ObjectiveTo explore the related factors for the influences and outcomes of mothers and infants, and further provide a basic reference for reducing maternal and prenatal mortality caused by central placenta previa, through the analysis of its clinical characteristics. MethodsWe retrospectively analyzed the clinical data of 89 patients with central placenta previa treated from January to August 2012. ResultsThere were 89 patients with central placenta previa, and the average age of these patients was (29.6±11.4) years, and the average number of pregnancy among the patients was 3.17. Nine patients had scar uterus; 8 had pernicious placenta previa (9%); 34 had prenatal anemia symptoms; 44 had prenatal vaginal bleeding with the bleeding volume ranged from 2 to 500 mL; 40 were treated before delivery. The average gestational age was 36 weeks ±4.2 days, and 28 of them were readmitted. The intraoperative bleeding in such patients as had placenta located in the anterior wall, placenta adhesion or implantation, history of uterine cavity operation or multipara was more than other patients. The postpartum hemorrhage of patients with the gestational age of 36 weeks or more was more than that of patients with the gestational age shorter than 36 weeks. The incidence of fetal distress in patients with the gestational age of 36 weeks or more is lower and the neonatal 1-minute Apgar score was higher than that in patients with the gestational age shorter than 36 weeks (P<0.05). ConclusionThe treatment of central type of placenta previa should be more active to prolong the gestational week. Patients with placenta adhesion or implantation, caesarean, multipara and placenta in the anterior wall are susceptible to intraoperative bleeding during the termination of pregnancy. Termination of pregnancy in these patients with central placenta previa should be carried out by cesarean section when gestation is more than 36 weeks to reduce postpartum hemorrhage and complications.
ObjectiveTo systematically review the clinical efficacy and safety of postpartum hemorrhage (PPH) prophylaxis with a single dose of tranexamic acid (TXA). MethodsThe Embase, PubMed, WanFang Data, VIP, CNKI, ChiCTR and Cochrane Library were electronically retrieved to collect clinical studies related to appraising the efficacy and safety in parturients after cesarean section used TXA perioperatively from inception to September, 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using R software. A trial sequential analysis of outcomes was carried out to investigate the reliability and conclusiveness of findings. ResultsA total of 43 RCTs including 23 497 parturients that compared the prophylactic use of a single dose of TXA with placebo or no treatment in parturients undergoing cesarean delivery. The results of meta-analysis revealed that: 1) there was a significantly reduced risk of PPH (RR=0.52, 95%CI 0.40 to 0.67, P<0.01), total blood loss (SMD=−183.73mL, 95%CI −220.87 to −146.60, P<0.01), need for blood transfusion (RR=0.42, 95%CI 0.30 to 0.60, P<0.01), and use of additional uterotonics (RR=0.55, 95%CI 0.43 to 0.70, P<0.01) with TXA use; 2) there were no statistical differences in thromboembolic events between TXA and control groups (RR=1.05, 95%CI 0.54 to 2.03, P=0.11); and 3) results were consistently in favor of TXA use across subgroups, and trial sequential analyses. ConclusionTaken as a whole, existing evidence suggests that TXA can effectively reduce PPH in patients undergoing cesarean delivery. Further, prophylactic TXA administration for parturients significantly reduced blood loss and need for blood transfusion, without increasing adverse events and use of additional uterotonics, supporting its use as a safe and effective strategy for reducing PPH in this population.