Prenatal Diagnosis Of Pernicious Placenta Previa Acrreta And Study On The Application Of Intraoperative Aorta Balloon Occlusion

BackgroundPernicious placenta previa belongs to placenta previa,in which the re-pregnant mother has placenta previa and the placenta attached to the caesarean scar.Placenta accrete is the loss of physiological clear zone between placenta and uterus.It is that one or more maternal cotyledon of placenta attach to deciduas or invade or even penetrate myometrium.Placenta accrete is common after placenta previa,especially pernicious placenta previa.As a result of cesarean scar,the myometrium distribution in scar is different from the other parts of the uterus.In subsequent pregnancy,it is more likely to have decidual dysplasia once the placenta attached to the uterus scar,resulting in placenta accrete.At present,the incidence of placenta accreta is increasing year by year,and the hospital admissions of placenta accreta patients are increasing accordingly.Due to the close attachment of placenta to the myometrium,placenta accreta is associated with an increased risk of heavy bleeding in a short time,for the placental blood sinus may rupture during cesarean delivery.However,it is difficult to reduce the loss of blood effectively because of the weak myometrium and uterine contraction.Presently,placenta accreta is commonly diagnosed by ultrasound and MRI.Ultrasound is considered significantly better with 80-90%sensitivity,and 98%specificity than MRI.As a result,it is the first choice for the diagnosis of placenta accreta.MRI is also the common method for the diagnosis.But it is not preferred with its high price and complexity.It can be act as the complementary method for ultrasound.Abdominal aortic balloon occlusion can temporarily block to the majority of pelvic and lower limb blood supply and reduce blood loss during operation time.It enables the view of surgery to be clear,making it easier for the operator to take the next step.Abdominal aortic balloon occlusion reduces the amount of blood loss during the short period of time that the placenta is peeled and help stabilize the patient’s vital signs,increasing the possibility of retention of the uterus in patients with severe placenta accreta.ObjectivesIn this study,we compared the current diagnostic methods and treatment of pernicious placenta previa and placenta accreta in order to obtain the best diagnosis and treatment methods.Particularly.we described and compared the clinical application of intraoperative aorta balloon occlusion in cesarean delivery of pernicious placenta previa patients.We also compared the short-term postoperative complications of various treatments in order to obtain the most appropriate treatment and management of patients with placenta previa and placenta accreta,providing a reference for clinical treatment options.Method114 patients with pernicious placenta previa undergoing sugery between March,2013 and March,2016 were collected and analysed.The patients were divided into two groups according to whether there was placenta accreta,and different factors were compared between the two groups.In addition,group of placenta accrete were divided into two groups according to whether using intraoperative aorta balloon occlusion,and different factors were compared between the two groups.ResultAmong all 114 enrolled cases,89 cases have proven to be pernicious placenta previa in surgery,in which 87cases were diagnosed as placenta accrete by prenatal ultrasound with positive diagnosis rate of 97.75%,In 72 cases,intraoperative finding was consistent with description of ultrasound with accuracy rate of 82.76%.69 cases accepted MRI,in which all cases were diagnosed as placenta accrete by MRI,with positive diagnosis rate of 100%.Intraoperative finds were consistent with description of MRI in 65 cases,accounting for 94.20%.The pernicious placenta previa acrreta in 89 cases,the average intraoperative blood loss was 1867ml,the red blood cell was 7.66U,the transfusion volume was 648ml.The average hospitalization time was 11.8 days;25 cases were non-implanted group,the average intraoperative blood loss was 650ml,the red blood cell volume was 2.48U.the transfusion volume was 164ml,the average hospital stay was 7.8 days.There was a statistically significant difference between the two groups(p<0.05).114 cases of preclinical placenta cases,cesarean section at the same time hysterectomy in 29 cases,bladder injury repair in 10 cases,all from the placenta accreta group.Of the 89 patients with placenta accreta,59 patients underwent abdominal aortic balloon occlusion,the average amount of bleeding was 1759ml,and the intraoperative blood loss was 2080ml,but there was no statistically significant difference between the two groups(p>0.05).There was no difference between the two groups in postoperative complications(p>0.05).However,there were statistically significant differences in the degree of implantation between the two groups.The number of placenta implants in the intervention group was significantly higher than that in the untreated group.(p<0.05)The amount of bleeding in the surgical treatment of the placenta previa in our hospital decreased year by year.Neonatal Intensive Care Unit(NICU)is necessary for the neonatal up to the gestational weeks,length of stay,neonatal weight.ConclusionThis paper verifies the diagnostic effect of type-B ultrasonic and MRI on the placenta praevia and placenta accreta.B-ultrasonography could be the first choice.The diagnostic effect of MRI is also good and could be used as a supplemental examination method.Pernicious placenta previa has a significant influence on patient hospitalization,intra-operative haemorrhage,and blood transfusion.It is very important for follow-up treatment to make the prenatal diagnosis of placental accreta.The treatment involving interventional treatment and cesarean hysterectomy can reduce the temporary intra-operative haemorrhage for patients diagnosed as placenta accreta,also it has significant clinical value to reduce total blood loss and complication.At the same time,interventional treatment does not increase the risk of postoperative complications.Neonatal birth score was only related to gestational age.and not to the extent of placental adhesion.If there is no obvious threat to the mother with fetal bleeding or other circumstances,cesarean hysterectomy can be performed when the fetal gestational age is slightly larger(36 weeks or later).