绵羊肌源性干细胞负载非交联生物补片植入绵羊阴道缺损模型的组织学和在体生物力学研究

目的:建立绵羊的阴道缺损和负载绵羊肌源性干细胞(MDSC)异种猪源生物补片埋植模型,明确移植负载MDSC的异种生物补片对阴道组织再生的可行性。方法:在体外将绵羊MDSC种植于非交联猪心包膜脱细胞基质和猪小肠黏膜下层基质补片表面,建立阴道缺损和负载MDSC异种生物补片绵羊阴道内埋植模型。分别于术后1周、1月、3月取材,a-SMA免疫组化染色检测补片埋植局部平滑肌组织再生情况;术后3月取材,生理盐水浸泡保存,3h内进行生物力学检测,了解补片及再生组织在体内的生物力学特点。结果:阴道内生物补片埋植后1周、1月、3月HE染色显示,补片内细胞长入情况好,负载MDSC生物补片埋植组的组织相容性优于单纯生物补片埋植组;负载MDSC生物补片埋植组的a-SMA表达大于单纯生物补片埋植组。非交联S型生物补片术后3月极限拉伸强度为(20.38±2.45)N/mm2。结论:绵羊是进行人阴道相关探索研究良好模型,负载绵羊MDSC的非交联猪小肠黏膜下基质补片可促进平滑肌生成,更有利于提供持久的生物力学支持。     

猪小肠黏膜下层补片在盆底重建手术中的应用进展

盆底重建手术的替代材料大体可分为合成补片和生物补片。由于合成补片有临床并发症的发生,人们开始探索生物补片的应用。猪小肠黏膜下层是近年来应用于临床的一种生物补片,国外已应用于盆底重建手术,国内尚无该补片治疗盆腔器官脱垂的临床报道。本文概述了猪小肠黏膜下层补片的组织结构特性,动物实验结果及临床应用效果。     

猪小肠黏膜下层生物补片在盆腔器官脱垂手术中的应用价值

应用移植替代物进行盆底重建的新式手术近十年来发展迅速。聚丙烯合成网片套盒手术虽能显著降低盆腔器官脱垂的复发率,但一些网片特有的并发症如侵蚀、感染、挛缩等越来越引起关注。寻求理想的移植替代物是医患共同的目标。猪小肠黏膜下层生物补片有强大的组织再生功能,且胶原丰富,支撑力度较强,近年来国外已应用于盆底重建手术,国内也开始尝试应用。本文概述了猪小肠黏膜下层生物补片的结构、功能及其在盆底重建手术的应用。     

替代物治疗盆底功能障碍性疾病的应用前景

目前用于治疗盆底功能障碍性疾病（pelvic floor dysfunction，PFD）的替代物主要是指网片，根据材料分为人工合成网片、生物补片和组织工程学网片。中重度盆腔器官脱垂（pelvic organ prolapse，POP）和压力性尿失禁（stress urinary incontinence，SUI）使用网片的手术方法包括经阴道植入网片（transvaginal mesh implantation，TVM）手术、阴道骶骨固定术（sacrocolpopexy，SC）和无张力尿道中段吊带术（mid-urethralslings，MUS），网片的并发症使网片手术陷入争论。文章通过论述网片手术现状、网片材质、手术操作的改进、生物力学的发展和监管随访机制的建立，探讨网片在PFD中的应用。     

替代物治疗盆底功能障碍性疾病的应用前景

目前用于治疗盆底功能障碍性疾病（pelvic floor dysfunction，PFD）的替代物主要是指网片，根据材料分为人工合成网片、生物补片和组织工程学网片。中重度盆腔器官脱垂（pelvic organ prolapse，POP）和压力性尿失禁（stress urinary incontinence，SUI）使用网片的手术方法包括经阴道植入网片（transvaginal mesh implantation，TVM）手术、阴道骶骨固定术（sacrocolpopexy，SC）和无张力尿道中段吊带术（mid-urethralslings，MUS），网片的并发症使网片手术陷入争论。文章通过论述网片手术现状、网片材质、手术操作的改进、生物力学的发展和监管随访机制的建立，探讨网片在PFD中的应用。     

