Clinical Application Of Interventional Therapy In Obstetric Hemorrhagic Diseases

ObjectiveTo retrospectively analyze the clinical application of interventional therapy in cesarean scar pregnancy(CSP),induction of labor in placenta previa,pernicious placenta previa(PPP)and intractable postpartum hemorrhage(IPH),and analyze its effectiveness and postoperative complications.To explore the clinical application value of interventional therapy in these four obstetric hemorrhagic diseases.MethodFrom January 2012 to October 2019,279 cases(repeated 28 cases)of obstetric hemorrhagic diseases were treated in the Department of Obstetrics and Gynecology,Jiangsu Subei People's Hospital,including group A :203 patients with CSP,5 patients with placenta previa in group B,51 patients with PPP in group C,and 48 patients with IPH in group D.The four groups of patients were divided according to different treatment schemes,and retrospective analysis of general clinical data and related observation indicators such as bleeding volume.The incidence of pain in the waist?abdomen and hips,postoperative fever,venous thrombosis in the lower extremities,and menstrual flow reduction in all patients undergoing interventional therapy were analyzed.Result1.Among patients with CSP,there was no significant differences in blood transfusion rate and hysterectomy rate between MTX intramuscular injection group,local MTX treatment group(hereinafter referred to as MTX treatment group)and UAE+ MTX + curettage group,UAE + curettage group(hereinafter referred to as intervention group)(P >0.05);hospitalization time,blood HCG return to normal level and re-treatment rate in the intervention group were significantly less than the MTXtreatment group,the blood HCG return to normal time of the two intervention groups were not statistically different from the MTX intramuscular injection group,the re-treatment rate of the UAE + MTX + curettage group and local MTX group was no statistical difference(P >0.05),the remaining differences were statistically significant(P <0.05).Compared with the direct curettage group,the blood HCG return to normal level,re-treatment rate,intraoperative blood loss,postoperative blood loss and blood transfusion rate of the two intervention groups were lower,except that.there was no statistically significant difference in blood transfusion rate between the UAE + MTX +curettage group and direct curettage group(P >0.05),the other differences were statistically significant(P <0.05).The hospitalization time and hysterectomy rate were not significantly different from the direct uterine curettage group(P >0.05).There were no significant differences in postoperative observation indexes between the UAE +MTX + curettage group and the UAE + curettage group(P >0.05).2.Preventive intervention can significantly reduce the bleeding volume in patients with complete placenta previa induction labor.3.Among the patients with PPP,the "one-stage" dual interventional technique had significantly reduced blood loss volume and hysterectomy rate in patients than patients with directly cesarean section(P <0.05).There were no significant differences in postoperative bleeding volume,blood transfusion volume,length of hospital stay,postoperative hospital stay and neonatal asphyxia rate between the two groups of patients(P >0.05).4.Among patients with IPH,the blood transfusion rate,hysterectomy rate,shock,and DIC incidence were significantly lower in patients with interventional embolization than those in the direct hysterectomy group(P <0.05).There was no significant difference in hospitalization time and treatment success rate between the two groups of patients(P >0.05).5.The rate of postoperative fever,waist?abdomen?and hip pain were significantly higher in patients after intervention than those in the non-intervention group(P <0.05),and they could be cured after symptomatic treatment.In addition,82.7% of patientsexperienced menstrual reduction after intervention,compared with the non-intervened group,the difference is statistically significant(P <0.05).including 2 patients with amenorrhea,2 patients with lower extremity vascular thrombosis and 1 patient with paralysis.Conclusion1.Compared with MTX intramuscular injection,preventive interventional technology combined with curettage can shorten the hospitalization time of CSP patients and reduce the retreatment rate;compared with local MTX treatment,preventive interventional technology combined with curettage can shorten the hospitalization time and blood HCG return to normal time of CSP patients;compared with direct curettage group,preventive interventional technology can reduce the time of blood HCG return to normal,re-treatment rate,intraoperative bleeding and postoperative bleeding.The simultaneous injection of MTX in the uterine artery during intervention may not have a significant effect on the treatment effect.2.UAE before induction of labor in patients with complete placenta previa can reduce the amount of bleeding.3.For patients with PPP,especially combined with placenta accreta,the use of "one-stage" dual intervention technology can reduce the rate of hysterectomy and intraoperative blood loss.4.For patients with IPH,on the basis of ensuring the safety of maternal life,interventional embolization techniques can be used to retain the uterus as much as possible.5.Although interventional technology can reduce the amount of bleeding and hysterectomy in obstetric hemorrhagic diseases,patients have the risk of reduced menstrual flow and even amenorrhea.Therefore,clinically,especially for patients with fertility desire,the pros and cons should be fully weighed and used with caution.