Characteristics of women with cesarean section due to placenta previa at national hospital of obstetric and gynecology in 2020

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RESEARCH ARTICLE
Journal of Nursing Science - Vol. 04 - No. 01
CHARACTERISTICS OF WOMEN WITH CESAREAN SECTION DUE TO PLACENTA 
PREVIA AT NATIONAL HOSPITAL OF OBSTETRIC AND GYNECOLOGY IN 2020
Nguyen Thi Thanh Huong1, Vu Dung2
1National Hospital for Obstetric and Gynecology, 2Thang Long University
ABSTRACT
Objective: Describe the clinical, 
subclinical, and resuscitation care after 
placenta previa operations at the National 
Hospital For Obstetric And Gynecology. 
Method: Descriptive study design was 
used to recruited 149 women who had a 
cesarean section due to placenta previa at 
the department of resuscitation anesthesia 
in the National Hospital For Obstetric And 
Gynecology from January to September 
2020. Results: The average age of pregnant 
women was 32.5 ± 4.9 years old, mainly in 
the 22 to 35 years old group (71.1%); 23.5% 
of them had comorbidities; 40.9% get 
pregnant up to 3 times; 61.7% of them had 
ever a C-section. In the pregnancy, 42.8% 
of the women had preterm birth and 4.1% 
of them were pregnant with twins. While 
admitted to the hospital, 49% of women 
presented with vaginal bleeding and 34.9% 
of them were anemia; 57% of women had 
uterine contractions and most of them 
presented with an open cervix. Almost of 
participants had completed placenta previa 
(85.2%) and 34.9% of them had Placenta 
Accreta. 63.1% of women had a cesarean 
section and preserved the uterus and 36.9% 
of them undergo surgery of hysterectomy. 
43.6% of the women experienced servere 
bleeding and half of them had to have a 
blood transfusion, the average amount of 
transfusion was 3.11 ± 2.6 units of blood. 
After surgery, 55% of pregnant women 
recovered well. Conclusion: Most of the 
women had better progress after surgery 
in terms of mental status, breathing, 
circulation, pain sensation. Health care staff 
should provide post-cesarean care for the 
woman with history of cesarean section due 
to placenta previa, pregnancy with comorbid 
diseases, placenta accreta, emergency 
surgery and women with servere bleeding 
pre-and post- surgery.
Keywords: after cesarean section, 
placeta previa, the National Hospital For 
Obstetric And Gynecology.
1. INTRODUCTION. 
The placenta previa resulted a high rate 
of preterm birth due to premature bleeding, 
making it difficult to continue the pregnan-
cy. One of the common indications in ce-
sarean section is placenta previa. In the 
surgery, the risk of bleeding, difficult he-
mostasis and after surgery, bleeding may 
still happen life-threatening for the wom-
en. Complications that may occur during 
and after surgery are hemorrhage, uterine 
atony, hypovolemic shock and finally stop 
circulation, death [1]. Resuscitation care 
is intensive care, requiring the nurse to be 
professional, quickly and accurately assess 
the pregnant woman’s condition, carefully 
monitor and follow-up the patient, then, the 
complications may be detected early. After 
surgery, notice and timely implementation 
of medical intervention from the doctor as 
Cor. author: Vu Dung
Email: vuzung246@gmail.com
Received: Feb 08, 2021
Revised: Feb 15, 2021
Accepted: Mar 05, 2021
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RESEARCH ARTICLE
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well as the optimal nursing care interven-
tion, thereby avoiding complications, espe-
cially those that severely affect the life of 
the woman. In order to describe the char-
acteristics of the pregnant woman who had 
a cesarean section due to the placenta and 
the results of monitoring and providing care 
of the woman during the tesuscitation care 
period, the researcher conducted the study 
with the objective to examine the clinical, 
subclinical and post-operative regression of 
women who underwent a cesarean section 
at the National Hospital For Obstetric And 
Gynecology
2. RESEARCH METHOD
2.1. Research settings, time and 
participants
Research settings: the department of 
resuscitation anesthesia in the National 
Hospital For Obstetric And Gynecology
Research time: from January to Sep-
tember 2020.