两种补片在前盆底重建术中的应用比较

目的:比较两种补片(聚丙烯合成网片和生物补片)在前盆底重建术的围手术期情况及近期疗效,探讨更为适宜的前盆底重建手术方式及材料。方法:40例行前盆底重建术的患者分为两组,其中25例采用聚丙烯网片的骨盆底修复系统(Prolift)的前盆底重建系统行前盆底重建术(Prolift组),余15例采用美国Cook公司研发的百得塞(Biodesign)生物补片行前盆底重建术(Cook组)。比较两组患者围手术期和随访情况,并进行统计学分析。结果:Cook组手术时间和术中出血量高于Prolift组,差异有统计学意义(P0.05);两组术后最高体温、尿管留置时间、术后残余尿比较,差异无统计学意义(P0.05)。Prolift组术后2例(8.0%)发生补片侵蚀,2例(8.0%)出现阴道疼痛,1例(4.0%)出现复发;Cook组术后1例(6.7%)出现阴道壁血肿,无补片侵蚀及复发。结论:生物补片与聚丙烯网片比较,手术时间较长,术中出血量较多,但生物补片在术后近期疗效和手术并发症方面有一定优势。     

生物补片在女性盆底重建术中的应用进展

简述了生物材料的分类及目前常用的生物补片种类,并以猪小肠黏膜下层(small intestinal submucosa,SIS)为例,介绍了生物补片的成分及各自在组织修补过程中的作用机制。分析了同层数不同种类间或同种类不同层数间生物补片的力学强度的差异,得出目前应用较多的生物补片为4层的SIS,其力学强度既可达到支撑盆底组织早期修补的作用,又能同时兼顾阴道壁柔软度且富于弹性的特点。基于生物补片的力学性能及可降解特性,不是所有盆底重建部位都能用生物补片来进行修补,如在持续抗拉强度占主导地位部位的重建,如穹窿骶骨固定和重度膀胱膨出修补,合成网片可能会提供一个更好的解剖效果。而在治疗压力性尿失禁的手术中,两者的成功率相当。对于性生活活跃的患者,尤其是年轻女性,在恢复阴道壁的正常解剖结构及保留其柔软且富于弹性的功能方面,生物补片具有独特的优势。作为一种新兴材料,生物补片在盆底重建术中的应用尚处于探索阶段,但随着盆疷器官脱垂患者的年轻化,生物补片仍具有潜在的发展空间。     

猪小肠黏膜下层补片植入兔膀胱阴道间隙的转归研究

目的观察猪小肠黏膜下层(SIS)补片植入兔膀胱阴道间隙的转归,探讨SIS补片在妇科盆底手术中的应用价值。方法以家兔作为动物模型,16只雌性家兔随机(抽签法)分为4组,即7 d组、30 d组、90 d组和180 d组,每组4只家兔。4组家兔均通过手术方式于膀胱阴道间隙内植入SIS补片,分别于术后7、30、90、180 d处死各组家兔,并同时整块取出补片及其周围的膀胱阴道组织。标本均制成蜡块后切片,采用HE染色观察补片内部及周围组织产生的形态学变化,采用Masson染色观察补片组织内胶原形态和数量的变化。结果(1)HE染色后光镜下观察,7 d组SIS补片周围可见大量以嗜酸性粒细胞和淋巴细胞为主的炎性细胞浸润,并可见新生血管形成;30 d组炎性细胞浸润区域进一步增大;90 d组炎性细胞浸润区域明显缩小;180天组炎性反应基本消退。(2)Masson染色后光镜下观察,7 d组4只家兔SIS补片胶原结构清晰,保留完整;30 d组4只家兔SIS补片已有部分降解,但仍可见SIS胶原结构;90 d组有2只家兔尚可见少量残留SIS碎片结构,另2只家兔的SIS补片已被完全降解;180 d组4只家兔的SIS补片均被完全降解,其中1只家兔似可见部分有排序的胶原结构。结论SIS补片植入兔膀胱阴道间隙后可导致一过性的非感染性炎症反应,植入180 d后可被完全降解并有少量新生胶原结构产生。SIS补片用于盆底重建手术需谨慎。     

