宫颈缝合、穹隆填塞联合宫腔球囊和水囊放置术治疗前置胎盘产后出血

Cervical Suture and Vaginal Fornix Yarn Filling Combined With Uterine Balloon and Water Sac Placement in the Treatment of Postpartum Hemorrhage With Placenta Previa

目的探讨宫颈缝合、穹隆填塞联合宫腔球囊和水囊放置术治疗边缘性前置胎盘或低置胎盘阴道分娩产后出血的可行性。方法对28例边缘性前置胎盘或低置胎盘产后出血,药物治疗失败后采用宫颈缝合、穹隆填塞联合宫腔球囊和水囊放置压迫子宫下段治疗。结果28例产后出血均得到有效控制,治疗成功率100%。2例进行重新放置球囊止血,1例追加注水止血。产后出血量(1568±750)ml,血红蛋白下降(34±18)g/L,注液量(450±100)ml,填塞物留置时间(30±6)h,控制出血时间(15.2±10.1)min,输血率67.9%(19/28),产后住院时间平均2 d(1~3 d)。28例均未发生产褥感染、再次出血、下肢静脉血栓等。产后42 d复查均子宫复旧正常,宫颈形态与正常分娩后无异常外观。结论宫颈缝合、穹隆填塞联合宫腔球囊和水囊放置术治疗边缘性前置胎盘或低置胎盘阴道分娩产后出血方法简单、有效,创伤小,可在基层医院推广应用。

Objective To investigate the feasibility of cervical suture and vaginal fornix yarn filling combined with uterine balloon and water sac placement in the treatment of postpartum hemorrhage with marginal placenta previa and hypoplacenta.MethodsA total of 28 cases of postpartum hemorrhage with marginal placenta previa and hypoplacenta were treated with cervical suture,fornix packing,and uterine balloon and water sac placement.Results All the 28 cases of postpartum hemorrhage were effectively controlled,the treatment success rate being 100%.Balloon replacement for hemostasis was performed in 2 cases,and water injection was added in 1 case.The postpartum blood loss was(1568±750)ml,the hemoglobin decreased by(34±18)g/L,the fluid injection volume was(450±100)ml,the indwelling time of the filler was(30±6)h,the bleeding control time was(15.2±10.1)min,the blood transfusion rate was 67.9%(19/28),and the average length of postpartum hospital stay was 2 d(range,1-3 d).No puerperal infection,rebleeding,lower extremity venous thrombosis occurred in the 28 cases.The uterine involution was normal at 42 d postpartum.There was no abnomal appearance of cervical morphology as compared to normal delivery.Conclusions Cervical suture and vaginal fornix yarn filling combined with uterine balloon and water sac placement is a simple,effective and minimally invasive method for the treatment of postpartum hemorrhage after vaginal delivery with placenta previa and hypoplacenta.It can be widely used in primary hospitals.