Document Detail


Second- and third-trimester therapeutic terminations of pregnancy in cases with complete placenta previa--does feticide decrease postdelivery maternal hemorrhage?
MedLine Citation:
PMID:  15539869     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To study the feasibility of second- and third-trimester termination of pregnancy (TOP) with complete placenta previa, and the impact of performing feticide before labor induction on maternal hemorrhagic morbidity. PATIENTS AND METHODS: From 1987 to 2002, the databases of two referral hospitals were reviewed. We identified 15 cases of second- or third-trimester TOP in women with complete placenta previa. Feticide was performed 2-14 days before induction in 6/15 cases. Cervical ripening was achieved in 8 cases by mifepristone alone (n = 2) or by mifepristone and dilapan (n = 6). Labor was induced by vaginal gemeprost (n = 2), intramuscular (n = 5) or intravenous (n = 4) sulprostone, vaginal misoprostol (n = 1) or a combination of misoprostol and sulprostone (n = 3). Hemorrhage was defined by the need for transfusion. The difference between the preoperative and the lowest per- or postoperative maternal hemoglobin level was also analyzed. RESULTS: Of the 9 women who underwent labor induction without previous feticide, 4 required blood transfusions, 1 of whom had a hemostat hysterectomy. The mean hemoglobin difference was 2.5 g/dl (range: 0.5-5.3). None of the 6 patients with preinduction feticide required transfusion. The hemoglobin difference was significantly smaller in this group than in terminations without previous feticide (mean: 1.0 g/dl ; range: 0.1-2.2; p = 0.03). CONCLUSION: In cases with complete placenta previa, second- or third-trimester TOP is feasible. It carries a substantial risk of hemorrhage that might be decreased by preinduction feticide.
Authors:
R Ruano; Y Dumez; D Cabrol; M Dommergues
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Fetal diagnosis and therapy     Volume:  19     ISSN:  1015-3837     ISO Abbreviation:  Fetal. Diagn. Ther.     Publication Date:    2004 Nov-Dec
Date Detail:
Created Date:  2004-11-12     Completed Date:  2005-02-10     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  9107463     Medline TA:  Fetal Diagn Ther     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  475-8     Citation Subset:  IM    
Copyright Information:
2004 S. Karger AG, Basel.
Affiliation:
Maternité, Hôpital Necker Enfants Malades, AP-HP et Université Paris V, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Abortion, Therapeutic / methods*
Blood Transfusion
Female
Hemoglobins
Humans
Labor, Obstetric
Placenta Previa / mortality,  therapy*
Postpartum Hemorrhage / mortality,  prevention & control*
Pregnancy
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Risk Factors
Chemical
Reg. No./Substance:
0/Hemoglobins

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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