Aortic balloon occlusion for controlling intraoperative hemorrhage in patients with placenta previa increta/percreta.

BACKGROUND/AIMS: To investigate whether abdominal aortic balloon occlusion (ABO) effectively reduces intraoperative hemorrhage in patents with placenta previa increta/increta. METHODS: Forty-three women were diagnosed as placenta previa increta/percreta by ultrasound and MRI. These patients' assessments were taken by their chief physician, and they were under necessity of previous cesarean section as confirmed by the committee of experts during consultation. There was no significant difference in disease risk rating between them in whole process. Although our department provided a more appropriate method, 10 of 43 patients chose intraoperative aortic balloon occlusion (IABO). Other 33 patients who refused that suggestion were considered as control group. Fully informed consents were obtained from all patients in this study group. The intraoperative blood loss, blood transfusion, rate of hysterectomy and complications of mothers and fetus of IABO group and control group were analyzed. RESULTS: The median intraoperative blood loss was 1000 ml in the IABO group compared with 2000 ml in the control group (p < 0.05). The median volume of transfused red blood cells was 1100 ml in the IABO group compared with 2000 ml in the control group (p < 0.05). 33.3% (11/33) patients in the control group had hemorrhagic shock, and one of them suffered from cardiac arrest intraoperatively because of severe bleeding. However, none of these serious events occurred in the IABO group (p < 0.05). The hysterectomy rate was 70% (7/10) in the IABO group and 63.3% (21/33) in the control group (p > 0.05). No IABO-related complications were observed in the mother and fetus. CONCLUSION: IABO is an effective and safe method to control intraoperative blood loss and blood transfusion in patients with placenta previa increta/percreta.

[Clinical analysis of continuous electronic fetal heart rate monitoring for preterm small for gestational age during labor].

OBJECTIVE: To investigate the clinical value of continuous electronic fetal heart rate (FHR) monitoring for preterm small for gestational age (PSGA) during labor. METHODS: Three hundred and three pregnant women who had inevitable preterm labor at 32 - 36 weeks' gestation because of premature rupture of membrane or unknown cause underwent continuous electronic FHR monitoring during labor from Jan 2002 to May 2004. In total, 78 newborns were preterm small for gestational age (PSGA, PSGA group) and 225 newborns were preterm appropriate for gestational age (PAGA, PAGA group). The cardiotocography (CTG), outcome of labor, and cases with combined umbilical cord abnormality of both groups were analysed retrospectively. RESULTS: The number of cases with pure U type variable deceleration of PSGA group and PAGA group was respectively 24 (30.8%) and 10 (4.4%) (P < 0.01). The number of cases of U type variable deceleration accompanied with other abnormal CTG of both groups was respectively 10 (12.8%) and 1 (0.4%) (P < 0.01). Of PSGA group, the rate of cesarean section and forceps among cases of pure U type variable deceleration was lower than that of cases with U type variable deceleration accompanied with other abnormal CTG (20.8% vs 60.0%, P < 0.05. While, the rate of umbilical cord abnormality (44.1%) among 34 cases with U type variable deceleration was higher compared with that (20.5%) among 44 cases without U type variable deceleration (P < 0.05). CONCLUSIONS: U type variable deceleration is the characteristic FHR graph of PSGA during labor and is not the sign of fetal distress when not accompanied with other abnormal CTG.