A Study On The Effect Of Separating The Bladder And Ligation Of The Implanted Transport Vessels Before The Delivery For The Treatment Of The Pernicious Placenta Previa Accreta With Placenta Implantation

Objective: The study was to explore the safety and efficacy of the new operative method of separating the bladder and liagting the implanted traffic vessels before the fetus delivery in the treatment of the pernicious placenta previa with placenta implantation.Mehtods: The 43 cases of the pernicious placenta previa accreta with placenta implantation,as the research group,admitted to the Department of Obstetrics of Zhangzhou Municiple Affiliated Hospital of Fujian Medical University from November 2016 to November 2018 were treated with separating the bladder,exposing to the implanted lesions,ligation of the lower uterine,ligation of ascending branch of the uterine artery,and resection and necessary repair of anterior wall of uterus ect.before the delivery.Other 32 cases of the same symptoms during the same time period treated by routine surgery were set as the control group,including none separating the bladder and ligation of the implanted transport vessels before the delivery.Comparative analysis was made between the two groups,concerning clinical indicators such as the intraoperative blood loss,the total postoperative blood loss within 24 hours,blood transfusion volume,blood transfusion rate,operation time,hospitalization time after operation,hospitalization payment,hysterectomy rate,delivery time of the fetus,Neonatal Apgar Score,the rate of Ureter injury,the rate of bladder injury and repair,the hemoglobin content after operation,surgical complications,shock occurrence,coagulation dysfunction and changes in blood pressure.Results: Significant reduction was found with the study group concerning the intraoperative blood loss,the total postoperative blood loss within 24 hours,blood transfusion volume,blood transfusion rate,operation time,hospitalization time after operation,hospitalization cost,hysterectomy rate,bladder injury rate,shock incidence(P<0.05).Moreover the fetus delivery time saw significant increase in the study group(P<0.05),while the Neonatal Apgar Score was not statistically significant(P>0.05).Conclusion: By the new surgical method,it could reduce the operation time and the intraoperative blood loss effectively,reduce the blood transfusion and the hysterectomy rate,lower the hospitalization days and hospitalization expenses.It provides a new,safer and more effective surgical method for these patient.Of course,the safety and effectiveness of these new surgical method should be further evaluated by multi-center,randomized and prospective clinical studies.