脱细胞生物组织补片在盆底重建手术中的应用

目的初步探讨脱细胞生物组织补片在盆腔器官膨出患者盆底重建手术中的应用情况。方法选择北京大学人民医院妇科2006年5月至12月期间接受盆底修补和重建手术并应用脱细胞生物补片的盆腔器官膨出患者20例,其中子宫脱垂19例,子宫切除术后阴道穹隆脱垂Ⅱ度1例;合并存在膀胱膨出20例、直肠膨出17例。20例患者中17例同时行阴道前后壁修补术,3例行阴道前壁修补术;阴道前壁置入补片15例,阴道后壁置入补片2例,阴道前壁和后壁同时置入补片3例。结果20例患者总手术时间平均为113．1min（70～180min）,其中放置补片的时间平均为10min。术中出血平均为175ml（50～300ml）。术后恢复良好,平均随访9．3个月（6～12个月）,未发现补片侵蚀阴道黏膜情况,无感染发生。随访期间4例（20％）患者出现盆腔器官膨出复发,3例为膀胱膨出Ⅰ度,复发时间均为6个月复查时,其中2例随访12个月时仍为膀胱膨出Ⅰ度,另1例随访8个月时也为膀胱膨出Ⅰ度,未见加重;1例为膀胱膨出Ⅱ度,复发时间为6个月复查时;所有复发患者均无临床症状。结论脱细胞生物组织补片用于盆底重建手术,方法简单,操作容易,未见补片侵蚀发生,其长期效果有待进一步观察。     

组织工程医用生物补片用于阴道重建的动物实验研究

目的 观察应用组织工程医用生物补片(一种脱细胞真皮基质材料)在实验动物体内进行阴道重建的效果.方法 对12只中国小型实验猪行阴道全切除术,应用组织工程医用生物补片行阴道重建术,分别于术后1、2、4、6、8、12周每次选择2只实验猪切除全层阴道,并以其中2只实验猪阴道切除术中切除的正常阴道组织为对照.对阴道重建术后不同时间切除的阴道组织行HE染色和Van Gieson(VG)染色,以观察和评价阴道各层组织的生长状态;采用上皮广谱角蛋白单克隆抗体AE1/AE3、平滑肌α肌动蛋白(α-actin)单克隆抗体进行免疫组化染色,以证实重建阴道是否存在上皮组织和平滑肌组织;于重建术后1、12周行透射电镜检查,观察阴道组织超微结构的变化;于重建术后12周应用组织浴槽对离体阴道组织进行药物和电刺激,以评价阴道平滑肌的收缩功能.结果 (1)阴道重建术后1周,可见阴道黏膜覆盖近2/3,光镜下观察,阴道上皮层数少,仅1～2层;电镜下观察,上皮细胞排列疏松,不规则.阴道重建术后4～6周,可见黏膜上皮层数增多,达4～5层.重建术后12周,大体上很难与正常阴道区分,上皮广谱角蛋白单克隆抗体AE1/AE3免疫组化染色结果与HE染色结果一致;电镜下观察,阴道上皮细胞分层分化良好,排列有序,细胞的相邻面有桥粒连接.(2)VG染色、免疫组化染色显示,阴道重建术后4周,开始出现散在的平滑肌细胞,此后逐渐形成排列均匀的肌束.(3)阴道重建术后12周,重建的阴道与正常阴道组织对KCl刺激均能产生收缩波,收缩反应强度变化相似,分别为(2.96±0.29)和(3.14±0.30)g;对于不同电压、不同频率的电刺激,当电压固定、频率逐渐升高时,两者收缩反应强度变化分别为(3.43±0.34)和(4.65±0.73)g;当频率固定、电压逐渐升高时,两者收缩反应强度变化则分别为(4.92±0.38)和(4.89±0.44)g.结论 组织工程医用生物补片是在实验动物体内进行阴道重建较理想的材料,重建术后3个月基本可以完成组织重建.     

Serum levels of placenta-specific tissue protein 12 (PP12) in pregnancies complicated by pre-eclampsia, diabetes or twins

PP12 is one of the recently discovered soluble tissue antigens of the placenta. During normal pregnancy maternal serum PP12 levels rise during the first 18 weeks reaching a mean peak value of 139.9 +/- 40.26 micrograms/l; after that there is a fall to a mean value of 111.9 +/- 42.39 micrograms/l between 28 and 40 weeks. Significantly higher mean serum PP12 levels were found in the third trimester in two high risk pregnancy groups (281.09 +/- 117.08 micrograms/l in pre-eclamptic toxaemia and 203.71 +/- 73.77 micrograms/l in diabetes) while serum PP12 levels remained normal (114.94 +/- 58.06 micrograms/l) in twin pregnancy. The increase of serum PP12 concentration in toxaemia and in diabetes may be of considerable diagnostic significance.     

