Clinical Application Of Interventional Treatment In Pernicious Placenta Previa

Objective:To retrospectively analyze the intraoperative,postoperative and neonatal outcomes of different treatment methods for pernicious placenta previa,and to explore the clinical application value of interventional treatment in pernicious placenta previa.Methods:A retrospective analysis of 179 cases of pernicious placenta previa by Cesarean delivery from December 2012 to December 2017 in our department of obstetrics,1 case with twins and 2 cases with vaginal delivery were excluded,176 cases were included.69 patients took interventional treatment.According to whether or not to take interventional treatment,this study was divided into interventional group and non-interventional group;according to whether the incision before the uterus interventional therapy is divided into 19 cases active intervention group and 50 cases passive intervention group.By comparing the general condition of patients between groups,the intraoperative,postoperative and neonatal outcomes,to evaluate the effects of clinical application.Results:1.The incidence of previous cesarean section was higher in the interventional group than in the non-interventional group,and the termination of pregnancy gestational age was shorter in the interventional group than in the non-interventional group(P<0.05).There was no difference between the two groups in terms of age,parity,and miscarriage times.2.There was no statistically significant difference between the active intervention group and the passive intervention group in the general case.3.The amount of postpartum hemorrhage in the interventional group(794.20±357.23ml)was significantly lower than the non-interventional group(1153.74±1002.44ml),and the difference was statistically significant(P<0.01).The amount of postpartum hemorrhage(642.11±273.49ml)was lower in the active intervention group than in the passive intervention group(844.00±372.61ml).The difference was statistically significant(P<0.05).5.The hysterectomy rate,postpartum hemorrhage rate,blood transfusion rate,postoperative DIC rate,postoperative hospitalization days in the interventional group were all lower than those in the non-interventional group(P<0.05).The rate of placenta implantation abnormality was higher in the interventional group than in the non-interventional group.The placenta implantation abnormality rate between the two groups was statistically different(P<0.05);there was no statistical difference in the rate of transfer to the ICU.6.The rate of placenta implantation abnormality in the active intervention group was higher than that in the passive intervention group(P<0.05);There was no statistical difference in the ICU rate,hysterectomy rate,postpartum hemorrhage rate,blood transfusion rate,concurrent DIC rate and the postoperative hospitalization days.7.The preterm birth rate of the interventional group was higher than that of the non-interventional group,there was a significant difference(P<0.01).There was no significant difference in neonatal asphyxia rate,NICU transfer rate,neonatal mortality rate between the two groups.8.There was no significant difference in the rate of neonatal preterm birth,asphyxia,neonatal mortality,and NICU transfer rate between the active intervention group and the passive intervention group.Conclusion:1.PPP increased the risk of pregnancy and childbirth,especially in patients with placenta accreta usually accompanied by adverse pregnancy outcomes,strictly control of cesarean section indications,avoidance of cesarean section without indications of cesarean section.2.The emergence of interventional therapy provides an alternative to conventional hemostasis measures,reducing postpartum hemorrhage,hysterectomy,and blood transfusion rates.3.Interventional treatment did not increase adverse neonatal outcomes.4.PPP combined with severe placenta accreta can be used in preoperative prophylactic endovascular balloon occlusion to reduce intraoperative blood loss.5.The development of interventional treatment requires multi-disciplinary teamwork,step-by-step prenatal diagnosis,and flexible application of intervention methods.It is necessary to establish standard treatment guidelines to reduce the occurrence of complications.