Application of improved " Triple P" surgery in uterine preservation surgery for patients with placenta previa and placental implantation / 中国医师杂志

ABSTRACT

Objective:To explore the application value of improved " Triple-P" surgery in uterine preservation surgery for patients with placenta previa and placental implantation.Methods:A retrospective analysis was conducted on the clinical data of 100 patients with placental implantation admitted to Nanfang Hospital of Southern Medical University from January 2018 to January 2023. All patients underwent modified " Triple-P" surgery, which focused on bladder management, uterine incision selection, tourniquet ligation of the lower segment of the uterus to stop bleeding, complete removal of the placenta, removal of the anterior wall of the uterus at the site of placental implantation, and uterine shaping and suturing. Clinical data such as the patient′s general condition, intraoperative and postoperative conditions were analyzed.Results:The age of 100 postpartum women with placental implantation was (31.2±5.1)years old, with (3.7±1.5) pregnancies, (1.6±0.6) deliveries, and (36.2±1.7)weeks of termination of pregnancy. All patients had a clear preoperative diagnosis. 76 cases (76%) had a history of 1 cesarean section, 18 cases (18%) had a history of 2 cesarean sections, and 6 cases (6%) had a history of ≥3 cesarean sections. As the number of cesarean sections increased, the proportion of placental penetration (placental implantation reaching the serosal layer or invading the surrounding organs of the uterus) significantly increased (all P<0.05). The patient had a 24-hour blood loss of (1 230±340)ml, including postpartum hemorrhage of (237±132)ml, intraoperative blood transfusion of (986.3±463.8)ml, and surgery time of (73.6±12.7)minutes. 56 patients (56%) were transferred to the intensive care unit (ICU), and the postoperative hospital stay was (5.8±1.7)days. Four cases (4%, 4/100) underwent hysterectomy, all with penetrating placental implantation. All surgical incisions of the pregnant women healed as scheduled and were discharged after recovery. The birth weight of the newborn was (2 870±340)g, and there was no occurrence of neonatal asphyxia. The 24-hour blood loss, intraoperative blood transfusion, surgical time, proportion of transfer to ICU, and proportion of hysterectomy in patients with placental penetration were all higher than those in patients with placental implantation, with statistically significant differences (all P<0.05). Conclusions:The improved " Triple-P" surgery has a clear hemostatic effect, which can effectively reduce intraoperative bleeding and preserve reproductive function. It has strong operability and low requirements, and can be further promoted in clinical practice.