Functional Analysis Of Bundles Modle In Pregnancy Management Of Patients With Placenta Accreta

Research backgroundPlacenta accreta is a serious complication in obstetrics,which is the main cause of severe postpartum hemorrhage and perinatal hysterectomy.Placenta previa and previous cesarean section is the main risk factor for placenta accreta.With the adjustment of the fertility policy in recent years,many women with a history of cesarean section become pregnant again,leading to an increasing incidence of placenta accreta.Management of maternal women to improve maternal perinatal adverse outcomes has become a research hotspot in the field of obstetrics in recent years.There is evidence that perioperative multidisciplinary team management can reduce the incidence of complications and maternal mortality,but there are no reports of out-of-hospital management.To improve the safe delivery of pregnant women with placenta accreta,normative Bundles model management of safe delivery has been carried out for patients with placenta accrete since 2017,integrating in-hospital and out-of-hospital management of placenta accreta into a systematic and continuous management model,aiming to reducing adverse perinatal pregnancy outcomes through the clinical promotion of these management models.Research objectivesTo explore the effect of Bundles model management on pregnancy outcomes of patients with palcenta accreta.Research objects and methodsThe obstetrics department of our hospital has implemented the Bundles model management in pregnancy for pregnant women with a history of cesarean section and prenatal diagnosis of placenta previa combined with placenta accrete since 2017,after a year of improvement,the model has been fully operational.A total of 140 parturients who were diagnosed with placenta previa combined with placenta accreta after delivery in the Third Affiliated Hospital of Guangzhou Medical University in the Bundles model management on January 1,2018 and December 31,2018 were collected and included in the study group.A total of 183 pregnant women who had placenta previa combined with placenta accreta without Bundles model management on January 1,2015 and December 31,2016 were included in the control group.The results of pregnancy outcomes of the two groups were analyzed by cross-sectional comparision study to compare the advantages of Bundles model management in the management of such patients.Analytical indicators: general information of the two groups of pregnant women(including age,pregnancy,cesarean section,number of induced abortions,gestational weeks of delivery),perinatal outcomes(including preoperative hemoglobin,preoperative blood transfusion rate,intraoperative blood loss,postoperative blood transfusion,hemorrhagic shock rate,ICU rate,Ratio of secondarysurgery,postoperative to discharge time,and hospitalization expenses)Classification of clinical data.Introduction to Bundles model:1.In Hospital and Out Hospital bundle(In to Out): The pregnant women who diagnosed placenta accreta intake to the out-of-hospital management system of the Third Affiliated Hospital of Guangzhou Medical University,and were admitted to the hospital for disease assessment,formulating treatment plans and informing them of the condition.she was discharged from the hospital after condition was stable.At the same time,the information(the contents of the record: the name of the patient who was followed up outside the hospital,blood type,hemoglobin and other general information,updated once every 2 weeks)was registered in the emergency department and the operating room to response emergency.The pregnant women needs to live in a place that is 5 minutes away from the treatment center.Pregnant women were closing follow-up through the out-of-hospital management system,every 2 weeks outpatients check-up and blood distribution to ensure blood product reserve,have to visit a doctor within five minutes,30 minutes within a rapid green channel admission for surgery for active vaginal bleeding patients.2.Doctor-nurse quickly boundle: Create a rapid response team for obstetrics,and when an emergency occurs,quickly set up a rescue team to implement emergency treatment measures for pregnant women.3.Bundling of multiple controlled bleeding measures(obstetrics-anaesthesiology-urology):improving maternal outcomes through multidisciplinary collaboration and the combined obstetric controlled haemorrhage in surgery.Results:1.There were no significant differences between the two groups in general information,including mean age,pregnancy,cesarean section,and number of induced abortions(P>0.05).2.Perinatal outcomes in the two groups: The preoperative HGB level in the study group was higher than the control group.The preoperative blood transfusion ratio,intraoperative blood loss,the amount of blood transfusion,hemorrhagic shock ratio,transfer ratio of ICU,postoperative hospital stay,and hospitalization expenses were all in the study group Lower than the control group,the difference was statistically significant(P <0.05).Conclusion:the perinatal outcome of pregnant women with placenta accreta can improve including increased preoperative hemoglobin,reduced the preoperative blood transfusion ratio,intraoperative blood loss,the amount of blood transfusion,hemorrhagic shock ratio,transfer ratio of ICU,postoperative hospital stay,and hospitalization expenses through implement Bundles model.