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However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The study cohort (<jats:italic>n<\/jats:italic>\u2009=\u2009141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (<jats:italic>n<\/jats:italic>\u2009=\u200912) and post groups (<jats:italic>n<\/jats:italic>\u2009=\u200912) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [<jats:italic>P<\/jats:italic>\u2009=\u20090.04] and 95.8% versus 63.2% [<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01], respectively). After propensity score matching (<jats:italic>n<\/jats:italic>\u2009=\u200972), intraoperative blood loss was significantly higher in the PEUA group (<jats:italic>n<\/jats:italic>\u2009=\u200924) than in the control group (<jats:italic>n<\/jats:italic>\u2009=\u200948) (1515\u00a0mL versus 870\u00a0mL, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (<jats:italic>t<\/jats:italic>\u2009=\u20092.46, <jats:italic>P<\/jats:italic>\u2009=\u20090.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180\u00a0mL versus 1827\u00a0mL, <jats:italic>P<\/jats:italic>\u2009=\u20090.04).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12893-020-01027-9","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T20:05:26Z","timestamp":1609963526000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Placenta previa with posterior extrauterine adhesion: clinical features and management practice"],"prefix":"10.1186","volume":"21","author":[{"given":"Yoshikazu","family":"Nagase","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5725-9994","authenticated-orcid":false,"given":"Shinya","family":"Matsuzaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Endo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeya","family":"Hara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiko","family":"Okada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuya","family":"Mimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Hiramatsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiko","family":"Kakigano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Nakatsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Miyake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Takiuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Ueda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuji","family":"Tomimatsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadashi","family":"Kimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,6]]},"reference":[{"issue":"1","key":"1027_CR1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1007\/s00404-010-1598-7","volume":"284","author":"T Rosenberg","year":"2011","unstructured":"Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E. 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Informed consent was not required from the patients because of the retrospective nature of this study, which was based on computerized data and anonymous selection criteria.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Shinya Matsuzaki is an Associate Editor for BMC Pregnancy and Childbirth. The authors declare no conflicts of interest (COI) about this study. All of authors have no competing financial interests regarding this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"10"}}