Clinical and Paraclinical Characteristics of Pregnant Women with Placenta Previa at Hanoi Obstetrics and Gynecology Hospital

X-shaped suture at the placenta. 24% of patients had intraoperative and postoperative complications including bladder injury (17%), infection (1%), bowel and excision hematoma (7%). 67% of patients required blood transfusion, with an average of 3.3 units of packed red blood cells [3].

Another study by author Le Hoai Chuong also at the Central Hospital for Tropical Diseases in 2010 - 2011 retrospectively on 39 RCRL patients showed that the age ≥ 35 was 56.4%, 69.2% of patients had MLT scars, 56% of patients had a history of abortion. Regarding treatment attitude, 59% of RCRL patients were operated on proactively. The rate of hysterectomy was 82.1% and conservation was 17.9% [50].

MLT in RCRL is a very difficult surgery due to the risk of severe bleeding in 2 stages: when cutting the uterine muscle to remove the fetus - especially when using the classic transverse incision of the lower uterine segment, and peeling the RCRL. To reduce the amount of blood loss during RCRL surgery, in 2012, author Vu Ba Quyet applied a longitudinal incision of the uterine body away from the upper edge of the placenta to remove the fetus for 18 RCRL patients with RTĐ and MLT scars, then immediately removed the uterus without peeling the placenta. The results showed that the amount of blood loss was reduced, with an average of only 3.9 units per patient, and bladder injury was also less common with a rate of 1/18 = 5.6% [34].

In a study at Hanoi Obstetrics and Gynecology Hospital in 2015 [9], placenta previa increased the risk of RCRL by 24.71 times, a history of 1 cesarean section increased the risk of RCRL by 9.58 times, a history of ≥ 2 cesarean sections increased the risk of RCRL by 19.44 times, abortion by ≥ 4 times increased the risk of RCRL by 18.5 times, and pregnant women ≥ 35 years old had a 4.59 times higher risk of RCRL than pregnant women under 35 years old. The rate of emergency surgery was 49%, and that of elective surgery was 51%. The rate of patients with RCRL detected before surgery was 68.6% and 65.7% of these patients had elective surgery. The rate of patients requiring blood transfusion was 91.2%, the average amount of blood transfused was 4.49 ± 2.9 units of red blood cells. Patients who were not previously diagnosed with RCRL, had a history of cesarean section, emergency cesarean section, placental abruption, or total hysterectomy required more blood transfusion. The rate of successful uterine preservation was 10.78%, total hysterectomy was 20.6%, and partial hysterectomy was 68.62%. The rate of longitudinal uterine incision was 48%, mainly applied to penetrating RCRL, anterior placenta, and patients with active hysterectomy. During RCRL surgery, bladder rupture was 20.6%, and ureteral injury was 2.9%. Penetrating RCRL is a factor that increases the risk of bladder rupture during surgery.

According to the study of Nguyen Lien Phuong, Tran Danh Cuong, Vu Ba Quyet in 2017 conducted at the Central Hospital for Pediatrics [5], some results were obtained: the rate of RCRL was 0.39% compared to the total number of births in 2017, RCRL occurred in 91.7% of pregnant women with old cesarean section scars. The number of pregnant women diagnosed prenatally by ultrasound was 64.3%. Treatment of RCRL is cesarean section.

The next pregnancy with active hysterectomy to stop bleeding was 100%. The main complication of surgery was damage to the urinary system 6%.

Tran Khanh Hoa's study conducted in 2020 at Hanoi Hospital for Pediatrics [7] gave some results: the average age of the pregnant women was 33.29 ± 4.66 years old, 63.46% of the pregnant women had no clinical symptoms, the remaining 34.62% had symptoms of vaginal bleeding. Indications for active MLT accounted for 75%, the main anesthesia method was endotracheal anesthesia accounting for 92.31%. The skin incision along the white line between the navel was dominant with 76.92%, the uterine incision was mainly longitudinal incision of the uterine body with 86.54%. The hemostasis method with low partial hysterectomy accounted for 86.54%. The complication rate was 7.69%, including bladder rupture (3.85%); bilateral ureteral injury (1.92%) and bladder rupture - T ureteral rupture - P ureteral contusion (1.92%). Birth weight was 2686.54 ± 579.05 grams.

Chapter 2

RESEARCH OBJECTS AND METHODS

2.1. Research subjects

2.1.1. Research subjects

All cases diagnosed and treated for RCRL at BVPSHN have their medical records stored in the hospital's General Planning Department from January 1, 2020 to April 30, 2022.

