ABSTRACT
Objective To analyse the pregnant outcome of second pregnancy women with scarred uterus after two-child policy was issued. Methods In this study, 51 308 pregnant women who gave birth in 6 hospitals in Minhang District from Jan 2015 to Dec 2018 were studied to analyze the delivery mode and pregnancy outcome in women with scarred uterus. Results ① From 2015 to 2018, there were 9 762 (19.03%) pregnant women with scarred uterus in Minhang District and 91 (0.93%) of them delivered vaginally.Scarred uterus was the most frequent indication of cesarean section (42.06%).② The incidence of severe postpartum hemorrhage (bleeding volume≥2 000 mL) in scarred uterus group was higher than that in no-scar uterus group(χ2=8.268, P=0.004).③ Adverse pregnancy outcomes were noted:there were 42 cases of pernicious placenta previa (4.30‰), 6 cases of hysterectomy (0.61‰) and 22 cases of critical rescue (2.25‰) in scarred uterus group, with higher risk than those in no-scar uterus group(χ2=178.9, P < 0.001;Fisher exact probability method P=0.000;χ2=4.272, P=0.039).There was no significant difference in perinatal mortality between scarred uterus group and no-scar uterus group (χ2=3.240, P=0.072);The maternal mortality rate among both groups was 0. Conclusion With the adjustment of fertility policy, the number of pregnant women with scarred uterus and the risk of pregnancy increase.It is necessary to strengthen the management of early warning and assessment of risk during pregnancy of scarred uterus.By effectively controlling the first cesarean section, the risk of scarred uterus re-pregnancy should be avoided.
ABSTRACT
Objective To discuss the clinical effect of prophylactic abdominal aorta balloon occlusion with Fogarty catheter before cesarean section in treating delivery woman with pernicious placenta previa.Methods The clinical data of 12 delivery women with pernicious placenta previa,who received prophylactic abdominal aorta balloon occlusion with Fogarty catheter before cesarean section,were retrospectively analyzed.The curative effect was evaluated.Results The average intraoperative blood loss in the 12 patients was (1256±318) ml.The uterus was successfully retained in 9 patients.Hysterectomy had to be carried out in 3 patients because of refractory hemorrhage;one of them had to receive total hysterectomy together with bladder repair as the placenta had penetrated into the bladder wall.After delivery no complications,such as infection,delayed hemorrhage,lower limb thrombosis,etc.,occurred.All 12 neonates were born smoothly.Conclusion Prophylactic abdominal aorta balloon occlusion with Fogarty catheter before cesarean section can effectively reduce intraoperative blood loss and help save the uterus.Therefore,it is a safe and effective therapeutic means for delivery woman with pernicious placenta previa before the performance of cesarean section.
ABSTRACT
Objective To compare the clinical efficacy of extra vascular occlusion of low abdominal aorta and low abdominal aorta balloon occlusion in the treatment of placenta previa with placenta previa.Methods From January 2014 to July 2017,68 implantable placenta previa patients were divided into two groups,elective cesarean section of extra vascular occlusion of low abdominal aorta in 34 cases(group A)and cesarean section on the lower abdominal aorta balloon occlusion in 34 cases(group B),and observation of pregnant women was compared between surgery of two groups. Results Operation time,complications of vascular injury and thrombosis,fetal radiation exposure in group A were significantly lower than that of group B(P<0.05);two groups of patients with sensory dysfunction incidence,cesarean operation time,intraoperative blood loss,blood transfusion rate,the uterus resection rate,hospitalization time had no statistically significant difference postoperatively(P > 0.05). Conclusion Two kinds of operation can safely and effectively reduce the bleeding during the treatment of placenta previa. While group A surgery operation time is short,without intraoperative and postoperative bleeding of the puncture site,without pelvic and lower extremity arterial thrombosis,without X-ray exposure,more safety of the womb and can be popularized in clinic.
