean delivery group (P=.9); severe maternal and neonatal morbidity rates were likewise similar (2.9% vs 2.0% [P=.7] and 12.9% vs 9.9% [P=.5], respectively). Trial-of-labor was not significantly associated with a higher rate of severe PPH after multivariable logistic regression and propensity score-weighted analysis (adjusted odds ratio [aOR] 1.42, 95% CI 0.62-3.24 [P=.4]; and aOR 1.34, 95% CI 0.53-3.38 [P=.5], respectively). The vaginal delivery rate in the trial-of-labor group was 50.0% (19/38) in those with an internal os distance of 11-20 mm and 18.5% (5/27) in those with a distance of 1-10 mm. CONCLUSION: Our results support a policy of offering a trial of labor to women with low-lying placenta after 35 weeks of gestation and an internal os distance of 11-20 mm. An internal os distance of 1-10 mm reduces the likelihood of vaginal birth considerably, compared with 11-20 mm, but without increasing the incidence of severe PPH or severe maternal morbidity. |
| Databáze: | OpenAIRE |
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