Participants: Women of all ages after 
cesarean delivery (emergency surgery, 
planned surgery). Except for pregnant 
women with infectious diseases (surgery in 
the Department of infected Obstetrics 
2.2. Methods: 
Research design: Descriptive study de-
sign
Sample size and and sampling meth-
od
- Calculate the sample size according 
to the formula to determine a rate with p = 
0.93 (the rate of cesarean section due to 
placenta previa in 2019 was listed at the 
Department of Resuscitation anesthesia 
in the National Hospital For Obstetric And 
Gynecology). 95% confidence level and 
permissible error d = 0.05.
 p x (1-p)
n= z2(1- α/2) 
 d2
The minimum sample size calculated 
was 130 women. In fact, the study took all 
149 women who had cesarean section due 
to placenta previa during the study period.
- Sample selection method: conven ... 5 women 
experienced a blood transfusion and the average amount of transfusion was 3.11 ± 2.6 
blood units. Especially, women had to transfuse up to 13 blood units (for two operations).
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Table 6. Progress of pain sensation of women after surgery
Grade of 
VAS
Hour 1
n=149
Hour 2
n=149
Hour 3
n=136
Hour 4
n=49
Hour 5
n=22
Hour 6
n=12
0 20(13,4%)
19
(12,8%)
10
(7,4%)
8
(16,3%)
5
(22,7%)
4
(33,3%)
1-3 127(85,2%)
95
(63,8%)
54
(39,7%)
13
(26,5%)
2
(9,1%)
1
(8,3%)
4-6 1(0,7%)
32
(21,4%)
68
(50,0%)
27
(55,2%)
14
(63,7%)
6
(50,1%)
7-9 1(0,7%)
3
(2,0%)
4
(2,9%)
1
(2,0%)
1
(4,5%)
1
(8,3%)
 Pain level was assessed 1 hour after surgery and once an hour. The results indicated 
that in the first hour, the effect of anesthetic drugs caused less pain in pregnant women, 
and the later hours, pain level increased mainly on average. 
Table 7. Results of resuscitation care of women after surgery 
 and related factors
Results n Percentage
Resuscitation time:
- In 3 hours
- ≥ 3 hours
82
67
55,0
45,0
Complications
- No
- Yes and mild
- Yes and heavy
125
17
7
83,9
11,4
4,7
Results of resuscitation
- Good
- Not good
82
67
55,0
45,0
55% of women had resuscitation before 3 hours; 45% had resuscitation from over 
3 hours, of which 11 women (7.4%) had resuscitation more than 6 hours. The average 
resuscitation time was 3 hours and 52 minutes. Women were consciousness as early 
as after 2 hours and 20 minutes and women had the longest resuscitation time of 18 
hours. Most women had no complications (83.9%); 17 women had mild complications and 
4.7% (7 women) had serious complications, in which 3 cases of re-surgery for hemostasis 
suture, 3 cases of uterine hemostasis balloon and 1 placenta accreta woman with very 
servere bleeding before surgery, surgery resulting injured bladder, a total of 2000ml of 
blood transfusion and blood products. After surgery, blood clotting disorder, the recovery 
time was 10.5 hours. 14 women with complications of varying degrees had resuscitation 
time of more than 6 hours.
The results of general resuscitation included 82 women with well resuscitation 
(resuscitation time ≤ 3 hours and no complications) reaching 55%; 67 women had not 
good resuscitation (resuscitation time was over 3 hours with or without complications), 
accounting for 45%
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Table 8. Factors related to the resuscitation results
Factors Good resuscitation
Not good 
resuscitation OR, 95%CI p
History of 
cesarean 
section
Not yet 44 13 4,8
(2,28-10,12) <0,01Had 38 54
Comorbidities 
No 70 44 3,05
(1,38-6,74) <0,01Had 12 23
Surgical type
Planned 38 20 2,02
(0,97-4,25) <0,05Emergency 44 47
Placenta previa 
No placenta 
accreta 70 27 8,6
(3,72 – 20,63) <0,01With placenta 
accreta 12 40
The amount of 
blood lost
<500ml 68 16 15,4
(6,43-37,51) <0,01≥ 500ml 14 51
The results showed that the good resuscitation results were more common in women 
who had not had cesarean section before; no comorbidities; planned surgery; placenta 
previa without placenta accreta and low and average blood loss before and during surgery 
(less than 500ml).
