Obstetrics & Gynecology: Placenta Praevia Research Paper

Introduction

            Placenta praevia is a serious problem that some women face in the course of pregnancy and delivery of children. The condition requires the particular attention from the part of health care professionals and involves complex measures that have to be undertaken before surgery, during surgery and after surgery. Women with placenta praevia have to be under the supervision of health care professionals all the time. The observation of patients with placenta praevia during pregnancy is also very important to prevent complications and failure of pregnancy. At the same time, anaesthesiology plays an important part in the course of surgery of patients with placenta praevia because anesthesiology defines, to a significant extent, the safety of the patient and the baby. In such a situation, both health care professionals and patients should come prepared to surgery and be ready to observe patients during pregnancy, if patients have placenta praevia because such measures are essential for the successful completion of pregnancy and the birth of the healthy child along with the full protection of mother’s health.

Surgery article

The purpose of the study

            The study conducted by A. Nankali and colleagues (2014) Frequency of Placenta Previa and Maternal Morbidity Associated with Previous Cesarean Delivery focuses on the study of the risk of the emergence of placenta previa triggered by previous caesarean sections. Placenta previa (P.P) is a rare pregnancy complication where a placenta particularly or completely covers the internal cervical os thereby preventing normal vaginal delivery. This study was conducted to evaluate the relationship between repeated cesarean deliveries and subsequent development of placenta previa (Nankali, 2014). Therefore, the primary purpose of the study conducted by A. Nankali and colleagues (2014) was to reveal the impact of surgeries, namely caesarean section on the risk of the development of placenta previa.

Research problem and research questions

            The research problem studied by Nankalli and colleagues (2014) related to the possible dependence between surgery, namely caesarean section, and the risk of the development of placenta previa. Hence, the main research question was whether caesarean sections could trigger the development of placenta previa in patients during their follow-up pregnancies.

Literature search and review

            Researchers conducted the literature review before they conducted their own research in the field of surgery of patients with placenta praevia. They focused on studies related to the problem of placenta praevia and surgery of patients, who have this condition. Placenta praevia exists when the placenta is inserted wholly or in part into the lower segment of the uterus (Oyelese & Smulian, 2006). It is classified by ultrasound imaging according to what is relevant clinically: if the placenta lies over the internal cervical os, it is considered a major praevia; if the leading edge of the placenta is in the lower uterine segment but not covering the cervical os, minor or partial praevia exists (Cromblehoholme, 2006). However, both conditions are dangerous for the health of both mother and fetus. Researchers argue that the distinction between placenta previa as major or minor/partial praevia is important for the preparation of patients with placenta previa. The treatment of the health problem requires the understanding of its nature and the specific type of placenta previa that the patient suffers from. In such a way, health care professionals can undertake adequate and effective steps that lead to the safe pregnancy and the successful delivery of the baby and recovery of the mother.

            Surgery of patients with placenta praevia involves complex preparations that should be made before surgery to conduct it successfully and safely for the patient. Placenta praevia without previous caesarean section carries a risk of massive obstetric haemorrhage and hysterectomy and should be carried out in a unit with a blood bank and facilities for high dependency care (Wittkope, 2002). The care bundle for suspected placenta accreta should be applied in all cases where there is a placenta praevia and a previous caesarean section or an anterior placenta underlying the old caesarean scar (Fisk, et al., 2001). The assessment of the condition of the patient before surgery is very important to find out all risk factors and possible complications to come prepared to address them fast and effectively, if they occur.

Ethical issues

            The study conducted by Nankali and colleagues (2014) raised several ethical issues among which the privacy and anonymity of participants of the study was the major ethical concern. The authors provided the confidentiality and prevented the risk of the revelation of the private information of participants of the study.

Sample selection

            The study conducted by Nankali and colleagues (2014) included all pregnant women with repeated cesarean sections while nullipara and patients with placenta previa without previous surgery were excluded. Diagnosis was made on ultrasound and at surgery. Hence, the researchers focused on the specific population: women, who had caesarean section and who were diagnosed with placenta previa after their surgery and in case of their new pregnancy.

Research design and data collection

            This cross-sectional study was held in Imam Reza Hospital Kermanshah-Iran during 2008-2011.