* Selection criteria:

- Pregnant women diagnosed clinically and pathologically as having RCRL had surgery at the Hanoi Hospital for Tropical Diseases.

- Gestational age from 28 - 42 weeks.

- Has complete patient information including: obstetric and gynecological history, clinical and paraclinical characteristics, ultrasound, pathology, surgical information, and evaluation of treatment results.

* Exclusion criteria

- Medical records do not contain all the information needed for research.

- Pregnant women diagnosed with RCRL before surgery but not RCRL after surgery such as: RTD, premature placental abruption...

- Pregnancy under 28 weeks.

2.1.2. Research location

Research conducted at BVPSHN

2.1.3. Research time

- Research period: from November 2022 - June 2022.

- Data collection period: from March 2022 - April 2022.

- Time of medical records review: From January 1, 2020 – April 30, 2022.

2.2. Research method

2.2.1. Research design

Cross-sectional description.

2.2.2. Sample size and sample selection

- Sampling method: total sampling, taking all medical records that meet the selection criteria for the study.

- In fact, we collected information from 93 medical records in 2 years (from January 1, 2020 to April 30, 2022) that met the selection criteria for the study.

2.2.3. Research variables

Table 2.1: Research variables/indicators

STT

Research variables/indicators	Variable classification	How to collect
Objective 1: Describe the clinical and paraclinical characteristics of patients with placenta accreta who underwent surgery at Hanoi Obstetrics and Gynecology Hospital.
Characteristics of the research subjects
1	Age (in Gregorian calendar years)	Quantitative	Medical record
2	Occupation: farmer, worker, office worker, freelancer, housewife, teacher, businessman.	Qualitative	Medical record
3	Location: Hanoi, outside Hanoi	Qualitative	Medical record
4	Obstetric history: number of curettages, number of cesarean sections	Quantitative	Medical record
5	RCRL rate / total number of births. Ratio of RCRL / total number of cesarean sections.	Quantitative	Analysis
Clinical features
6	Stomach-ache	Qualitative	Medical record
7	Bleeding	Qualitative	Medical record

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Asymptomatic	Quantitative	Medical record
Paraclinical characteristics
9	RCRL diagnosed on ultrasound	Qualitative	Medical record
10	Placental location by ultrasound: placenta attached to the front of the uterus, placenta attached to the back of the uterus.	Qualitative	Medical record
11	RCRL grading on pathological anatomy	Qualitative	Medical record
12	Hemoglobin (g/L): preoperative, postoperative	Qualitative	Medical record
Objective 2: Evaluate the results of uterine -preserving cesarean section in the above patients.
For mom
13	Timing of cesarean section: proactive, emergency	Qualitative	Medical record
14	Anesthesia method	Qualitative	Medical record
15	Skin incision method	Qualitative	Medical record
16	Hysterectomy	Qualitative	Medical record
17	Amount of blood transfused	Quantitative	Medical record
18	Surgery time	Quantitative	Medical record
19	Maternal complications: organ damage, reoperation, postoperative infection, death.	Qualitative	Medical record
For children
20	Gestational age at birth	Qualitative	Medical record
21	Baby's weight immediately after birth	Qualitative	Medical record
22	Apgar score (1 minute, after 5 minutes)	Qualitative	Medical record
23	Neonatal mortality	Qualitative	Medical record

2.2.4. Data collection and processing methods

- Use data collection forms to collect information from medical records according to study variables and indicators.

- Data is entered, managed and analyzed on SPSS 20.0 software with the following algorithms:

+ Descriptive statistics of quantitative variables include mean, standard deviation, maximum value, minimum value.

+ Descriptive statistics of qualitative variables include percentages.

+ Inferential statistics for quantitative variables are used to compare differences between groups. The statistical significance level p < 0.05 is used in inferential statistics.

2.2.5. Ethical aspects of the topic

- Our study is a retrospective study so it does not affect the health of patients.

- Information about the patient's medical history and personal characteristics is kept confidential and used for research purposes only.

- The thesis outline was approved by the thesis defense council of the Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Vietnam National University, Hanoi and with the permission of the Board of Directors - Hanoi Obstetrics and Gynecology Hospital.

RESEARCH OUTLINE

Include in research

Collect medical records

Check GPB results

Figure 2.1: Research diagram

All medical records diagnosed with RCRL and operated on at Hanoi PSHN Hospital from 1/2020 - 4/2022

There is uterine muscle in the placenta.

No myometrium in the placenta

Excluded from study

Complete medical records for research. Enter and collect data. Write and complete thesis.

Chapter 3

RESEARCH RESULTS