The Timing Of Stripping Placenta During Cesarean Section For Puerperae With Placenta Implantation

Objective: Currently affecting maternal life safety first is still the postpartum hemorrhage, and the incidence of placenta implantation is on the rise in recent years, second only to the uterine contractions fatigue, to become the obstetric hemorrhage of emergency hysterectomy thumb. Treatment of placenta implantation usually is to unarmed stripping the placenta, and the timing of the unarmed stripping is still controversial. Someone reported the immediate detachment of the placenta after finding placenta implantation, other argued even confirmed placenta implantation, the placenta only could be stripped after uterus contraction. This study was to explore the effect of the immediate detachment of the placenta and placenta stripping after uterus contraction during cesarean section with placenta implantation on the cesarean delivery end, provide reference for clinical work, by comparing the bleeding in cesarean section, intraoperative blood transfusion treatment, in presence of promoting the application of uterotonic, preoperative reduced hemoglobin levels after operation, postoperative intervention, hysterectomy, and other treatment, postoperative disease rate of this a few indicators.MethodsIn this retrospective study, we selected 86 cases of pregnant women for cesarean delivery, without placenta implantation diagnosed by preoperative ultrasonography, with intraoperative diagnosed implantation in October 2015 to May 2016 in the second affiliated hospital of zhengzhou university.According to the placenta stripping time all cases divided into immediate unarmed placenta group(45 cases), waiting for uterine contractions when stripping the placenta group(41 patients). Exclusion criteria included coagulation dysfunction, gestational diabetes or diabetic pregnancy, preeclampsia eclampsia, macrosomia, multiple pregnancy, and polyhydramnios. The blood loss during surgery, intraoperative blood transfusion treatment, uterus contraction drugs such as hin levon Ann column g card prostaglandin tromethamine drugs were measured. We also tested preoperative and postoperative 2 days change of hemoglobin and red blood cell volume level changes(postoperative intravenous fluids are all on the first day of 2200 ml, the second day of 1700 ml), postoperative intervention, hysterectomy, and other treatment, the postoperative body temperature(after 24 hours, after 4 hours, two temperature is more than 38.0 ?), two days after the blood leukocyte regular reminders > 15 * 109 / L, postoperative uterine tenderness, infection of incision, postoperative complication rate. Statistical methods using SPSS17.0 statistical software to analyze the experimental data, the quantitative data using t test, the comparison of qualitative data by chi-square test, and the correlation of two quantitative data analysis used Pearson contingency analysis, inspection level for alpha = 0.05. Results:1. Group 45 cases with immediate unarmed stripping the placenta and 41 patients waiting for uterine contraction unarmed stripping the placenta group of patients age, pregnant time, production time, preoperative hemoglobin concentration, preoperative red blood cell volume, there were no statistically significant difference(P > 0.05);2. In terms of intraoperative blood loss, instant unarmed stripping placenta group(539 + 97 ml) and wait for uterine contractions unarmed stripping placenta group(342 ml) plus or minus 48 difference was statistically significant(P < 0.05)3. Immediate unarmed stripping placenta group 45 cases, there are 14 maternal used special uterine contractions drugs(card prostaglandin tromethamine drugs), but waiting for uterine contraction placenta group only 1 case, and the difference was statistically significant(P < 0.05)4. Immediate unarmed stripping placental blood transfusion in the set of cases was two cases, when waiting for uterine contractions unarmed stripping placenta group was none. The difference was not statistically significant(P > 0.05); In immediate unarmed stripping in the placenta group, 5 cases of uterine contraction after the intraoperative application of drugs was still poor implementation of B-lynch suture, and waited to unarmed stripping placenta group had 1 case. The difference was statistically significant.(P < 0.05)5. Postoperative hemoglobin concentration difference in the two groups were compared with preoperative decline.The immediate unarmed group stripping placenta hemoglobin concentration difference(6.3 + 7.3 g/L) and wait for uterine contractions unarmed stripping placenta group(6.2 + 7.7 g/L) had no statistically difference(P = 0.525 > 0.05);6. Postoperative difference of red blood cell volume in the two groups were compared with preoperative decline, immediate unarmed stripping placenta group(2.08-2.10) and wait for uterine contractions unarmed stripping placenta group of red blood cell volume difference(2.07 + 2.47) between the two had no statistically difference(P = 0.093 > 0.05);7. Postoperative intervention, hysterectomy, and other treatment, immediate unarmed stripping placenta group and treat postoperative uterine contraction unarmed stripping the placenta group were no intervention, treatment such as hysterectomy8. Immediate unarmed stripping placenta group 45 cases, there are three women with twice more than 38.0 ?temperature after postoperative 24 hours.The wait for uterine contractions unarmed stripping placenta group appeared in 2 cases. no incision infection occurred, the two groups after 2 days postoperatively routine blood leukocyte count > 15 * 109 / L, from tenderness obvious signs of infection, and the difference was not statistically significant(P > 0.05); ConclusionIn the cesarean section, if the area of the placenta increta is small and its infiltrating myometrium is shallow, and the treatment is expected to line the artificial stripping the placenta, the intraoperative blood loss of the delay stripping the placenta after uterine contractions is less than that of the immediate stripping the placenta, the corresponding application of special uterine contractions drugs and the impossibility needing B- lynch of uterus suture are all reduced. So, barring special circumstances the placenta is must immediately childbirth, the delay stripping the placenta is advisable.