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Placenta previa is increasing, occurring in 1.3% of pregnancies, and is associated with maternal morbidity. Although the literature has focused on the morbidity associated with concurrent placenta accreta,
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7/21/2019 Jurnal Review placenta acreta
http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 1/16
Quantifying Maternal MorbidityAssociated with Placenta Previa
Karen J. Gibbins, Michael W. Varner, obert M. !ilver"niversity of "tah #ealth !ciences and $nter%ountain #ealthcare
!alt &a'e (ity, ")
Astri rahma rosita
22010113220172
7/21/2019 Jurnal Review placenta acreta
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∗ Placenta *revia is increasing, occurring in
+.- of *regnancies, and is associated with%aternal %orbidity.
ac'ground
7/21/2019 Jurnal Review placenta acreta
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∗ Placenta *revia is increasing, occurring in +.-
of *regnancies, and is associated with %aternal%orbidity. Although the literature has focusedon the %orbidity associated with concurrent*lacenta accreta, the %orbidity of *revia in theabsence of accreta with conte%*orary%anage%ent is not well described. #ence, our*ur*ose was to characteri/e %aternal %orbidityassociated with *lacenta *revia.
0b1ective
7/21/2019 Jurnal Review placenta acreta
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∗ (ohorts were co%*ared using Wilco2on ran' su% test, chi3
s4uare test, and ris' ratios 5s6∗ Target Population : wo%en undergoing cesarean delivery were
those with *revia co%*ared to those without *revia.
∗ Source Population : Maternal37etal Medicine "nits 8etwor'(esarean egistry
∗ Sample : women with *revia co%*ared to those without *revia.
Wo%en with *lacenta accreta were e2cluded. Maternalhe%orrhagic %orbidity included %ortality, blood *roducttransfusion, atony re4uiring uterotonics, uterine9hy*ogastricartery ligation, hysterecto%y, coagulo*athy, e2*loratoryla*aroto%y, and $(" ad%ission.
Method
7/21/2019 Jurnal Review placenta acreta
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∗ Data Analysis : secondary analysis of
characteristics of the patients with cohort casefatality rate
Method
7/21/2019 Jurnal Review placenta acreta
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∗ :;+ wo%en with *revia were co%*ared to :,<:= wo%en without.
∗
Maternal he%orrhagic %orbidity was higher with *revia 5+< vs :->a ?.<, <:-($ ?.?3.<6 .
∗ !evere%aternal%orbidity was increased with *revia 5 vs +-6 in
univariate but not %ultivariable analysis.
∗ Wo%en with *revia had increased use of uterotonics 5++ vs@-, a.6, red blood cell transfusion 5+ vs ?-, a @.;6, and
hysterecto%y 5? vs ;.?-, a @.<6.
∗ Wo%en with *revia also had a larger he%oglobin dro* 5?. g9d& vs
+.= g9d&, *B;.;;+6 and higher rate of@ units red cells transfused 5?.?vs ;.-, a ?.< C+.+3D.;E6.
∗ More wo%en with *revia had e%ergent delivery 5?@ vs +-6 but thisdid not *ersist after ad1ust%ent, a +.? 5;.<3+.:6.
esult
7/21/2019 Jurnal Review placenta acreta
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∗ Al%ost ?;- of wo%enwith *revia but noaccreta had he%orrhagic
%orbidity.∗ - had severe %orbidity
and ?- re4uiredhysterecto%y. )hesedata are useful in
counseling wo%en with*lacenta *revia.
(onclusion
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∗ Validity
∗ selection
∗ Controlling confounding factors
∗ Information
∗ Analysis
∗ Causal
∗ Importancy
∗ Applicability
(riti4ue
7/21/2019 Jurnal Review placenta acreta
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∗ !election criterion F this study
didnt have s*esiHc criterionabout the research sub1ect, wedont 'now the gestasional ageof the *atient, wether *rete%,
ater%, *osster% or all of the*regnancy with *lacenta *reviawith the inclution criteria
Selection
7/21/2019 Jurnal Review placenta acreta
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∗ We dont see the sa%*ling rando%i/e
∗ We dont see any statistic analysis toHnd the ho%ogenity of the baselinecharacteristic *roHle that could be aconfounding factor.
(ontrolling cofounding
factors
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∗ )here is no s*esiHc statistical analysis
on charactheristic *roHle in this study∗ 8o analysis on %ain outco%e, wheter
there were really statistically signiHcant
Analysis
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∗ )his is a cohort study, so %eet the te%*oral
causality
(ausal
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∗ )he validity of this study is good enough
Validity
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∗ Maternal he%orrhagic %orbidity was higher with*revia 5+< vs :-> a ?.<, <:-
∗
!evere%aternal%orbidity was increased with*revia 5 vs +-6 in univariate but not %ultivariableanalysis.
∗ Wo%en with *revia had increased use ofuterotonics 5++ vs@-, a .6, red blood celltransfusion 5+ vs ?-, a @.;6, and hysterecto%y5? vs ;.?-, a @.<6.
∗ Wo%en with *revia also had a larger he%oglobindro* 5?. g9d& vs +.= g9d&, *B;.;;+6 and higherrate of@ units red cells transfused 5?.? vs ;.-,a ?.<
∗ More wo%en with *revia had e%ergent delivery5?@ vs +-6 but this did not *ersist after
ad1ust%ent, a +.?
$%*ortancy
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)his study showed us howfatality of the *lacenta*revia, so we can do earlydetection.
A**licability