4. DISCUSSION
4.1. General characteristics and 
pregnant history of women who had a 
cesarean section due to placenta previa. 
The study results showed that the 
average age of the participants was 32.5 ± 
4.9 years, of which mainly the age group 
from 22 to 35 years old, accounting for 
71.1%. This study result was similar to that 
of Pham Van Do (2018) while the pregnant 
woman’s age was about 20-45 years old 
[2]. Nguyen Trung Kien (2019) showed 
that the proportion of women over 35 years 
old participating in the study accounted 
for 30.9% [5], it was similar to the study of 
28.2%. The previous study results indicated 
that the participants were at high risk in the 
age group over 35. Especially in the study 
there was a 19-year-old woman who was 
in very young age, which was not found in 
literature. Therefore, the results showed 
that the placenta previa was always a 
serious situation, the intervention should 
considerate to preserve the uterus for very 
young women.
The research results indicated that 11.4% 
of women were thin; 12.1% of women were 
overweight and 23.5% had other medical 
problems before getting pregnant. Most of 
the other studies [3], [4], [5] did not mention 
these two characteristics of pregnant 
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Journal of Nursing Science - Vol. 04 - No. 01
women, however, the research conducted 
to find out more of these 2 information. The 
further studies should conduct to examine 
the effects of body status and comorbidities 
to the postoperative recovery. 
The research results indicated that the 
majority of study participants had ever been 
pregnant, from the 3rd time up, accounting 
for the highest percentage of 40.9%; 2 
times (26.8%) and one pregnancy (18.8%). 
The research results were different from 
those recorded in the study of Le Thi Giang 
(2015) with the highest percentage of 
participants who had ever been pregnant 
once (67.4%) [3]. The group of participants 
who had never had a cesarean section 
before accounted for the highest proportion 
(38.3%), and ranked second was the group 
who had a cesarean section twice (32.9%). 
Particiapnts with 3 times of cesarean section 
3 times or more accounted for a low rate 
(4%). Regarding the group of particiapnts 
who had never had a cesarean section, 
the research results were higher than the 
research results of Nguyen Lien Phuong 
(8.3%) [7].
4.2. Clinical and subclinical 
characteristics of women with cesarean 
section due to placenta previa
According to the research results, the rate 
of women with vaginal bleeding accounts for 
49%. The research results were consistent 
with research results of Le Thi Giang (55.2) 
[3]. The results were lower than that of 
Nguyen Trung Kien (67.9%) [5]. Most of 
the participants at the National Hospital for 
Obstetrics and Gynecology were appointed 
by doctors to stay in the hospital at full 
term, to take care of the overall health of 
the woman and fetus according to medical 
orders to detect and report to the doctor for 
early and timely intervention while there were 
signs of bleeding and labor to avoid vaginal 
bleeding, servere bleeding, which would be 
dangerous for the fetus and women.
The rate of women with anemia before 
giving birth in the study was lower than that 
of the Le Thi Giang with anemia up to 60.5% 
[3]. From this result, it showed that anemia 
status of pregnant women was a problem of 
concern because it may affect the outcome 
of the intervention and the resuscitation 
status after the surgery.
Results of placenta previa ultrasound of 
the particiants showed that the majority of 
women had the complete placenta previa 
(85.2%). This result was consistent with 
research results of some authors Pham 
Van Do (59.1%) and Pham Thi Linh (98%) 
[2], [6].
Regarding the handling of the placenta 
previa cases, the results showed that 
94 women underwent cesarean section 
and uterine preservation, accounting 
for 63.1% and 55 women with cesarean 
section and hysterectomy, accounting 
for 36.9%. Among the women who had a 
hysterectomy, one woman had to have a 
complete hysterectomy due to excessive 
bleeding, severe blood loss (this woman 
had to transfuse 13 units of blood). She was 
tvery short gestational age of 17th week. 
