The Clinical Research On Central Placenta Previa With Hematorrhea In Cesarean Section By Bilateral Ascending Uterine Arteries Ligation

ObjectiveNormal placenta attached to the bottom of the body in the womb, the back wall, front wall, or wall, such as adhere to the lower uterine segment, and even placenta edge reach or cover intrauterine mouth, its position below the presentation department were known as placenta previa. Clinical divided into the central sex placenta previa, some sex placenta previa and marginality placenta previa. With the artificial abortion, induced labor operation and uterine fibroids factors such as increase, placenta previa incidence increased significantly, especially the central type placenta previa, can lead to fatal hemorrhage. Placenta previa is a late gestation and one of the main causes of bleeding during delivery, postpartum hemorrhage is one of the risk factors, and gradually become a cesarean section hysterectomy when the main reason, seriously endangered the maternal health, among them with the central type placenta previa harmfulness maximum. In the process of childbirth fetal childbirth amount of bleeding after24h more than500ml called postpartum hemorrhage. Cesarean section intraoperative hemorrhage is one of the most serious complications of obstetrics, at present is still the main cause of maternal death. Pregnancy.laboratory is the central type placenta previa delivery main way, intraoperative produce massive haemorrhage rate significantly higher than other causes cutting palace art, the intraoperative hin our mother and seasonable injection corpus hemostatic, ligation bilateral uterine artery ascending branch method has obtained some experience and good results. Discuss bilateral ascending uterine artery ligation of the ascendant branch of sex in the central placenta previa cesarean section intraoperative hemorrhage hemostatic clinical curative effect and its clinical application.Methods81cases placenta previa with hematorrhea in cesarean section by bilateral ascending uterine arteries ligation were retrospective analyzed from February2008to February2012, aged21to42years old, all single pregnancy, gestational time1-10times, primipara16cases, of which3cases of early pregnancy primipara; Multipara65cases, including abortion, the qing dynasty palace,56cases of history, the history of cesarean section,46cases of gestational weeks and weeks-40weeks, and the average35weeks. Random divided the patients into bilateral uterine artery ascending branch ligation group (observation group)36cases and "figure of8" suture bleeding, uterine packing group45cases (control group). Choose the bilateral uterine artery ascending branch ligation treatment central sex placenta previa cesarean section patients with massive hemorrhage36cases (observation group) and line "figure of8" suture, uterine cavity filling hemostatic treatment patients45cases (control group), a comparative analysis of the two groups during the operation, the amount of bleeding, postoperative within24hours of vaginal bleeding＞500ml number, blood transfusion number, operation time. Discuss bilateral ascending uterine artery ligation of the ascendant branch of sex in the central placenta previa cesarean section intraoperative hemorrhage hemostatic clinical therapeutic effect.Resultsthe bilateral uterine artery ascending branch ligation treatment central sex placenta previa cesarean section patients with massive hemorrhage36cases (observation group) and line "figure of8" suture, uterine cavity filling hemostatic treatment patients45cases (control group), a comparative analysis of the two groups during the operation, the amount of bleeding, postoperative within24hours of vaginal bleeding＞500ml number, blood transfusion number, operation time. Control group45cases of14cases of hemostatic invalid,9of routine internal iliac artery ligation,5routine uterine time to cut method. The observation group36cases were successful hemostasis,7cases of assembling section implantable placenta,4cases of the patients with a history of cesarean section more amount of bleeding, amount of bleeding1200～1800ml without postoperative bleeding again cases, no hysterectomy cases. The observation group during the operation, the amount of bleeding, postoperative within24hours of vaginal bleeding＞500ml number, blood transfusion number, duration of surgery, are less than control group, between the two groups (P＜0.05). Control group2cases of postoperative line uterine artery embolization, the observation group was no late postpartum hemorrhage occurs, postoperative follow-up42days, B ultra tip uterine size normal echo even, double side accessories normal, postoperative3-6months menstrual complex tide, the quantity and the delivery before have no obvious change. The observation group patients during the operation, the amount of bleeding, postoperative within24hours of vaginal bleeding＞500ml number, blood transfusion number, duration of surgery, are less than control group.ConclusionThe central sex placenta previa must take cesarean section termination of pregnancy, when cesarean section was the amount of bleeding, intraoperative educe bleeding is the key. Gravid uterus blood flow of90%from uterine artery, ligation uterine artery ascending branch can make uterine blood flow after interrupted, at the same time because of oxygen and make uterine smooth muscle contraction, and further oppression blood sinus bleeding. Uterine artery ascending branch ligation1hour uterine establish collateral circulation, uterine contraction instauration, postoperative8days joint firm blood vessels can absorption line loose, blood vessels can recanalization, do not affect uterine blood supply, do not affect the menstruation after agger again and pregnancy and childbirth. In the uterus incision cesarean section slightly below2～3cm in line uterine artery ascending branch ligation, push down bladder, touched the uterine artery beat, make sure no ureteral after joint firm, won’t injure ureteral, high safety. Bilateral uterine artery ascending branch ligation treatment central sex placenta previa cesarean section massive haemorrhage, operation time is short, less intraoperative amount of bleeding, hemostatic effect and reliable, and is to control the placenta previa pregnancy.laboratory bleeding in the effective treatment methods.