First-trimester maternal placental protein 13 levels in pregnancies resulting in adverse outcomes

BACKGROUND: In a previous study, reduced levels of maternal serum placental protein 13 (PP13) in the first trimester have been correlated with adverse pregnancy outcomes. The objective of this study was to compare first-trimester PP13 levels in control pregnancies with pregnancies resulting in one or more of the following adverse outcomes: intrauterine growth restriction (IUGR), small and very small (3rd, 5th, 10th centile) for gestational age (SGA), low (<1.5 and < 2.5 kg) birth weight (LBW), macrosomia (the > 90th centile), large birth weight (>4.5 kg), preterm (35-36 weeks) and very early (<34 weeks) delivery (PTD), and intrauterine fetal demise (IUFD). METHODS: Maternal serum samples from 1940, 11 to 14 weeks singleton pregnancies, were assayed for PP13 and the concentrations were corrected for gestational age, maternal weight, smoking status, and ethnic origin. A comparison of the levels of PP13 in 364 controls and 1576 adverse outcome categories was made. PP13 levels were expressed in terms of both concentration and multiple of medians (MoMs). RESULTS: Comparison of PP13 MoMs from SGA, PTD, and low birth weight samples with control pregnancy samples showed no statistically significant difference. In macrosomic pregnancies (>90th centile), levels of PP13 were significantly higher than controls (p = 0.0263) although the number of cases in this study was small. CONCLUSION: Decreased levels of PP13 were not significantly correlated with the studied adverse pregnancy outcomes of IUGR, PTD low birth weight, and IUFD. Further studies are required to evaluate if measurement of PP13 has any value in the early assessment of pregnancies.     

How to repair an anal sphincter injury after vaginal delivery: results of a randomised controlled trial

OBJECTIVE: To compare two surgical techniques and two types of suture material for anal sphincter repair after childbirth-related injury. DESIGN: Factorial randomised controlled trial. SETTING: Tertiary referral maternity unit. POPULATION: Women with an anal sphincter injury sustained during childbirth. METHOD: Women were randomised into four groups: overlap repair with polyglactin (Vicryl); end-to-end repair with polyglactin (Vicryl); overlap repair with polydioxanone (PDS); and end-to-end repair with PDS. All repairs were completed as a primary procedure by staff trained in both methods. MAIN OUTCOME MEASURES: Suture-related morbidity at six weeks. Bowel symptoms at 3, 6 and 12 months. Anorectal physiology at three months. Quality of life scores at 3 and 12 months. RESULTS: One hundred and fifty women (1.5% of deliveries) were eligible and 112 (75%) were randomised. One hundred and three (92%) attended follow up visit at 6 weeks, 89 (80%) at 3 months, 79 (71%) at 6 months and 60 (54%) at 12 months. At six weeks, there was no difference in suture-related morbidity between groups (P=0.11) and 70% patients were completely asymptomatic. Incidence of bowel symptoms and quality of life disturbances were low, with no differences between the four groups. CONCLUSION: Obstetric anal sphincter repair carried out by appropriately trained staff is associated with low morbidity, irrespective of the suture material and repair method used.     

过期与延期妊娠胎盘形态学变化及其与妊娠结局的关系

目的 探讨过期、延期妊娠胎盘绒毛和胎盘床螺旋动脉的病变特点及其与胎儿预后的关系。方法 应用图像分析技术对过期妊娠２０例（过期组）、延期妊娠１５例（延期组）和正常足月妊娠２９例（对照组）,进行形态计量学观察。结果 过期组的胎盘重量减轻,绒毛合体细胞结节增多,细胞滋养细胞增生,基底膜增厚,纤维素样坏死,血管合体细胞膜形成,绒毛直径、周长、面积,胎盘床螺旋动脉管壁增厚,以及羊水过少和羊水粪染的发生率均与     