About blood loss, 43.6% of pregnant 
women had very servere bleeding (over 
500ml). With such blood loss, 75 women had 
to transfuse blood and the average amount 
of transfusion was 3.11 ± 2.6 units of blood. 
Especially, there were women who had to 
transfuse up to 13 units of blood, which 
was the case of emergency surgery due to 
placenta previa with placenta accreta. In the 
3-unit blood transfusion surgery, 15 hours 
after surgery, the patient had to re-operate 
due to monitoring bleeding in the abdomen, 
continued extremly blood loss and 
continued infusion of 10 units. Our results 
were similar to those published by Le Hoai 
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Chuong showed that out of a total of 500 
cases of placenta previa, hysterectomy was 
42 cases, accounting for 8.4%. According 
to Hoang Van Yen (2010), research on the 
management of bleeding during and after 
cesarean section at the National Hospital for 
Obstetrics and Gynecology in 2008-2009, 
uterine artery constriction was selected in 
86.9% of cases [8].
Regarding the results of regressive 
care and related factors: In the study, we 
analyzed and showed that women who 
had had a caesarean section; women 
with comorbidities; women who have both 
a striker and a toothpaste and those who 
have surgery in an emergency situation; 
women who lost a lot of blood before, 
during surgery had worse recovery 
results than women with advantages: no 
history of cesarean section, no associated 
disease, planned surgery and little blood 
loss. or medium. Our research results are 
consistent with research results of some 
other authors [9], [10]. These authors 
indicated that there was an association 
between cesarean section history, forward 
placenta characteristics, degree of blood 
loss, and time of resuscitation after 
cesarean section. The more women who 
have had a caesarean section before, the 
longer the time had consciousness and 
recovered from a cesarean section due to 
the placenta.
The resuscitation results and related 
factors indicated that the women with 
cesarean section, comorbidities, placenta 
previa with placenta accreta and emergency 
surgery; blood lost before and during 
surgery had worse resuscitation results 
than the women without previous cesarean 
section, comorbidities, placenta previa with 
placenta accreta and emergency surgery. 
Results of the research were consistent 
with the results of some other authors [9], 
[10]. This author pointed out that there was 
a relationship between previous cesarean 
section, placenta characteristics, level of 
blood loss and resuscitation time after 
cesarean section. The higher number of 
previous cesarean sections made the longer 
the resuscitation time after caesarean 
section.
The following-up and detecting the 
heavy status after cesarean sections 
due to placenta previa is the task of 
the resuscitation therapist to track vital 
signs, monitor bleeding in the wound, 
bleeding in abdomen, signs of uterine 
contraction, monitoring postpartum fluid, 
monitoring transmission. Therefore, in the 
recsuscitation care, nurses should plan fully 
and properly intervention for the risk women 
with previous cesarean sections, placenta 
previa, placenta accreta blood lost before 
and during surgery and comorbidities.
5. CONCLUSION AND RECOMMENDATION
Conclusion: 
Characteristics of research participants 
results indicated that the women were 
average age 32.5 ± 4.9 years; 40.9% of 
pregnant women had pregnant ≥ 3 times; 
61.7% of women had ever had a C-section; 
while admitted to hospital, 49% of pregnant 
women had vaginal bleeding; 57% of 
women had uterine contractions and 89.9% 
had an open cervix; 85.2% of women had 
complete placenta previa (85.2%) and 
34.9% of women had placenta accreta; 
36.9% of women had a hysterectomy and 
50.3% had a blood transfusion, the average 
amount of transfusion was 3.11 ± 2.6 units 
of blood.
Most women had better progress after 
surgery in terms of mental health, breathing, 
circulation, pain sensation status. The results 
of good resuscitation care accounted for 
55%. The rate of good resuscitation results 
was higher among women who had not 
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Journal of Nursing Science - Vol. 04 - No. 01
previously had C-section; no comorbidities; 
planned surgery; no placenta previa, no 
placenta accreta and not much blood loss
Recommendation: Providing care of 
women after cesarean section due to pla-
centa previa, the nurses should pay atten-
tion to women who had a history of previous 
cesarean section, with comorbid diseases, 
emergency surgery; placenta previa, pla-
centa accreta and extremly loss of blood 
before and during surgery.
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