Objectives To evaluate the severe outcomes in pregnancies with pernicious placenta previa and prior cesarean delivery, and to analyze the predictive examinations and prevention strategies regarding severe complications in these women. Design Multicentre retrospective cohort study. Setting Thirteen hospitals in China. Population Selected 747 women with pernicious placenta previa and prior cesarean history. Methods The basic data relating to pregnancy, the examinations during gestation and the outcomes were collected and analyzed. Main outcome measures Outcomes including massive bleeding, placenta implantation and hysterectomy were monitored. Results Our results showed that placental implantation occurred in 47.5% of patients and the hysterectomy rate was 10.4%. The incidence of massive bleeding and blood transfusion was 55.8% and 64%, respectively. The women with placenta implantation predicted by both ultrasound and MRI had higher blood loss than those diagnosed only by either one of the examinations. Surprisingly, vascular occlusion had no effect on the occurrence of severe hemorrhage and hysterectomy. The latter was even higher in the vascular blocking group compared to that in the non-blocking group (34.2% and 8.6%, respectively). Conclusions: The pregnancies with pernicious placenta previa and prior cesarean delivery, had a dramatically higher risk of placenta implantation, hysterectomy and massive hemorrhage. MRI combined with ultrasound examination presented high accuracy in predicting severe outcomes in these patients. Vascular occlusion does not appear to be an effective approach to prevent severe outcomes. Surgical hemostasis should be the key goal in blocking massive bleeding, preserving the uterus and improving the prognosis of the patients.

Objective To explore the prevalence of contraceptive use, unintended pregnancy, and induced abortions within 24 months postpartum in eastern, central, and western regions of China and in China overall. Design A retrospective cohort study. Setting Hospital-based Maternity units. Population Women who delivered a live baby between 12 and 24 months. Methods: We randomly selected postpartum women at 60 hospitals in eastern, central, and western regions of China. We applied descriptive statistics and life-table analyses. Main outcome measures Prevalence of contraception, unintended pregnancy, and abortions. Results: A total of 18,045 participants were enrolled and interviewed, and 12-, and 24-month contraceptive rates were 85.7% (95% CI 85.2-86.2 ), and 86.8% (95% CI 86.3-87.2 ), respectively. Condoms accounted for 79% of contraceptive initiators. The 12-, and 24-month rates were 5.3% (95% CI 5.0-5.6) , and 13.6% (95% CI 12.2-15.0) for unintended pregnancy; and 4.0% (95% CI 3.7-4.3), and 10.8% (95% CI 9.5-12.1) for induced abortion, respectively. Three-quarters of unintended pregnancies ended in abortion. Postpartum contraceptive use was higher in the western region relative to the eastern or central regions, but the risks of unintended pregnancy and induced abortion were also higher in the west. Conclusions: Postpartum contraception use was relatively high in China but dominated by less-effective methods, and these may contribute to higher risks of unintended pregnancy and induced abortion during the postpartum period. Use of long-acting reversible contraceptives and effective and reliable short-acting methods should thus be fostered in postpartum family planning services in China.