Investigate The Experience Of Conserving Uterine During Caesarean Section In Placenta Previa

Objective: To investigate the effect of keeping uterine during caesareansection in placenta previa by assessment and preparation before operation andmultiple sutures applied in operation.Methods: In2009~2014in our hospital obstetrics department treated225cases of patients with placenta previa cesarean delivery,who were not withvaginal labourand or discharged from hospital after spuco or the patients withheart, liver, kidney and other important viscera severe disease. Includingmarginal placenta previa54cases, partial placenta praevia65cases andcomplete106cases,25cases of placenta increta. Retrospective analysis ofimprovement of uterine outcome by evaluation and preparation beforeoperation and multiple sutures applied in caesarean section delivery improvematernal womb ending.After omphalotomy, according to the hemostatic methods are divided intoA, B, C three groups. Our hospital maternity mainly used group A hemostaticmethod in2009: Oxytocin, misoprostol drugs→Salt water hot compress,massage the uterus, uterine cavity filling yarn oppression hemostasis→Noobvious effect perform a hysterectomy.Then continuously explore and improvesurgical skills, from2010, group B method hemostatic scheme graduallyadopted: Based on group A and added selectively used hemabate, bloodtransfusion, blood coagulation factor when necessary→“8” suture of placentadetachment surface over and over again→Tourniquet cerclage lower uterine segment for a few minutes→B-Lynchsuture.From2011gradually formed groupC hemostatic method and applied to date: Based on group B added prophylacticuse hemabate,→After appropriate wedge excision the part of placenta accretethen stitched myometrium→improved CHO suture→If the cervix bleeding isdifficult to use methods of oppression stopped, pushed down the bladderimmediately so as to fully expose the cervical segment, longitudinal cutcervical muscle layer4～5cm when necessary, under direct vision “8” suturethe hemorrhage→Improved lower B-lynch surgical→Uterine artery ligationof uplink.Results:1. The number of placenta previa patients increased from January2009to December2014,and the morbidity is going up.2. After performed the evaluation and preparation before caesarean sectionand multiple sutures during the operation to the placenta previa patients,significantly improve the pregnancy outcome in patients with the placentaprevia.The ratio of hysterectomy in different years have significant difference（P<0.05）; The ratio of postpartum hemorrhage in different years there was nosignificant difference（P>0.05）.3. The ratio of hysterectom of different hemostatic schemey: group B thanin group A were reduced、group C than in group A were reduced、group C thanin group B were reduced, differences were statistical significance（P<0.05）；The postpartum hemorrhage ratio of different hemostatic scheme there was nosignificant difference between group A and group B（P>0.05）;Compared withA, B two groups, group C significantly reduce the incidence of postpartumhemorrhage, the difference had statistical significance (P <0.05). 4.The rate of hysterectomy and postpartum haemorrhage during theelective caesarean section is lower than the emergent caesarean section（P<0.05）.Conclusions:1.The morbidity of patients with placenta previa showsan increasing trend.2. It is significant to reduce the rate of hysterectomy andpostpartum haemorrhage during the caesarean section with placenta previa byconsiderate assessment and preparation before operation and multiple suturesapplied in caesarean section.3. By continuous exploration and improvementthe hemostasia method during the caesarean section with placenta previa, thepresent multiple sutures is significant to reduce the rate of hysterectomy andpostpartum haemorrhage.4. The rate of hysterectomy and postpartumhaemorrhage during the elective caesarean section is lower than the emergentcaesarean section.