Results and analysis of findings

            The researchers (Nankali, et al., 2014) revealed the fact that among 2696 Women, 98 cases had P.P (3.63%). The mean age was 30 years, 76.5% (75 cases) had gravidity 2 and 3 and 87.8% (86 cases) had parity 1 – 3. Anterior location of placenta was 44.9% while posterior was 55.1%. 48% were complete P.P, 32.7% low lying P.P, 13.3% marginal P.P, and 6% Partial P.P. 26.5% of patients had history of abortion. 55.1% of patients had male fetus. There was an increase in frequency of placenta previa with just one previous C-section (74.5%). Frequency of accreta P.P 32% (n = 7), increta (14.3%, n = 3) and percreta 28% (n = 6). Among those who underwent emergency hysterectomy (21 cases) 23.8% cases had no abnormal placentation. 30.6% of newborns had birth weight < 2500 g. Such results and findings made by the researchers show that caesarean sections increase the risk of the development of plancta previa in women, in case of their new pregnancies. The risk increases, if women had their first caesarean section rather than several caesarean sections.

Conclusions, recommendations and limitations

            The authors (Nankali, et al., 2014) concluded that patients with history of one pervious cesarean delivery had more Placenta previa and need to hysterectomy were more than those with history of 2 and 3 previous cesarean delivery. The most common type of abnormal placentation was accreta, percreta and increta respectively. Therefore, they proved that the risk of placenta previa increases in the result of caesarean section but the risk is particularly high if the patient has had one surgery only, whereas the risk of the development of placenta previa is lower in patients who had two or more caesarean sections. Hence, they recommend conducting hysterectomy for patients after caesarean section to diagnose placenta previa at the early stage of its development.

Anaesthetic article

The purpose of study

            The article Management of anaesthesia for caesarean section in parturients with placenta previa with/without placenta accreta: a retrospective study by N. Kocaoglu and colleagues (2012) focuses on the problem of anaesthesia management in patients, who undergo caesarean section and have placenta previa. The authors explore the problem and develop the detailed analysis of management of anaesthesia. The main goal of the researchers is to reveal the procedure how the process of management of anaesthesia takes place. The authors point out that anaesthesia is a very individual issue that means that every patient has his or her specificities that make it necessary to apply the personalized approach to manage anaesthesia effectively. The aim of the retrospective study conducted by N. Kocaoglu and colleagues (2012) was to review placenta previa cases and determine the prognostic factors effective on morbidity and mortality and to evaluate the strategy of anaesthetic management.

The research problem and research questions

            The development of the effective strategy of anaesthetic management is essential for effective and successful surgery of patients with placenta previa. Therefore, the main research question the researchers (Kocaoglu, et al. 2012) attempt to answer in their study is how to manage anaesthesia in patients with placenta previa effectively.

The literature search and review

            The literature review performed by Kocaoglu and colleagues (2012) reveals the existence of the problem of the development of effective approaches to management of anaesthesia in patients with placenta previa. As the researchers conducted the literature review, they identified two main approaches to management of anaesthesia for patients, who undergo caesarean section and have placenta previa. On the one hand, there is the option of the local anaesthesia which has a milder impact on the overall condition of the patient. On the other hand, there is the general anaesthesia. The researchers conduct the further study of management of anaesthesia to find out which approach is more effective.

Ethical issues

            There are several ethical issues that emerge in the course of the study that the researchers have to take into consideration. First, there is the issue of anonymity and confidentiality of patients involved in the study since the researchers should provide the full protection of their privacy and prevent any case of the violation of their privacy right and the revelation of their personal information to the third parties. Also, the researchers should determine the wellbeing of patients and the priority of the comfortable surgery and recovery or the safety of the patient. For example, the general anaesthesia is safer compared to the local anaesthesia because of the lower risk of bleeding. However, the local anaesthesia is milder and easier to cope with for patients since they can recover faster and effectively compared to the recovery after the surgery and anaesthesia.

Sample selection

            Kocaoglu and colleagues (2012) selected the sample population randomly and studied the effect of local and general anaesthesia and attempted to determine the most effective management of anaesthesia for patients with placenta previa. They selected women, who delivered babies and underwent caesarean section with placenta previa. This was the main criterion for the selection of the sample population. At the same time, the researchers defined two groups of patients in the sample population. First, there were patients, who had local anaesthesia. Second, there were patients, who had general anaesthesia. They studied the sample population, measured and evaluated their condition before and after the surgery to determine the overall effect of surgery on their health. They collected the data to find out effects of anaesthesia and determined the most effective approach to management of anaesthesia.