ABSTRACT
Objective To explore the influence of high quality nursing interventions in patients with pernicious placenta previa and the neonate's prognosis. Methods The clinical data about 28 patients with pernicious placenta previa treated from January 2016 to January 2017 were reviewed;the high quality nursing interventions were applied(study group). 30 patients with pernicious placenta previa treated from December 2014 to December 2015 were selected;the conventional nursing cares were applied (control group). After intervention, the clinical prognosis for the infants and mom was analyzed. Results At the time of admission, the research group of state anxiety and trait anxiety and depression scale scores were 58.42±3.61,55.57±2.69,55.06±2.67,before discharge,patients in the study group,state anxiety and trait anxiety and depression scale scores were 42.19 ±2.16,47.20±2.74 and 44.25± 4.36,the control group were respectively 58.96±3.35,55.27±2.75,55.23±3.12,before discharge respectively 44.35± 3.13, 49.35 ± 3.13, 48.67 ± 5.16, two groups were SAI, TAI and SDS score comparison no statistical significance (t=0.591, 0.420, 0.222, P > 0.05), the difference between the two groups before discharge compared with statistical significance (t=3.038, 2.775, 3.511, P<0.01);the time of termination of pregnancy, postpartum hemorrhage and neonatal postpartum 1min Apgar scores of the study group were 36.15± 0.77,1 000.19 ± 14.21,9.13± 0.10,the control group were 33.50±0.66,1 516.71 ±29.08,8.79± 0.50, and the difference was statistically significant (t=14.102, 32.490, 3.531, P<0.01);comparison of body mass in two groups showed no statistical significance (P>0.05);group of maternal and neonatal complications for a total of 7.14% (2/28), significantly lower than the control group 20.00%(6/30), the difference between significant(χ2=7.050,P<0.01);evaluation of nursing measures of maternal satisfaction in the study group(95.23+4.65)was higher than that of the control group(91.36±5.63),the difference was statistically significant correlation (t=2.842,P<0.05). Conclusions The high quality nursing interventions have an obvious effect in patients with pernicious placenta previa.It can relieve the negative emotions and improve the mom&infant's outcomes and the clinical satisfaction.
ABSTRACT
Objective To study the nursing effect of temporary ballon occlusion of the abdominal aorta in the treatment of pernicious placenta previa and placenta accrete. Methods Nursing points and experience of 126 cases of pernicious placenta previa and placenta accreta using temporary ballon occlusion of the abdominal aorta to prevent intraoperative bleeding in caesarean section were retrospectively summarized. This paper introduced the method, safety and superiority of the way of temporary ballon occlusion of the abdominal aorta, and the method of nursing care of patients with temporary ballon occlusion of the abdominal aorta, and the methods of the observation and prevention of postoperative bleeding and the nursing of pain. Results Totally 126 patients successfully achieved hemostasis, no hysterectomy occurred. Conclusions Through effective nursing of temporary ballon occlusion of the abdominal aorta in the treatment of pernicious placenta previa and placenta accrete, the postpartum hemorrhage, blood transfusion and the risk of hysterectomy can be reduced.
ABSTRACT
Objective To assess the value of one-stage hybrid technique for treatment of pernicious placenta previa. Methods 12 patients with pernicious placenta previa who had received simultaneously Cesarean section and temporary balloon occlusion of abdominal aorta or internal iliac artery in the hybrid operation room were included in this study. 12 patients with pernicious placenta previa who had preserved balloon ducts in internal iliac artery before Cesarean section were chosen as a control group. Balloons were filled to control hemorrhage during the procedure. The hemodynamic parameters including blood pressure and heart rate were monitored during the opera-tion. Surgical duration ,amount of blood loss ,amount of blood transfusion ,volume of infusion ,urine volume during the procedure,postoperative volume of blood loss within 24 hours,uterine hysterectomy rate and neonatal conditions were compared between the two groups. Results During the operation,the blood pressure and heart rate in hybrid group were more stable. The mean surgical duration was(72 ± 8)min,the intraoperative mean amount of blood loss was(620 ± 95)mL,the mean amount of blood transfusion was(550 ± 40)mL,the mean volume of infusion was(1850 ± 160)mL,the mean amount of blood loss in 24 h after the operation was(75 ± 9) mL in the hybrid group,which were significantly lower than those in the control group(P<0.05 for all comparisons). No serious complications occurred in any of the two groups after the operation. There were no significant differences in neonatal conditions between the two groups. Conclusions One-stage hybrid technique has an obvious effect in the control of intraoperative bleeding in patients with pernicious placenta previa. It is worth popularizing in the hospital whose conditions are permitted.
