Jurnal Review placenta acreta

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

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 2/16

∗ Placenta *revia is increasing, occurring in

+.- of *regnancies, and is associated with%aternal %orbidity.

ac'ground

7/21/2019 Jurnal Review placenta acreta

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 3/16

∗ 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

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 4/16

∗ (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

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 5/16

∗ Data Analysis : secondary analysis of

characteristics of the patients with cohort casefatality rate

Method

7/21/2019 Jurnal Review placenta acreta

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 6/16

∗ :;+ 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

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 7/16

∗ 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

7/21/2019 Jurnal Review placenta acreta

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 8/16

∗  Validity 

∗ selection

∗ Controlling confounding factors

∗  Information

∗ Analysis

∗ Causal

∗ Importancy 

∗ Applicability

(riti4ue

7/21/2019 Jurnal Review placenta acreta

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 9/16

∗ !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

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 10/16

∗ 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

7/21/2019 Jurnal Review placenta acreta

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 11/16

∗ )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

7/21/2019 Jurnal Review placenta acreta

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 12/16

∗ )his is a cohort study, so %eet the te%*oral

causality

(ausal

7/21/2019 Jurnal Review placenta acreta

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 13/16

∗ )he validity of this study is good enough

Validity

7/21/2019 Jurnal Review placenta acreta

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 14/16

∗ 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

7/21/2019 Jurnal Review placenta acreta

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 15/16

 )his study showed us howfatality of the *lacenta*revia, so we can do earlydetection.

A**licability

7/21/2019 Jurnal Review placenta acreta

http://slidepdf.com/reader/full/jurnal-review-placenta-acreta 16/16

THANK YOU