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AUTHORíS REPLY
Year : 2018  |  Volume : 131  |  Issue : 12  |  Page : 1505

Reply to “Placenta Previa Accreta and Previous Cesarean Section: Some Clarifications”


Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing 100191, China

Date of Web Publication8-Jun-2018

Correspondence Address:
Dr. Yang-Yu Zhao
Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing 100191
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.233962

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How to cite this article:
Shi XM, Wang Y, Zhang Y, Wei Y, Chen L, Zhao YY. Reply to “Placenta Previa Accreta and Previous Cesarean Section: Some Clarifications”. Chin Med J 2018;131:1505

How to cite this URL:
Shi XM, Wang Y, Zhang Y, Wei Y, Chen L, Zhao YY. Reply to “Placenta Previa Accreta and Previous Cesarean Section: Some Clarifications”. Chin Med J [serial online] 2018 [cited 2018 Jun 24];131:1505. Available from: http://www.cmj.org/text.asp?2018/131/12/1505/233962



First, we want to thank the readers for their comments about our study design. Their opinions about the possible reasons why elective (labor −) cesarean section (CS) leads to higher risk of placenta previa accreta are really valuable and make good sense.

Second, we are quite impressed by their strategies to reduce the occurrence of accreta after elective CS. The first strategy is to delay the timing of CS or perform oxytocin administration to change labor (−) CS to labor (+) CS. This strategy is in consistent with lowering the incidence of nonmedically indicated CS. However, there are still many precautions in oxytocin administration before CS. Some patients may not respond well and still lack uterine contractions after oxytocin administration. On the other hand, induction of labor by oxytocin should be based on strict medical indications, not all patients are indicated to oxytocin, some patients are even contraindicated.[1],[2] Moreover, oxytocin has been shown to have side effects on women such as tachycardia, chest pain, palpitations, dyspnea, and nausea.[3] Our current results are not sufficient to draw the conclusion that oxytocin is applicable to all patients before CS. However, this might provide valuable reference for clinicians. Moreover, as mentioned by the readers, the effect of uterine contractions on the lower uterine segment is not determined yet, and still need further investigation. In short, oxytocin administration before CS is still controversial but worth further investigation. The second strategy is to make more “caudal” lower incision in lower segment which might decrease the damage to uterus. To verify this conception, more clinical and ultrasonic data are required to prove that more “caudal” lower incision leads to thinner lower uterine segment afterwards.

In summary, we still need more exploration and further discussion for these two strategies.



 
  References Top

1.
ACOG Committee on Practice Bulletins – Obstetrics. ACOG practice bulletin no 107: Induction of labor. Obstet Gynecol 2009;114:386-97. doi: 10.1097/AOG.0b013e3181b48ef5.  Back to cited text no. 1
    
2.
Page K, McCool WF, Guidera M. Examination of the pharmacology of oxytocin and clinical guidelines for use in labor. J Midwifery Womens Health 2017;62:425-33. doi: 10.1111/jmwh.12610.  Back to cited text no. 2
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3.
Svanström MC, Biber B, Hanes M, Johansson G, Näslund U, Bålfors EM, et al. Signs of myocardial ischaemia after injection of oxytocin: A randomized double-blind comparison of oxytocin and methylergometrine during Caesarean section. Br J Anaesth 2008;100:683-9. doi: 10.1093/bja/aen071.  Back to cited text no. 3
    




 

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