Clinical Study On The Postpartum Hemorrhage In Patient With Placenta Previa Undergoing Cesarean Section

Objective:(1)To explore the risk factors of postpartum hemorrhage in patients with placenta previa(PP)in the first affiliated hospital of Jinan University.(2)To analyze the efficacy of "one-stage" temporary bilateral internal iliac arteries balloon occlusion and selective artery embolization in treatment of women with pernicious placenta previa(PPP)complicated with placenta implantation abnormality(PIA)undergoing cesarean section.Methods:(1)A retrospective analysis of 193 cases of placenta previa patients admitted to the Department of Obstetrics,the First Affiliated Hospital of Jinan University from June2015 to June 2018.According to the amount of bleeding during cesarean section,the193 patients were divided into two groups.The research group were 32 cases with the patients of placenta previa with postpartum hemorrhage,and the control group were placenta previa without postpartum hemorrhage.Then the age,gestational age,cesarean section history,placenta accreta spectrum disorders,placental attachment site,preoperative hemoglobin(Hb),preoperative activated partial thromboplastin time(APTT)were compared between two groups.The factors with statistical difference were analyzed with logistic regression analysis.(2)A retrospective analysis of 55 cases of placenta previa with placenta implantation patients in the Department of Obstetrics,the First Affiliated Hospital of Jinan University from January 2013 to December 2018,33 of whom underwent bilateral internal iliac artery balloon occlusion,and 22 of whom underwent traditional cesarean section.Review the clinical data,collect the amount of bleeding during cesarean section,intraoperative isoform concentrated red blood cell input,intraoperative frozen plasma input,intraoperative hysterectomy rate,operation time and other perioperative indicators and neonatal weight,Apgar scores and other indicators.To compare and analyze the clinical effects of the two treatment methods.Result:(1)There were statistically significant differences in age,parity,gravidity,cesarean section history,APTT,Hb,placenta accreta spectrum disorders(P < 0.05).Logistic regression analysis showed that more cesarean section history,preoperative activated partial thromboplastin time(APTT),placenta accreta spectrum disorders were the independent risk factors of postpartum hemorrhage in patients with placenta previa undergone cesarean section(P<0.05).(2)The bilateral internal iliac balloon occlusion technique can effectively reduce intraoperative bleeding,blood transfusion in cesarean section of pernicious placenta previa complicated with placenta implantation.Conclusion:(1)Postpartum hemorrhage is a result of comprehensive results induced by various factors.more cesarean section history,preoperative activated partial thromboplastin time(APTT),placenta accreta spectrum disorders are the independent risk factors of postpartum hemorrhage in patients with placenta previa undergone cesarean section.(2)According to the results of our study,we should take a comprehensive strategy to prevent and control postpartum hemorrhage so as to prevent the occurrence of postpartum hemorrhage.(3)With advantages of reducing blood loss and complications and other advantages,bilateral internal iliac arteries balloon occlusion is advisable in controlling hemorrhage during cesarean section of patients of pernicious placenta previa complicated with placenta implantation.