A Meta-analysis Of The Clinical Efficacy On Two Different Methods In The Treatment Of Pernicious Placenta Previa

Objects:The difference of the clinical efficacy between uterine artery embolization with cesarean section and conventional cesarean section in the treatment of pernicious placenta previa are compared and analyzed,and whether uterine artery embolization combined with cesarean section has advantages in the treatment of pernicious placenta previa should be evaluted.We hope to provide a favorable evidence-based basis for the clinical application of uterine artery embolization combined with cesarean section surgery in the treatment of pernicious placenta previa.Methods:Surfing online to find relevant literatures on uterine artery embolization assisted cesarean section surgery for the treatment of pernicious placenta previa,by searching Wanfang Medicine Network,CNKI,Pubmed,Cochrane Library.The retrieval time is from the beginning of the database until January 2019.Two evaluators separately screened the retrieved documents,evaluated the quality of the literature,and extracted relevant data according to the established criteria.If the opinions of the two evaluators are different,they will apply for a third evaluator to resolve the differences through discussion.Finally,the statistical software RevMan 5.3 was used to perform Meta-analysis on the relevant literatures.Results:After screening,a total of 18 articles that met the criteria and all included literatures were in Chinese.The types of studies all belonged to retrospective cohort studies.According to whether using uterine artery embolization in cesarean section or not,the patients were divided into two groups: the embolization group and the controlgroup.The number of patients in the embolization group was 667,while the number in the control group was 639.The total number of patients was 1316 cases.Meta-analysis results were as follows:(1)Compared with the two groups,the embolization group had less intraoperative blood loss,and the difference was statistically significant(SMD=-2.15,95% CI[-2.64,-1.66],P<0.00001);(2)Compared with the two groups,the operation time of the embolized group was shorter,the difference was statistically significant(SMD=-4.03,95% CI [-5.65,-2.42],P<0.00001);(3)Compared with the two groups,the postoperative hospital stay was shorter in the embolization group,the difference was statistically significant(SMD=-1.44,95% CI [-2.16,-0.71],P=0.0001);(4)between the two groups In comparison,patients with embolization had a lower rate of hysterectomy,and the difference was statistically significant(OR=0.12,95% CI [0.07,0.19],P<0.00001);(5)compared between the two groups,patients in the embolization group the incidence of DIC was lower,and the difference was statistically significant(OR=0.24,95% CI[0.15,0.38],P<0.00001);(6)Compared with the two groups,the rate of puerperal infection was lower in the embolization group,and the difference was statistically significant.(OR=0.30,95% CI [0.16,0.57],P=0.0002);(7)Neonatal asphyxia rates between the two groups had no significant difference,and the difference was not statistically significant(OR =0.61,95% CI [0.33,1.1 4],P=0.12).Conclusions:1.The clinical efficacy of uterine artery embolization assisted cesarean section surgery in the treatment of pernicious placenta previa is significantly better to conventional cesarean section.2.Compared with conventional cesarean section surgery,uterine artery embolization assisted cesarean section surgery for the treatment of pernicious placenta previa can reduce the incidence of complications such as hysterectomy,DIC and puerperal infection.3.Using uterine artery embolization during cesarean section does not adversely affect neonatal outcomes.