Application Of Abdominal Aortic Balloon Occlusion In Patients With Pernicious Placenta Previa Complicated With Placenta Implantation

Background Pernicious placenta previa is one of the long-term complications of cesarean section,which can cause serious obstetric complications such as perioperative hemorrhage,hysterectomy,hemorrhagic shock and life-threatening,it often accompanied by placenta implantation.Cesarean section is often used to terminate pregnancy,fast and effective hemostasis is the key of the treatment.At present,the commonly used hemostatic methods in cesarean section include: vascular ligation,uterine cavity packing,uterine compression suture,and interventional therapy: vascular embolization,balloon occlusion,etc.With the continuous development of interventional technology,the application of abdominal aortic balloon occlusion in obstetrics is more and more,but the complications caused by it also cause extensive attention.This paper mainly discusses the application value and risk of abdominal aortic balloon occlusion in patients with pernicious placenta previa complicated with placenta implantation under multidisciplinary model.Objective 1.To explore and analyze the clinical application of abdominal aortic balloon occlusion for patients with pernicious placenta previa complicated with placenta implantation;2.To explore the feasibility of reducing the complications related to abdominal aortic balloon occlusion by optimizing the operation process,multidisciplinary cooperation and strengthening postoperative care.Method From January 2017 to January 2020,81 patients with pernicious placenta previa and placenta implantation were treated in our Hospital,the information were collected and retrospectively analyzed.According to the treatment plan,they were divided into two group,include group A: preset abdominal aortic balloon group(n=37)and group B: conventional group(n=44).In group A,the patients underwent cesarean section after preseting abdominal aortic balloon occlusion in hybrid operating room under the multidisciplinary model.In group B the patients received cesarean section in the conventional operating room under the multidisciplinary model.The differences in age,gestational weeks,times of pregnancy,times of delivery,number of abortions,times of cesarean section between the two groups were analyzed.The operation time,intraoperative blood loss,blood loss two hours after operation,blood transfusion volume,blood transfusion rate,the use rate of special uterine contraction agents,blood loss two hours after operation,postpartum hemorrhage rate,postoperative exhaust time,number of hysterectomy cases,average postoperative hospital stay,incidence of postoperative complications,postoperative transfer to intensive care unit,postoperative white blood cell count,postoperative bloody lochia duration,42 days of postoperative uterine recovery,postoperative menstrual flow time and neonatal prognosis and so on,were compared between the two groups.Results 1.There was no significant difference in age,gestational weeks,times of pregnancy,times of delivery,times of cesarean section and number of abortions(P=0.823,P=0.304,P=0.399,P=0.606,P=0.099,P=0.966)between the two groups(group A and group B)(P > 0.05);2.The operation time,intraoperative blood loss,blood loss two hours after operation,blood transfusion volume,blood transfusion rate,postpartum hemorrhage rate,utilization rate of special uterine contractile agents,hysterectomy rate,average postoperative hospital stay,postoperative bloody lochia duration in the group A,were significantly lower than those in the group B(P<0.001,P=0.004,P<0.001,P<0.001,P=0.007,P<0.001,P<0.001,P=0.02、P=0.003,P<0.001),the difference was statistically significant(P < 0.05);3.There were no significant differences in postoperative transfer to intensive care unit,postoperative exhaust time,leukocyte count two days after cesarean section,postoperative complication rate,42 days of postoperative uterine recovery,menstrual flow time and neonatal prognosis(P=0.06,P=0.476,P=0.06,P=0.77,P=0.528,P=0.561)between the two groups(group A and group B)(P > 0.05).Conclusion 1.Abdominal aortic balloon occlusion in patients with pernicious placenta previa complicated with placenta implantation can reduce operation time,intraoperative bleeding,blood loss two hours after operation,blood transfusion volume,blood transfusion rate,postpartum hemorrhage rate,usage rate of special uterine contraction agents,hysterectomy rate,average postoperative hospital stay,postoperative bloody lochia duration,which has positive effect and has clinical promotion value.2.Through multi-disciplinary joint mode,hybrid operating room,and symptomatic treatment and nursing care during and after operation,abdominal aortic balloon occlusion therapy does not increase the risk of serious postoperative complications.