Related Factors For Hysterectomy After The Application Of Temporary Ballon Occlusion Of The Abdominal Aorta In Cesarean Section For The Pernicious Placenta Previa And Consequent Perinatal Outcomes

Objective: To explore the influence factors for hysterectomy after the application of temporary balloon occlusion of the abdominal aorta in cesarean section for the pernicious placenta previa,and analyze maternal and neonatal outcomes.Methods: A total of 146 women receiving temporary balloon occlusion of the abdominal aorta in cesarean section because of pernicious placenta previa were collected from February 2015 to July 2017 in the First Affiliated Hospital of Chongqing Medical University with hysterectomy(n=22)and without hysterectomy(n=124).The other 146 cases were selected from the patients who did not undergo temporary balloon occlusion of the abdominal aorta in cesarean section and were diagnosed as scar uterus with placenta increta at a ratio of 1:1 to each of subjects mentioned above with similar degree of placenta increta during surgery,among which there were 36 cases with hysterectomy and 110 cases without hysterectomy.Data of the clinical information before and after surgery were recorded,as well as maternal and neonatal complications.A conditional logistic regression analysis were applied to investigate the relevant confounders of hysterectomy.Results: The hysterectomy rate in balloon group was significantly lower than that in non-balloon group(15.1% VS 24.7%,P<0.05).The uterine artery embolization was the protective factor to hysterectomy(B value:-1.968,OR 0.355,95%CI 0.239~0.528),frequency of artificial abortion(B value: 0.929,OR 1.307,95%CI 1.054~1.655)and degree of placental implantation(B value: 1.622,OR 1.204,95%CI 1.103~1.305)were the risk factors.They were all closely related to hysterectomy(P<0.05).The hysterectomy group were characterized with significantly more blood loss and blood transfusion,longer operation time and length of stay,higher rate of operative complication and transferring to ICU in comparison with those in non-hysterectomy group(P<0.05).The blood loss and blood transfusion volume in balloon group were significantly lower than those in non-balloon group among 58 patients with hysterectomy(P<0.05).There was no significant difference between balloon group and non-balloon group among 234 patients without hysterectomy(P>0.05).Conclusion: Frequency of artificial abortion and degree of placental implantation associated with hysterectomy.Temporary balloon occlusion of the abdominal aorta in cesarean section could significantly reduce intraoperative blood loss and blood transfusion,and reduce the hysterectomy risk.The patients with hysterectomy had more blood loss and higher rate of transferring to ICU.Consequent neonatal outcomes haven't been obviously affected.