ABSTRACT
Objective Onto observe the curative effect of carboprost tromethamine injection combined with mifepristone on the treatment of the patients with risky placenta previa. Methods 66 cases with placenta previa during mid pregnancy from January 2016 to December 2016 in Dingbian county people's hospital were randomly divided into two groups, 33 cases in the control group and 33 cases in the observation group. All patients were received cesarean section and traditional treatments such as oxytocin and gauze filling. Hemostatic effect, prognosis and incidence of adverse reactions in the two groups were compared. Results The intraoperative bleeding volume, the amount of vaginal bleeding 2 hours after operation and the amount of vaginal bleeding 2 to 24 hours after operation in the observation group were less than those in the control group (P<0.05). The rate of postpartum hemorrhage, the rate of disseminated intravascular coagulation and the incidence of puerperal disease in the observation group were significantly less than those in the control group (P<0.05). The sanguinous lochia time and menstrual recovery time in the observation group were better than those in the control group (P<0.05). There was no significant difference in the rate of hysterectomy and adverse reactions between the two groups. Conclusion Carboprost Tromethamine Injection combined with mifepristone in the treatment of pernicious placenta previa can effectively reduce the bleeding rate and promote the rehabilitation of pregnant women. It is safe and has no obvious adverse reactions. It is worthy of clinical application.
ABSTRACT
Objective To discuss the clinical application of ultrasound-guided temporary balloon occlusion in performing cesarean section for patients with pernicious placenta previa.Methods At Qujing Municipal First People's Hospital,the Interventional Department and Ultrasonography Department assisted the Obstetrics Department to accomplished cesarean section for 13 patients with pernicious placenta previa.The diagnosis of central placenta previa was confirmed by both color ultrasound and MRI in all the 13 patients.Before cesarean section,the balloons were placed in bilateral common iliac arteries or in abdominal aorta,and the balloons were inflated at the same time when the fetus was delivered so as to temporarily obstruct the target vessels.Based on the hemostatic condition,the balloon was timely withdrawn.Results Among the 13 patients,temporary abdominal aorta occlusion was employed in one and temporary bilateral common iliac artery occlusion in 12.Ultrasound-guided occlusion was successfully accomplished in 12 patients,and the average blocking time was ＜15 min.The amount of intraoperative blood loss was 800-1500 ml.Conclusion Ultrasound-guided temporary balloon occlusion before cesarean section is safe with reliable effect in treating pernicious placenta previa,it can remarkably reduce the amount of intraoperative blood loos,and it has no X-ray radiation damage,therefore,this technique is worthy of clinical application.
ABSTRACT
Massive postpartum hemorrhage is one of the most severe complications of pregnant women during deliveries, especially, on the basis of a scarred uterus with placenta previa and placenta implantation, the risk of occurrence of massive hemorrhage after delivery will be obviously increased. The recombinant human coagulation factorⅦa (rFⅦa) can be used to significantly reduce the incidence of delutional coagulopathy and the necessary amount of blood products in patients after major abdominal surgery. One patient with massive postpartum hemorrhage resulted from scarred uterus with placenta previa and previa accreta was administered into Guizhou Medical University Affiliated Hospital, whose hemorrhage was successfully stopped by using rFⅦa in case of surgical indication being excluded. It is suggested that rFⅦa can be regarded as an effective drug for postpartum hemorrhage on the basis of indication being strictly controlled.
ABSTRACT
Objective To investigate the efficacy and influence of ovarian function after multiple cervical suture for pernicious placenta previa.Methods A reteospective analysis was performed in 107 patients who underwent ineffective conservative treatment for PPP,indcluding 41 patients who underwent multiple cervical suture and 66 pantiets who underwent uterine packing.The clinical effects of the two groups were observed.The menstrual status and ovarian function were followed up.Results The significant difference of amount of blood loss during operation,transfusion volume,0peration time,hysterectomy rate,ICU stay days,hemostatic time and 24-hour postoperative vaginal bleeding amount,postoperative fever,continuance times of lochia was comporred (P ＜ 0.05).There were no significant differences in uterine insrauration rate,menstruation recovery and basic sex hormone levels between the two groups (P ＞ 0.05).Conclusion Multiple cervical suture for patients with pernicious placenta previa was effective,and worthy of clinical promotion and application.