Research design and data collection

            N. Kocaoglu and colleagues (2012) conducted the retrospective study and collected the information concerning the effect of various anaesthetic practices on patients. They focused on patients, who had placenta prevail and had either local or general anaesthesia. In such a way, they were capable to determine the effectiveness of each type.

Results and analysis of findings of the study

            Anaesthetic management is important for parturients with placenta previa who had previous caesarean section or abnormally invasive placentation. The researchers (Kocaoglu, et al., 2012) found that general anaesthesia was the most efficient method of preference for placenta previa as the researchers attempted to avoid the risk of bleeding (Kocaoglu, et al., 2012). However, regional anaesthesia can be safe in patients lacking any abnormally invasive placentation (Kocaoglu, et al., 2012). Therefore, the use of the general anaesthesia is the preferable method for patients with placenta previa, while other methods, such as regional anaesthesia, are not so effective and may raise unnecessary risks, such as the risk of bleeding. In case of using general anaesthesia health care professionals can keep the condition of the patient under control effectively and minimize risks to the health of the patient and the baby.

Conclusion, recommendations and limitations

            Hence, the researchers conclude that general anaesthesia is more effective compared to local anaesthesia because it has the lower risk of bleeding. This is why the researchers (Kocaoglu, et al., 2012) recommend using general anaesthesia to put the safety of patients first. However, local anaesthesia is still used in the contemporary treatment and surgery of patients with placenta previa.

Conclusion

            Thus, placenta previa is a serious condition that threatens to the health and life of pregnant women and their foetuses. This condition requires a particular attention from the part of health care professionals in the course of their pregnancy and surgery. Women with placenta previa undergo caesarean section and need the right anaesthesia. In this regard, the general anaesthesia is preferable. Also, health care professionals should have the accurate action plan and follow existing recommendations concerning surgery of patients with placenta previa.

References:

Bulich, L.A. and Jennings, R.W., 2014.  Anaesthetic and obstetric management of high risk pregnancy.  Intrauterine fetal manipulation, 33–44.

Cromblehoholme, T M., 2006.Surgical treatment of the fetus. Fanar off and Martin’s: Neonatal perinatal medicine, Oxford University Press..

Fisk, N, Gitau, R, Tiexeira, J, et al. 2001. Effect of direct opioid analgesia on fetal hormonal and hemodynamic stress response to intrauterine needling. Anesthesiology.  95:828–35

Gaiser, R.R and Kurth, CD., 1999. Anesthetic considerations for fetal surgery. Semin Perinatol.  23:507–514.

Galinkin, J.L., Schwarz, U., and Motoyama, E.K. 2006. Anesthesia for fetal surgery, In Smith’s anesthesia for infants and children, Oxford University Press, 509–20. 

Kocaoglu, N., et al., 2012. Management of anesthesia for cesarean section in parturients with placenta previa with/without placenta accreta: a retrospective study, Ginekol Pol.,83(2), 99-103.

Liley, AW., 1963, Intrauterine transfusion of foetus in haemolytic disease. BMJ.  5365, 1107–1109.

Nankali, A., et al., 2014. Frequency of Placenta Previa and Maternal Morbidity Associated with Previous Cesarean Delivery, Open Journal of Obstetrics and Gynecology, 4, 903-908

Oyelese, Y. and Smulian, J.C., (2006). Placenta Previa, Placenta Accreta, and Vasa Previa, Obstetrics & Gynecology, 107(4), 927-941.

Rosen, M., 1993. Anesthesia for fetal procedures and surgery. In: Schnider SM, Levinson G, editors. Anesthesia for Obstetrics. 3rd Ed. Baltimore: Williams & Wilkins; 281–295.

 Saxena, K.N., 2009. Anaesthesia for Fetal Surgeries, Indian J. Anaesth., 53(5), 554-559.

Wittkope, MM., 2002. Interventional fetal cardiac therapy-possible perspectives and current shortcomings. Ultrasound Obstet Gynecol.  20, 527–531. 

The terms offer and acceptance. (2016, May 17). Retrieved from

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"The terms offer and acceptance." freeessays.club, 17 May 2016

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[Accessed: March 28, 2024]

"The terms offer and acceptance." freeessays.club, 17 May 2016

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"The terms offer and acceptance." freeessays.club, 17 May 2016

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