| Objective: By analyzing the clinical data of patients with placenta accrete spectrum disorders,the dangerous factors of hysterectomy and the use value of internal iliac artery balloon occlusion were explored,providing treatment guidance for doctors in placenta accrete spectrum disorders.Methods: The clinical data of placental implantation patients who were treated in the Subei People’s Hospital from January 2015 to December 2021 were collected to analyze the incidence and clinical characteristics of placenta accrete spectrum disorders.Then they were divided into hysterectomy group and uterus preservation group.SPSS 26.0 was used to analyze the collected clinical data and explore the risk factors of hysterectomy.The included cases were further strictly screened,and were divided into balloon group and non-balloon group according to whether bilateral internal iliac artery balloon occlusion was applied.The clinical data of the two groups were compared to explore the effectiveness of bilateral internal iliac artery balloon occlusion,and the near and long term complications were explored by consulting medical records and telephone follow-up.Results:(1)From 2015 to 2021,there were 23932 pregnant women delivered in Subei People’s Hospital,and 79 patients with placenta accrete spectrum disorders.Of them,67 cases were diagnosed placenta accreta and 12 patients were afflicted with placenta penetrate.During the seven years,the overall delivery volume was dropping,with the mean incidence of 3.30‰.(2)Of the 67 placental accreta patients,3 cases experienced vaginal delivery because of no gist of cesarean section.The rest experienced cesarean section.Of them,56 patients were complicated with complete placenta previa,and 4 cases underwent hysterectomy.The bleeding during delivery up to 4700 m L.There were 12 patients with placenta penetration,7 patients’ placenta only penetrating the uterus,5 patients had placenta implanted in the bladder,and no placenta implanted in other organs.All patients complicated with complete placenta previa.Seven patients’ uteruses were removed,and a patient lost a lot of blood reaching 8000 m L.No death occurred.(3)In seven years,the overall hysterectomy rate of patients with placenta accrete spectrum disorders was 13.9%.There was no significant difference in the elderly rate,pregnancy ≥ 3,cesarean section history,uterine cavity operation,test-tube infant rate,the prevalence of placenta previa,and cervical canal implantation rate between the hysterectomy group and the uterus preservation group(P>0.05).The time of cesarean section ≥ 2,the proportion of anterior wall placenta,placenta penetrate,and the obvious dilation of the lower uterine blood vessels in the hysterectomy group were significantly higher(P<0.05).The proportion of placental implantation area ≥ 1/2 was higher in the hysterectomy group,but there was no statistical significance(P=0.052).(4)The proportion of intraoperative blood loss ≥ 3000 m L and the morbidity of hysterectomy in the balloon group were obviously lower,and the hospitalization cost was dramatically higher(P<0.05).There was insignificant difference in the amount of intraoperative bleeding,the total amount of red blood cells transfused,the total amount of plasma transfused,the proportion of red blood cells transfused ≥ 10 U,the transfusion of platelets,fibrinogen or cryoprecipitate,the incidence of hemorrhagic shock,bladder injury,transfer to ICU,the number of days in hospital after operation and the neonatal outcome.The common recent complications mainly include iliac artery rupture,arterial thrombosis,and inguinal hematoma.Long-term complications include abnormal menstruation and intermittent claudication.Conclusion:1.Placenta accrete spectrum disorders are heterogeneous.Placenta accrete spectrum disorders with the same grade have different hazard degrees.Each surgical method is not universal,and needs a specific problem-specific analysis.Obstetricians should constantly summarize their experience,identify placenta accrete spectrum disorders early as soon as possible,improve surgical techniques,achieve timely referral,and provide personalized therapy for different patients with placenta accrete spectrum disorders.2.The risk factors of hysterectomy in patients with placenta accrete spectrum disorders were the number of cesarean section ≥ 2,the anterior placenta,placenta penetrate,and the obvious dilation of the lower uterine blood vessels.Obstetricians should learn to identify risk factors of hysterectomy and avoid the occurrence of severe postpartum hemorrhage caused by blindly pursuing to retain the uterus.3.Internal iliac artery balloon occlusion can significantly reduce the incidence of intraoperative massive bleeding.At the same time,it can also cut down the risk of hysterectomy,but the effect is not obvious for reducing the intraoperative bleeding,total blood transfusion.This technology did not shorten the hospitalization time,reduce the conversion rate to ICU and reduce the incidence of hemorrhagic shock,but significantly increased the hospitalization costs of patients and increased the economic burden.As a pre-operative interventional technique,internal iliac artery balloon occlusion is only one of many hemostatic measures.Obstetricians should learn to master a variety of intraoperative hemostasis techniques and constantly improve their surgical skills.4.The occurrence of balloon-related complications is unpredictable,but once occurs,it can mildly affect their daily life and impose a certain psychological burden.It may also seriously endanger patients’ lives.Obstetricians should strictly grasp the use indications of internal iliac artery balloon occlusion.5.Multi-disciplinary cooperation plays an important role in the diagnosis and treatment of placenta accrete spectrum disorders.Obstetricians should be aware of the importance of teamwork,prepare a contingency plan for postpartum hemorrhage,improve professional skills,and ensure the safety to the greatest extent. |