ABSTRACT
Massive postpartum hemorrhage is one of the most severe complications of pregnant women during deliveries, especially, on the basis of a scarred uterus with placenta previa and placenta implantation, the risk of occurrence of massive hemorrhage after delivery will be obviously increased. The recombinant human coagulation factorⅦa (rFⅦa) can be used to significantly reduce the incidence of delutional coagulopathy and the necessary amount of blood products in patients after major abdominal surgery. One patient with massive postpartum hemorrhage resulted from scarred uterus with placenta previa and previa accreta was administered into Guizhou Medical University Affiliated Hospital, whose hemorrhage was successfully stopped by using rFⅦa in case of surgical indication being excluded. It is suggested that rFⅦa can be regarded as an effective drug for postpartum hemorrhage on the basis of indication being strictly controlled.
ABSTRACT
Objective To investigate the efficacy and influence of ovarian function after multiple cervical suture for pernicious placenta previa.Methods A reteospective analysis was performed in 107 patients who underwent ineffective conservative treatment for PPP,indcluding 41 patients who underwent multiple cervical suture and 66 pantiets who underwent uterine packing.The clinical effects of the two groups were observed.The menstrual status and ovarian function were followed up.Results The significant difference of amount of blood loss during operation,transfusion volume,0peration time,hysterectomy rate,ICU stay days,hemostatic time and 24-hour postoperative vaginal bleeding amount,postoperative fever,continuance times of lochia was comporred (P ＜ 0.05).There were no significant differences in uterine insrauration rate,menstruation recovery and basic sex hormone levels between the two groups (P ＞ 0.05).Conclusion Multiple cervical suture for patients with pernicious placenta previa was effective,and worthy of clinical promotion and application.
ABSTRACT
Objective To discuss the clinical efficacy of balloon occlusion technique in treating pernicious placenta previa.Methods Between January 2015 and March 2016,a total of 16 matcrnal patients with pernicious placenta previa,who were admitted to the Interventional Department of Qujing Municipal First People's Hospital,received balloon occlusion management to assist obstetrician in dealing with placenta previa.Central type of placenta previa with highly suspected placenta implantation were diagnosed in 15 patients by color ultrasound or MRI.Balloon catheters were placed in bilateral internal iliac arteries before cesarean section was carried out,and immediately after the fetus was taken out the balloons were inflated to temporary occlude the targeted arteries.Based on the hemostatic status the balloon catheters were timely retrieved.One patient received emergency temporary balloon occlusion of abdominal aorta,and laparotomy revealed that the placenta had penetrated to the subserosa of uterine anterior wall,and total hysterectomy had to be carried out.Results Successful balloon occlusion was achieved in all 16 patients.The mean blocking time of the artery was 15 minutes and the amount of blood loss was 300-1200 ml.Conclusion In treating pernicious placenta previa,balloon occlusion treatment before cesarean section is safe and reliable,it can significantly reduce the amount of blood loss during surgery,make quick and effective hemostasis,provide a clear surgical field for the performance of cesarean section,and,more important,save the maternal life.This effective technique has fully showed the necessity of multidisciplinary collaboration,including obstetrics,interventional radiology,etc.
