A 4-year Clinical Study Of The Diagnosis And Treatment About Placenta Accrete In The Third Trimester Of Pregnancy

Objective:The aim of this study is to analyze the risk factors,diagnosis,delivery time.anesthetic techniques associated with placenta implantation in the third trimester of pregnancy and further to explore its methods of diagnosis and treatment so as to improve the prognosis of patients.Method:A retrospective study about the diagnosis and treatment of 75 cases of placenta accrete from January 2013 to December 2016 was carried out at Obstetrics of Subei People's Hospital of Jiangsu Province.75 cases of placenta implantation in the third trimester of pregnancy' were divided into three groups based on the types of placenta accrete,which were the group of placenta accrete,the group of placenta increta,and the group of placenta percreta.The effects of different types of placenta implantation in the third trimester of pregnancy on maternal treatment,anesthetic techniques,intraoperative blood loss,postpartum hemorrhage,blood transfusion volume,hemoglobin,blood coagulation,urinary tract injury,infection,transferring to the intensive care unit and duration of hospitalization were analyzed.Result:1.The total pregnant women in hospital was 13068 at Obstetrics of Subei People's Hospital of Jiangsu Province from January 2013 to December 2016.There are 77 patients with placenta implantation,including 2 cases of placenta implantation in the second trimester and 75 cases of placenta accrete in the third trimester of pregnancy.The incidence of placenta implantation was 5.89‰,and its annual incidence of placenta implantation was 3.202‰,3.90‰,5.40‰,10.30%?,which was rising year by year.2.The risk factors for placenta implantation in the third trimester of pregnancy included previous cesarean delivery,scarred uterus,history of abortion and curettage,placenta previa.age>35years and multipara(P<0.05),among which previous cesarean delivery,scarred uterus,history of abortion and curettage and placenta previa were the most important risk factors of placenta implantation in the third trimester of pregnancy(P<0.001).There were significant differences among group of placenta accrete,group of placenta increta,and group of placenta percreta regarding previous cesarean delivery(P=0.004).history of abortion and curettage(P=0.007)and placenta previa(P=0.001).The more times maternity had the history of abortion and curettage and previous cesarean delivery,the much deeper the placenta implanted into myometrium.Patients with placenta previa were more prone to catch placenta increta and placenta percreta.3.All the cases make prenatal examinations by ultrasound at least once.The positive rate of prenatal diagnosis by ultrasound was 16%(12/75),and the missed diagnosis rate was 84%(63/75).7 cases were diagnosed by ultrasound combined magnetic resonance imaging,and its positive rate of prenatal diagnosis was 100%(7/7).47 cases were diagnosed by clinical symptoms.9 cases were diagnosed by pathology.4.The effective rate of conventional treatment with drugs was 71.43%(5/7).The effective rate of conservative operation was 96.83%(61/63),among which the effective rate of dilation and curettage,electrotomy with hysteroscope,uterine arterial embolization,internal iliac artery embolotherapy,internal iliac arteries balloon occlusion,internal iliac arteries balloon occlusion combined uterine arterial embolization,bilateral uterine artery ascending branch ligation,B-lynch were 100%(10/10),100%(4/4),85.71%(6/7),100%(3/3),100%(4/4),100%(9/9),100%(8/8),94.44%(17/18),respectively.The effective rate of hysterectomy was 100%(3/3).There was no maternal death.5.There were significant differences regarding postpartum hemorrhage,postpartum hemoglobin,blood transfusion volume,composition of blood transfusion,the incidence of urinary tract injury,the incidence of infection,the incidence of uterine rupture,the incidence of hysterectomy,the incidence of transferring to the intensive care unit and duration of hospitalization among group of placenta accrete,group of placenta increta,and group of placenta percreta(P<0.05).There were significant differences regarding amount of bleeding of elective surgery and amount of bleeding of emergency operation among the three groups(P<0.05).6.The comparison of anesthetic techniques among the three groups revealed that spinal anesthesia was main anesthetic techniques of placenta accrete,while combined spinal and epidural anesthesia was main anesthetic techniques of placenta increta.higher percentage combined spinal and epidural anesthesia.And there was a higher proportion of patients with placenta percreta turning combined spinal and epidural anesthesia to general anesthesia due to the deeper degree of placenta implantation,a large amount of intraoperative bleeding,prolonged operation time and patients can't tolerate operation under combined spinal and epidural anesthesia.7.The incidences of premature and transferring to the neonatal intensive care unit were 29.33%(22/75)and 25.33%(19/75),respectively.Conclusion:1.The incidence of placenta implantation from January 2013 to December 2016 showed an upward trend year by year.2.previous cesarean delivery,scarred uterus,history of abortion and curettage,placenta previa,age?5years and multipara are the risk factors for placenta implantation in the third trimester of pregnancy,among which previous cesarean delivery,scarred uterus,history of abortion and curettage and placenta previa were the most important risk factors of placenta implantation in the third trimester of pregnancy.And the more times maternity had the history of abortion and curettage and previous cesarean delivery,the much deeper the placenta implanted into myometrium.In addition,patients with placenta previa were more prone to catch placenta increta and placenta percreta.3.The improvement the imaging examination of placenta implantation is contributive to improve the positive rate of prenatal diagnosis of placenta implantation,which provide the opportunity for clinicians to make reasonable treatment measures.4.Conservative operation treatment is an ideal method for placenta implantation,but clinicians should grasp the indications of conservative operation treatment.For the deeper degree and larger area of placenta implantation with hemorrhagic shock,hysterectomy should be carried out immediately to save the patients' life.Hysterectomy was carried out under leaving the placenta in situ can reduce the intraoperative blood loss effectively.5.The effect of interventional therapy about placenta implantation in the third trimester of pregnancy is distinct.It is worth extending and applying in clinic because of its being minimally invasive,shorter operation time,better hemostatic effect,less adverse reaction and can retain the uterus and fertility function.6.For the deeper degree of placenta implantation(especially for placenta percreta),combined spinal and epidural anesthesia is the preferred anesthetic technique.If there is a large amount of bleeding during operation,combined spinal and epidural anesthesia can be turned to general anesthesia at any time in order to expanding the scope of the operation and prolong operation time.