Analysis Of Risk Factors Of Intraoperative Hemorrhage Of Caesarean Section In Complete Placenta Previa Complicated With Placenta Accreta

ObjectiveTo explore the risk factors of intraoperative hemorrhage of Caesarean section in complete placenta previa complicated with placenta accrete puerperae.MethodsA retrospective analysis was conducted.The clinical data from 185 pregnant women with complete placenta previa complicated with placenta accrete underwent caesarean delivery admitted to Third Affiliated Hospital of Guangzhou Medical University from September 1st 2015 to September 15 th 2017 was collected.The patients were divided into two groups the hemorrhage group 81 cases(greater than 1500ml)and the control group 104 cases(less than or equal to 1500ml)according to intraoperative hemorrhage of caesarean section.Through the case management system and consult clinical data,age,weight,gestational weeks,pregnancy times,production times,the degree and position of placenta accrete,history of previous cesarean section,operation history of uterine cavity,preoperative anemia,platelet(PLT),prothrombin time(PT),the international normalized ratio of Prothrombin time(PT INR),activated partial thromboplastin time(APTT),fibrinogen(fg),thrombin time(TT),ureteral stent,surgical retention of uterus,anesthesia method,colloidal solution,crystalloid solution.Measurement data with normal distribution were represented as sx±.The univariate analysis was done using the chi-square test and independent-samples T test,and multivariate analysis was done using the Logistic regression model.Results The rate of the hemorrhage group(81 cases)in all clinical cases was 43.78%,the rate of the control group(104 cases)was 56.22%.1.The result of univariate analysis showed that gestational weeks,preoperative anemia,history of previous cesarean section,the degree of placenta accrete,ureteral stent,surgical retention of uterus,anesthesia method,colloidal solution and crystalloid solution were the factors infecting intraoperative hemorrhage of caesarean section in complete placenta previa complicated with placenta accrete(P<0.05).2.The result of multivariate analysis showed that the degree of placenta accrete(OR=7.418,95%CI=1.991~27.644,P=0.003),hydroxyethyl starch(OR=3.226,95%CI=1.413~7.365,P=0.005)and crystalloid solution(OR=3.310,95%CI=1.098~9.979,P=0.034)were independent risk factors infecting intraoperative hemorrhage of caesarean section in complete placenta previa complicated with placenta accrete.Conclusions 1.The degree of placental implantation of puerpera is an independent factor infecting intraoperative hemorrhage of caesarean section in complete placenta previa and it should be evaluated before operation,and prepare for preoperative anesthesia.2.Intraoperative infusion of hydroxyethyl starch and crystal fluid was positively correlated with intraoperative hemorrhage during cesarean section.The mass use of hydroxyethyl starch and crystal fluid in the operation may increase the risk of bleeding during cesarean section.