Analyze The Different Grades Of Pernicious Placenta Previa's Choice Of Comprehensive Hemostasis Methods During Operation

Objective:To explore the selection analysis of hemostasis mode in different levels of pernicious placenta previa,and to strengthen the classification concept,to provide reference for the clinical treatment of different levels of pernicious placenta previa.Method:A retrospective analysis of 177 pernicious placenta previa patients admitted to the Jiangxi Provincial Maternal and Child Health Hospital from July 2016 to July2018,based on cesarean section and combined with postoperative pathology examination,It was divided into grade I,grade II,grade III and grade IV,including 57cases of grade I,78 cases of grade II,25 cases of grade III and 17 cases of grade IV,and they are divided into four groups,namely group I and group II,group III and group IV.To compare the different grades of pernicious placenta previa patients.The differences intraoperative hemorrhage methods between the four groups were chosen.The intraoperative blood loss,blood transfusion,operation time,postoperative hospital stay,and surgery between the four groups were analyzed,Differences in vaginal bleeding and neonatal outcomes after 12 hours;comparison of hysterectomy rate and urinary system injury rate in each group;comparison of clinical outcomes in different groups using different hemostasis methods.Results:(1)The intraoperative blood loss,blood transfusion and operation time were significantly different between group I,group II,group III and group IV(?~2=73.708,P<0.05;?~2=72.182,P<0.05;?~2=83.742,P<0.05),after the pairwise comparison,the difference between each group was also statistically significant(P<0.05).The higher the level of the pernicious placenta previa,the more the amount of bleeding and blood transfusion,The longer the time of surgery.(2)The difference of hysterectomy rate and urinary system injury rate between the four groups of patients was statistically significant(?~2=73.362,P<0.05;?~2=29.071,P<0.05);comparison of hysterectomy rate,there was no significant difference between the group I and the group II.The hysterectomy rate of the group IV was higher than that of the group III,while the group III was higher than the group I and the group II.comparison of urinary system injury rate,there was no difference between urinary system injury and group I and group II.There was no difference between group III and group IV,but the urinary system injury rate of group III and group IV was higher than group I and group II.(3)The choice of intraoperative hemostasis in the four groups of patients:In group I,the mode of hemostasis in the operation was mainly by one or two combined hemostasis;in group II,the hemostasis in the operation was mainly by three and four combined hemostasis;In the group III,the four methods of hemostasis were mainly used for hemostasis and partial hysterectomy.In the IV group,the hemostasis was mainly performed by hysterectomy.(4)There were no significant differences in the number of postoperative hospitalization stays in the difference intraoperative hemostasis methods of four groups(P>0.05).Comparison of vaginal bleeding at 12 hours after operation:Group I,II,and III,There was no statistical difference.There was a statistically significant difference in the amount of vaginal bleeding at 12 hours after operation in the group IV(P<0.05).The result was that use the four methods of hemostasis combination(1)(2)(3)(6),the postoperative vaginal bleeding was significantly greater than the use a hysterectomy.(5)There were significant differences in the number of postoperative hospital stays and the 12-hour postoperative vaginal bleeding between the four groups(P<0.05).After the comparison between the two groups,there were significant differences between the four groups.The higher the level,The more the number of the postoperative hospital stays;comparison of the 12-hour postoperative vaginal bleeding,Group I is different from group III and group IV,it was statistically significant.The amount of bleeding in group I after 12 hours was more than group III and group IV,and there was no difference in the other groups;There were no significant differences in the neonatal outcomes between the four groups(P>0.05).Conclusions:The higher the clinical grade of pernicious placenta previa,the more intraoperative blood loss and blood transfusion,the longer the operation time and postoperative hospital stay;the higher the hysterectomy rate and urinary system injury rate;the more complicated the intraoperative hemostasis measures selected during operation.It is recommended to strengthen the concept of clinical grading.Provide a reference for the surgical plan before surgery.