| Objective:With the increase of induced abortion and cesarean section,the incidence of placental accreta is getting higher and higher.Placental accreta can lead to massive hemorrhage in pregnant women and seriously endanger the lives of mothers and infants.To observe the clinical efficacy on controlling intraoperative bleeding and reducing the rate of hysterectomy and the perioperative complications related to interventional procedures in patients with placenta accreta who were treated with prophylactic abdominal aortic balloon catheter before caesarean section,and to explore and evaluate the safety and effectiveness of prophylactic abdominal aortic balloon catheter in cesarean section surgery for assisting patients with placenta implantation,as well as the prevention and treatment of complications related to interventional procedures.Methods:The clinical data of 230 cases of caesarean section due to placenta implantation in the Affiliated Hospital of Qingdao University from January 1,2015 to October 30,2018 were collected and analyzed retrospectively.Abdominal aortic balloon catheter was performed with DSA(digital subtraction angiography)before cesarean section in 205 cases(study group),and abdominal aortic balloon catheterization was not performed before cesarean section in 25 cases(control group).The amount of intraoperative blood loss,operation time,hospitalization days,cases of hysterectomy,neonatal Apgar score of1 minute and 5 minutes were analyzed and compared between the two groups by SPSS 22.0statistical software.The quantitative data were described by mean±standard deviation(x±s),the mean values of samples were compared by t test,the difference was statistically significant with P<0.05,while the qualitative data were described by number and percentage,Chi-square(X2)test was used,the difference was statistically significant with P<0.05.The perioperative complications related to interventional procedures were also analyzed.Results:A total of 230 patients were included in this study.All patients were diagnosed as placenta implantation by fetal color Doppler ultrasound or/and female pelvic MR plain scan.Cesarean section was performed to terminate pregnancy,and placenta implantation was confirmed during cesarean section.There were no significant differences in age,pregnancy times,delivery times,gestational weeks,blood pressure,heart rate and coagulation function between the study group and the control group before cesarean section(P>0.05).The average amount of blood loss during cesarean section in the study group and the control group was(1251.71±692.37)ml and(2316±1674.24)ml respectively,t=2.89,P=0.004;The average operation time was(76.30±17.89)min and(92.2±36.83)min respectively,t=3.62,P=0.000;the average hospitalization days were(10.15±3.42)days and(10.16±5.44)days respectively,t=0.01,P=0.990;the average neonatal Apgar score of 1minute was(9.16±1.25)min and(9.12±1.48)min respectively,t=-0.17,P=0.865;and the average neonatal Apgar score of 5 minute was(9.76±0.65)min and(9.64±0.76)min respectively,t=-0.86,P=0.392;the hysterectomy rate was 3.41%(7/205),16%(4/25)respectively,X~2=5.23,P=0.022.The amount of blood loss,operation time and hysterectomy rate in the study group were significantly lower than those in the control group(P<0.05),but there was no significant difference in the days of hospitalization and neonatal Apgar score of 1min and 5min between the study group and the control group(P>0.05).In the study group,uterine artery embolization was performed in 7 cases(3.41%)after ineffective conservative treatment,right inguinal hematoma was occurred in 3 cases(1.46%)and arterial thrombosis of right lower extremity was occurred in 5 cases(2.44%),and venous thrombosis of right lower extremity was occurred in 2 cases(0.98%).There were no other complications such as aortic dissection,aortic rupture,acute renal failure and reperfusion injury.In the control group,uterine artery embolization was performed in 2cases(8%)after ineffective conservative treatment with active bleeding after cesarean section,and there were no complications related to interventional operation.Conclusion:Prophylactic abdominal aortic balloon catheter placement before cesarean section in patients with placental implantation can effectively reduce the amount of intraoperative blood loss,shorten the operation time of cesarean section,and provide a relatively clear surgical field of vision for obstetricians.It can significantly reduce the hysterectomy rate,retain the fertility of patients,and its clinical efficacy has been confirmed,but abdominal aortic balloon catheter placement may lead to lower extremity arteriovenous thrombosis and other complications,which need to be given more attention.In a word,prophylactic abdominal aortic balloon catheter placement before cesarean section is a temporary,less invasive,safe and effective interventional adjuvant therapy for patients with placental implantation,which is worthy of clinical application. |
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