The Value Of Ultrasound-guided Balloon Occlusion Of The Abdominal Aorta In Patients With Pernicious Placenta Previa

Research background Pernicious placenta previa(PPP)was defined by Chattopadhyay[1] in 1993 as patients with the history of cesarean,and placenta attaches to the place of uterine incision during pregnancy this time.PPP is a serious complication in obstetrics,which usually induces unmanageable bleeding during prenatal or intrapartum time,and even causes disseminated intravascular coagulation(DIC),shock and other serious complications to death.This will lead to high rate of cesarean hysterectomy and maternal mortality.As the liberalization of two-child policy and constantly rising of caesarean section rate,we can foresee patients with PPP will also increase.Therefore,the clinical problems to be solved urgently is how to search a new method for the treatment of pernicious placenta previa to reduce the amount of blood and the rate of cesarean hysterectomy and maternal mortality.This paper aims to discuss the application value of Ultrasound-guided Balloon Occlusion of the abdominal aorta in Patients with pernicious placenta previa.By retrospectively analyzing situation during cesarean section and postoperative with different cesarean section in patients with pernicious placenta previa,we explore the clinical application value of the Ultrasound-guided Balloon Occlusion of the abdominal aorta in patients with pernicious placenta previa.Research objectiveResearch materials and methods 95 cases of pernicious placenta previa in our hospital from June 2013 to November 2016 were analyzed retrospectively.Among all the patients,ultrasound guided temporary balloon occlusion in abdominal aorta before the cesarean was carried out in 69 patients from September 2015 to November 2016 in hospital,as the intervention group,to temporarily block the flow of abdominal aorta blood.According to the different time of balloon block,intervention group is divided into prenatal group(the time of balloon occlusion is before fetal delivery)and postpartum group(the time of balloon occlusion is after fetal delivery).Because there has not yet been carried out this therapy,the other 26 patients from June 2013 to August 2015 in hospital didn't get operation like in intervention group,but were carried out cesarean directly(general group).The rate of presetting abdominal aorta balloon successfully and the block situation of intraoperative blood flow in the intervention group were collected.The volume of intraoperative blood,blood transfusion and specific drugs to promote uterine contraction,hysterectomy rate,maternal and child outcomes and related near and long-term complications and other indicators were compared between the two groups.All data used SPSS 21.0 to analysis.Data of the normal distribution was described by((?)±S).The comparison of measurable data used t test(normal distribution)or non-parametric test(abnormal distribution),while count data did ?2 test or Fisher's exact test.?=0.05 is the test level,and the difference had statistical significance as P< 0.05.Results 1.The comparison between intervention group and general group: 1As P>0.05,the difference in general situation of pregnant woman such as age,times of pregnancy,gestational age and history of cesarean section,preoperative complications,anesthetic and incision type had no statistical significance between intervention group and general group.2The average volume of intraoperative blood in intervention group(663.1±219.0ml)was obviously less than that in general group(1559.8±452.5ml),which had a statistically significant difference as t=-9.687,P<0.001.The volume of blood transfusion and specific drugs used in intervention group was less than that in general group.And they had statistically significant differences as both P<0.001.3There were two uterine removed in intervention group,while 15 in general group,which had a statistically significant difference as ?2=34.950,P<0.001.(4)The comparison of maternal and neonatal outcomes in two groups,there had statistically significant differences in fetal Apgar 1 minute and 5 minutes scores after delivery(P=0.001,P=0.004).And the situation in intervention group was better than that in general group.According to the common conditions of maternal and neonatal in each group,patients were divided into 3 categories.The results indicated different prognosis in two groups as Z=-5.055,P<0.001.And the outcomes in intervention group was better than that in general group.2.Conditions of intervention group in surgery: 1In the intervention group,the diameter of the abdominal aorta was 1.20 ~ 1.70 cm,and the concentration was 1.40 ~ 1.50cm;2Under the guidance of ultrasound,we can clearly see the process of femoral artery puncture,which can avoid femoral arteriovenous fistula?femoral nerve injury and other complications caused by blind puncture.Also,balloon catheter can accurately arrive the predetermined location,and ultrasound can monitor intraoperative blood flow dynamics;3According to the different time of balloon block,intervention group is divided into prenatal group(implementation of block before fetal childbirth)and postpartum group(implementation of block after fetal childbirth).As P>0.05,the difference in general situation of pregnant woman such as age,times of pregnancy,gestational age and history of cesarean section,preoperative complications,anesthetic and incision type had no statistical significance between prenatal group and postpartum group.The average volume of intraoperative blood in prenatal group(541.3±150.6ml)was less than that in postpartum group(812.4±197.4ml),which had a statistically significant difference as t=-6.471,P<0.001.The volume of blood transfusion and specific drugs used in prenatal group and postpartum group neither had no statistical significance(P=0.181,P=0.168).The comparison of maternal and neonatal outcomes in two groups,there neither had no statistical significance in fetal Apgar 1 minute or 5 minutes scores after delivery(P=0.104,P=0.103).According to the common conditions of maternal and neonatal in each group,patients were divided into 3 categories.The results of prognosis indicated there had no statistical significance in two groups as Z=-1.107,P=0.268.3.Follow-up: No significantly related complications was found..Conclusion: 1.Ultrasound can be used in the surgery of balloon occlusion of abdominal aorta.When used in the cesarean section of pernicious placenta previa,it can reduce the amount of bleeding and the rate of hysterectomy,and improve the prognosis of maternal and fetal.2.Ultrasound-guided balloon occlusion in abdominal aorta can measure abdominal aortic diameter before operation,thus we can select appropriate balloon catheter.During the operation,the puncture process can be observed clearly,and it can accurately guide balloon preset in abdominal aortic below the opening of the renal artery.Also it can monitor the situation of blockade.3.The best blocking time is before fetal delivery,but there needs relatively high requirements for operator.4.The whole procedure is accomplished in ordinary operation room,so that maternal and fetal and medical personnel can avoid radiation damage.