ABSTRACT
Objective To compare the safety and effectiveness of temporary occlusion techniques with different balloons in performing cesarean section for patients with pernicious placenta previa.Methods The clinical data of 15 patients with pernicious placenta previa,who received cesarean section during the period from March 2014 to April 2016,were retrospectively analyzed.In order to reduce bleeding during operation and to preserve the uterus as far as possible,temporary occlusion of abdominal aorta with balloon was adopted in 7 patients (group A),and temporary balloon occlusion of bilateral internal iliac arteries was employed in 8 patients (group B).The intraoperative radiation dose,the amount of blood loss and blood transfusion during cesarean section,the hysterectomy rate,the postoperative hospitalization days,and the intervention-related complications were documented,and the results were compared between the two groups.Results All the 15 patients were suffered from central type of placenta praevia complicated by extensive placenta accreta.With the help of temporary balloon occlusion technique,the cesarean section was successfully accomplished in all 15 patients.Subtotal hysterectomy had to be done in 7 patients,including 4 patients of group A and 3 patients of group B,and every one patient from each group developed arterial thrombosis of lower limb.The intraoperative radiation dose of group A was significantly lower than that of group B (P＜0.01),besides the amount of blood loss and blood transfusion during cesarean section,the hysterectomy rate,the postoperative hospitalization days,and the intervention-related complications of group A were all lower than those of group B,but because of the limited number of cases these differences were not statistically significant (P＞0.05).Conclusion For the treatment of pernicious placenta previa,temporary balloon occlusion technique-assisted cesarean section is safe and effective.The intraoperative radiation dose in the group using temporary balloon occlusion of abdominal aorta is remarkably lower than that in the group using temporary balloon occlusion of bilateral internal iliac arteries.
ABSTRACT
Objective To investigate the clinical application of temporary balloon occlusion of the common iliac artery in performing cesarean section for patients with pernicious placenta previa and placenta accreta.Methods A total of five cases with ultrasound or MRI diagnosed pernicious placenta previa and placenta accreta were analyzed retrospectively.One of the cases was diagnosed Rh(-)blood type.Prophylactic temporary balloon implantation in bilateral common iliac arteries were carried out before cesarean section.Digital subtraction angiography ensured the position of balloon catheter and the catheter was fixed.The balloon was inflated immediately after the removal of the fetus.The balloon was removed at 6-8 hours after the cesarean section.The amount of blood loss,transfusion requirement,cesarean hysterectomy rate, and X-ray exposured time and dose during the procedure were recorded.Results Temporary balloon implantation in bilateral common iliac arteries in all five patients were obtained successfully.The blood loss was seen <500 mL in one patient and 500-1 000 mL in other four patients.Because of placenta implantation over depth of serosa and placenta percreta in one case,massive intractable hemorrhage occurred in short time,partial hysterectomy had to be carried out.The uterus was retained in other four cases.Conclusion The temporary balloon occlusion of the common iliac artery in performing cesarean section is a safe and effective technique,and it can reduce the amount of blood loss,transfusion requirement and secondary risk due to uncontrollable bleeding during surgery.
ABSTRACT
Objective To investigate the clinical effect of perioperative integrated operation approaches on the operation treatment of pernicious placenta previa.Methods 50 patients with pernicious placenta were divided into the treatment group (29 cases) and the control group (21 cases).Patients in treatment group were treated by integrated operation approaches,namely before cesarean section,patients were treated by uterine artery catheterization and after the baby was delivered,interventional therapy was applied immediately;patients in the control group were treated by routine operation method.The amount 24 h bleeding,hospital stay,hysterectomy rate and neonatal asphyxia rate were compared in the two groups.Results Compared with the control group,operative time,bleeding volume,bleeding volume in 24 h,postoperative hospitalization time in treatment group were shortened obviously,hysterectomy rate was lower significantly (P＜0.05);the neonatal asphyxia rate difference between the two groups had no statistical significance (P＞0.05).Conclusion Integrated operation approaches can shorten the operation time,bleeding and reduce the hysterectomy rate for patients with pernicious placenta previa,which can maintain the physical and mental health as much as possible,so it is a safe and effective treatment and worthy of clinical promotion.
ABSTRACT
Objective To explore the MRI diagnostic value for pernicious placental abnormalities.Methods MRI findings of 1 5 patients with pernicious placenta previa were retrospectively analyzed after cesarean section.Results Among all cases,total placenta previa was,1 1 cases and partial placenta previa was 4 cases.The placenta located in the anterior wall in 8 cases,posterior wall in 4 cases,lateral wall in 3 cases.4 cases were diagnosed as normal placenta,6 cases as adhesion,4 cases as implanted,and 1 case as penetrating.These cases had certain special MR features.Conclusion MRI is helpful in diagnosing the location and type of the perni-cious placenta,and showing whether complicated with previa implantation and penetrating.