The Analysis Of Diagnosis And Treatment About Placenta Previa

Objective:To discuss the risk factors of placenta previa and placenta increta;To evaluate the meaning and method of antenatal diagnosis in the patient of pernicious placenta previa with increta;and the effectiveness of temporary balloon occlusion of the internal iliac artery before uterine incision to prevent massive obstetric hemorrhage.Methods:This retrospective study included 381placenta previa patients between January 2010 and December 2014 without complication.(1).According to the condition of placenta,they are divided into four groups:placenta previa,placenta previa with increta,pernicious placenta previa,pernicious placenta previa with increta.Analyzing the risk factors of placenta increta and the different outcomes.(2). Comparing the effectiveness of Bakri balloon tamponade in this four groups.Summarizing the best indications of Bakri balloon tamponade.(3).Making sure where the placenta adhere according to the Ultrasound and MRI,the group of pernicious placenta previa with increta can be divided three groups:anterior group,posterior group,broadside group.Comparing the maternal outcomes.(4). Calculating the sensitivity,specificity,positive predictive value,negative predictive value of Ultrasound in placenta increta.(5).The pernicious placenta previa andpernicious placenta previa with increta can be divided into two groups:with and without interventional radiology. Summarizing the clinical evalue and the best indication.Results:(1).The difference of average gravidity,the rate of PPH and hysterectomy,the measure of transfusion and blood loss is prominent between the four groups(P< 0.05).The A group’s blood gas analysis is higher than the other three groups(P< 0.05).(2).The effectiveness of Bakri balloon tamponade of A group is lower than the other three groups(P<0.05).(3).In the D group,the blood loss and hysterectomy (2763.27±1808.17; 73.4%)of anterior group are higher than the posterior group(1766.67±1058.30; 44.8%)(P<0.05).(4).The sensitivity,specificity,positive predictive value,negative predictive value,the rate of missed diagnosis,and the misdiagnosis rate are 85.3%,89.9%,73.6%,94.8%,14.7%,10.1%.(5).The rate of DIC,hysterectomy,infection,transfusion and blood loss between the two interventional radiology group have significant difference(P<0.05).Conclusion;(1).Multiple gravidity,delivery,abortion,and caesarean section have significant correlation with placenta previa and placenta increta.The more aborions and caesarean sections,the more placenta incretas.(2).The Bakri balloon tamponade is appropriate for PPH with different reasons,especially for placenta previa.It is better than uterine artery ligation.(3).In the pernicious placenta previa with increta group,the prognosis of the placental position in the anterior portion is bad than the posterior portion.(4).The ultrasound has higher sensitivity in placenta increta.It is very important in the patients of pernicious placenta previa and placenta increta.(5).Temporary balloon occlusion of the internal iliac artery before uterine incision during caesarean delivery can potentially reduce the blood loss in the patient without placenta increta,but for the patients with the placenta percreta,the uterine segment damaged hard,and the abundant collateral circulation have no significant effectiveness.