Distribution of placental protein 14 in tissues and body fluids during pregnancy

Placental protein 14 (PP14) levels were measured in serum samples from non-pregnant and pregnant women, amniotic fluid, cord blood, and extracts of placenta, decidua and fetal membranes. The levels were low (15-40 micrograms/l) in serum of non-pregnant women. In four pregnancies following in-vitro fertilization, the serum PP14 levels started to rise 2-12 days after embryo replacement. In normal pregnancy, the highest serum PP14 concentrations (up to 2200 micrograms/l) were detected between 6 and 12 weeks. After 16 weeks the level decreased and plateaued at 24 weeks to around 200 micrograms/l. In amniotic fluid, the highest PP14 levels (232 mg/l) were found between 12 and 20 weeks, being considerably higher than those in maternal serum throughout pregnancy. In cord blood, the levels were low (15-22 micrograms/l) or undetectable. In early pregnancy decidua, the PP14 content was higher (41-160 mg/g total protein) than in late pregnancy decidua (60-2700 micrograms/g total protein). In amnion and chorion laeve, the PP14 concentration varied from 50 to 750 and 50 to 1000 micrograms/g protein, respectively. Early pregnancy placenta contained 0.25-15 mg/g and late pregnancy placenta 3-430 micrograms/g protein of PP14. These results show that the levels of PP14 in pregnancy serum have a similar profile to hCG, but in contrast to other placental proteins, the amniotic fluid PP14 levels are remarkably high. This may be explained by suggesting that decidua is a source of PP14.     

Distribution of placental protein 14 in tissues and body fluids during pregnancy

Summary. Placental protein 14 (PP14) levels were measured in serum samples from non-pregnant and pregnant women. amniotic fluid, cord blood, and extracts of placenta, decidua and fetal membranes. The levels were low (15–40 μg/ l ) in serum of non-pregnant women. In four pregnancies following in-vitro fertilization, the serum PP14 levels started to rise 2–12 days after embryo replacement. In normal pregnancy, the highest serum PP14 concentrations (up to 2200 μg/l) were detected between 6 and 12 weeks. After 16 weeks the level decreased and plateaued at 24 weeks to around 200 μg/l. In amniotic fluid, the highest PP14 levels (232 mg/l) were found between 12 and 20 weeks, being considerably higher than those in maternal serum throughout pregnancy. In cord blood, the levels were low (15–22 μg/l) or undetectable. In early pregnancy decidua. the PP14 content was higher (41–160 mg/g total protein) than in late pregnancy decidua (60–2700 μg/g total protein). In amnion and chorion laeve, the PP14 concentration varied from 50 to 750 and 50 to 1000 μg/g protein, respectively. Early pregnancy placenta contained 0-25-15 mg/g and late pregnancy placenta 3–430 μg/g protein of PP14. These results show that the levels of PP14 in pregnancy serum have a similar profile to hCG, but in contrast to other placental proteins, the amniotic fluid PP14 levels are remarkably high. This may be explained by suggesting that decidua is a source of PP14.     

Expression and intracellular localization of protein phosphatases 2A and 2B, protein kinase a, A-Kinase anchoring protein (AKAP79), and binding of the regulatory (RII) subunit of protein kinase a to AKAP79 in human myometrium

OBJECTIVE: To determine the expression and intracellular localization of protein phosphatases 2A (PP2A) and 2B (PP2B), protein kinase A (PKA), and A-kinase anchoring protein (AKAP79), and expression of PKA (RII subunit) binding to AKAP79 in human postmenopausal and pregnant myometrium and to correlate their expressions to blood levels of estradiol, progesterone, and oxytocin. METHODS: Myometrial samples were taken from postmenopausal hysterectomy specimens (group 1, n = 5), from pregnant nonlaboring women (group 2, n = 7) and pregnant laboring women (group 3, n = 5) at cesarean. Western immunoblotting, immunohistochemical, and RII overlay assays were performed. Blood samples were assayed for estradiol, progesterone, and oxytocin levels. RESULTS: There were no significant differences in expression of PP2A, PKA, AKAP79, or PKA(RII) binding to AKAP79 between the three groups. Expression of PP2B was significantly greater in the nonlabor group (group 2) compared with groups 1 and 3. Protein phosphatase 2B, PKA, and AKAP79 expressions were localized in myometrial cytoplasm, but PP2A was localized in blood vessel endothelium. There was no significant correlation between the protein expression and the hormone level in the three groups. CONCLUSION: Human postmenopausal and pregnant (nonlabor and labor) myometrium expressed PP2A, PP2B, PKA, AKAP79, and PKA (RII)-AKAP79 binding. Levels of PP2A, PKA, and AKAP79 expression did not appear to be determinants of human myometrial contractility at parturition. Expression of PP2B may play a role in uterine quiescence. No association was found between protein expression and hormone level.     

