Control Of Postpartum Hemorrhage In Women With Placenta Accreta Spectrum Using Internal Iliac Artery Balloon Catheterization Combined With Pituitrin Intra-arterial Infusion

Object:The aim of this study is to evaluate the safety and efficacy of prophylactic internal iliac arteries balloon catheterization combined with Pituitrin intra-arterial infusion during cesarean section in the control of postpartum hemorrhage in women with placenta accreta spectrum(PAS).Methods:This is a prospective and non-randomized controlled study of women diagnosed with PAS during prenatal care.The participants were assigned into three groups: Pituitrin intra-arterial infusion combined with internal iliac arteries Balloon Catheterization(PBC)group,internal iliac arteries Balloon Catheterization(BC)group,and no pituitrin and Balloon Catheterization(non-BC)group.The primary outcomes were estimated blood loss(EBL)and the number of transfused units of packed red blood cells(PRBC).The secondary outcome was the incidence of hysterectomy.The general clinical characteristics of the patients among three groups,the prognosis of intraoperative and postoperative patients and neonates were compared,combined with the analysis of the relative risk of hysterectomy and postpartum blood loss greater than or equal to 1500 ml in the three groups,to evaluate the clinical application value of PBC.Finally,the linear regression analysis was performed to analyze the risk factors affecting the amount of postpartum hemorrhage in patients with PAS.Results:A total of 100 participants were recruited between January 2014 to December 2018 and assigned into the respective groups as follows: 27 in the non-BC group,22 in the BC group,and 51 in the PBC group.No statistical differences were found in demographic characteristics between the three groups.(1).The mean EBL was(1,846 ± 2,187)m L in the PBC group,(2,695 ± 2,334)m L in the BC group,and(3,717 ± 2,717)m L in the non-BC group(P < 0.001).Compared with the non-BC group,patients in the BC group had a trend for lower EBL,while it did not reach statistical significance(P>0.05).Patients in the PBC group had significantly deceased EBL compared with the non-BC group(P < 0.001).(2).The volume of PRBC was(5.65 ± 5.71)U in the PBC group,(7.77 ± 7.09)U in the BC group,and(11.48 ± 8.72)U in the non-BC group(P < 0.001).Compared with the non-BC group,patients in the BC group had a trend for lower PRBC,while it did not reach statistical significance(P>0.05).Patients in the PBC group had significantly deceased PRBC compared with the non-BC group(P < 0.001).(3).The rate of hysterectomy was5.9%(3/51)in the PBC group,4.5%(1/22)in the BC group,and 22.2%(6/27)in the non-BC group(P = 0.046).Compared with the non-BC group,patients in the BC group had a trend for lower hysterectomy rate,while it did not reach statistical significance(P>0.05).Patients in the PBC group had significantly deceased hysterectomy rate compared with the non-BC group(P = 0.032).(4).There were no differences in the prognosis of neonates between the three groups(P > 0.05).(5).The analysis of the relative risk for the occurrence rate of hysterectomy showed that patients in the non-BC group had a relative risk of 4.89(95% confidence interval0.64-37.63)compared with the BC group,while it was not statistically significant(P > 0.05).But when compared with patients in the PBC group,patients in the non-BC group had a relative risk of 3.78(95% confidence interval 1.02-12.93),which was statistically significant(P = 0.032).(6).The analysis of the relative risk for the occurrence rate of EBL greater than or equal to 1500 m L showed that patients in the non-BC group had a relative risk of 2.34(95% confidence interval 1.67-3.27)compared with the BC group,which was statistically significant(P < 0.001).(7).The analysis of the factors influencing EBL with linear regression showed that internal iliac artery balloon combined with pituitrin intra-arterial infusion(V.S others,including simple balloon occlusion and no balloon occlusion)was negatively correlated with EBL(P=0.004).No balloon occlusion(P=0.003)and placenta accreta depth(P<0.001)were positively correlated with EBL.No balloon occlusion predicted independently more volume of postpartum hemorrhage,and placenta accreta depth is an independent risk factor for postpartum hemorrhage in patients with PAS.Conclusions:Internal iliac artery balloon combined with pituitrin intra-arterial infusion is an effective treatment method which significantly reduces EBL,PRBC transfusion and hysterectomy rate in patients with PAS.