Comparison of rabeprazole-based four- and seven-day triple therapy and omeprazole-based seven-day triple therapy for Helicobacter pylori infection in patients with peptic ulcer.

BACKGROUND AND PURPOSE: Rabeprazole is a new proton pump inhibitor producing rapid inhibition of gastric acid secretion. This may potentiate the inhibitory effect of antibiotics against Helicobacter pylori. This study compared the efficacy, safety, and tolerability of 4- and 7-day rabeprazole-based triple therapies versus 7-day omeprazole-based triple therapy. METHODS: A total of 70 H. pylori-infected peptic ulcer patients were randomly assigned to 1 of 3 groups: RAC4 (rabeprazole 20 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily for 4 days), RAC7 (rabeprazole 20 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily for 7 days), and OAC7 (omeprazole 20mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily for 7 days). Endoscopy, Campylobacter-like organism (CLO) test, H. pylori culture, and 13C-urea breath test were performed before randomization and 8 weeks after the start of triple therapy. RESULTS: Intention-to-treat (ITT) eradication rates for the RAC4, RAC7, and OAC7 groups were 87% (20/23), 83%(19/23), and 88% (21/24), respectively, and per-protocol (PP) eradication rates were 91% (20/22), 95% (19/20), and 100% (21/21), respectively. There was no significant difference among the ITT or PP eradication rates of the 3 groups. All 3 regimens were well tolerated and compliance was excellent. CONCLUSIONS: One-week RAC and 1-week OAC are equally effective for H. pylori eradication in peptic ulcer patients. The duration of RAC triple therapy can be shortened to 4 days without compromising its efficacy.     

ATM对卵巢癌细胞株CaOV3顺铂敏感性的影响

目的:探讨ATM激酶表达水平和活性对卵巢癌细胞Ca OV3顺铂敏感性的影响,以及可能的机制。方法:以ATM-siRNA转染Ca OV3细胞48h下调ATM蛋白水平,以KU-55933预处理Ca OV3细胞12h下调ATM激酶活性。CCK8试验检测细胞活性,Western blot法检测ATM及r-H2AX蛋白表达,荧光共聚焦confocal检测细胞DNA双链损伤标志蛋白r-H2AX表达及同源重组修复关键蛋白RAD51表达及两者细胞核中共定位,应用碱性慧星试验检测细胞内DNA双链损伤情况,流式细胞术检测细胞周期分布。结果:卵巢癌细胞系Ca OV3具备相对完整的同源重组修复能力,下调ATM或抑制ATM激酶活性均可降低DNA双链损伤情况下的同源重组修复能力,增加其对c DDP敏感性,同时减少c DDP引起的G0/G1期周期阻滞。结论:抑制ATM可影响卵巢癌细胞同源重组修复过程,增加DNA双链损伤,缓解G0/G1期周期阻滞,增加其对顺铂敏感性。     

Complete versus incomplete placenta previa and obstetric outcome.

OBJECTIVE: To compare obstetric outcome in women with complete versus incomplete placenta previa (PP). METHODS: A 10-year retrospective case-control study was conducted between 1992 and 2001. A 202 singleton pregnancies with PP were analyzed. RESULTS: The incidence of PP was 0.4%. Complete PP comprised 32.7% and incomplete PP 67.3% of cases. No difference was observed in the frequency of antepartum hemorrhage. Women with complete PP had significantly higher requirement for antepartum and postpartum transfusions, higher frequency of postpartum hemorrhage and postpartum hysterectomy. The risk for placenta accreta was increased in complete PP group even after controlling for confounding factors (adjusted OR=3.75, 95% CI=1.11-12.68, p<0.05). No difference in the frequency of preterm delivery was found between the groups. Term infants of mothers with complete PP had significantly lower birth weight (3205 vs. 3360, p=0.04). CONCLUSION: Complete PP is a high-risk subgroup of PP associated with higher maternal morbidity in comparison to incomplete PP.