Balloon displacement during caesarean section with pernicious placenta previa: A case report

BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta previa(PPP)and placenta accreta.Nevertheless,there are still few reports on surgical complications related to interventional therapy,and its safety should be a concern.CASE SUMMARY We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section.However,the balloon shifted during the operation,which damaged the arterial vessels after filling,resulting in severe postpartum haemorrhage in the patient.Fortunately,after emergency interventional stent implantation,the pa-tient was successfully relieved of the massive haemorrhage crisis.CONCLUSION It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases,but surgical complications related to intervention therapy can also cause adverse consequences.It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.

Application of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section

Objective:This study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section.Methods:We performed a retrospective analysis of the clinical data for 623 patients who experienced pernicious placenta previa complicated with placenta accreta and received treatment in our hospital from January 2013 to January 2019.All patients underwent abdominal aortic balloon occlusion before their cesarean section.Seventyeight patients received bilateral uterine artery embolization,and among them,placenta accreta was found at the opening of the cervix in 13 patients.Due to suturing difficulty after the removal of the placenta,gauze packing was used to temporarily compress the hemorrhage.As soon as the uterus was sutured,emergent bilateral uterine artery embolization was performed.Active bleeding was noted in the remaining 65 patients when the lower part of the uterus was pressed after the placenta was removed and the uterus was sutured,therefor,bilateral uterine artery embolization was performed urgently.Results:Of the 623 patients,545 patients underwent only abdominal aortic balloon occlusion and 78 patients underwent additional emergent bilateral uterine artery embolization due to hemorrhaging during or after their cesarean section.No hysterectomies were performed.In the 78 patients,the amount of bleeding was 800-3,200 ml with an average of 1,650 ml during the operation;the volume of blood transfused was 360-1,750 ml(average:960 ml).The fetal fluoroscopy time was 3–8 s(average:5 s).The dose of radiation exposure was(4.2±2.9) m Gy.Fetal appearance,pulse,grimace,activity,and respiration(Apgar) score were normal.No serious complications were observed during or after the operation in the follow-up visits.Conclusion:For patients with pernicious placenta previa complicated with placenta accreta who experience active bleeding after cesarean section and abdominal aortic balloon occlusion,bilateral uterine artery embolization can effectively reduce blood loss and requirement of blood transfusion during the operation,and lowers the risk of hysterectomy.

Clinical Analysis on the Effectiveness of Conservative Compression Suture Technique to Conserve Fertility on Pernicious Placenta Previa

Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: This was a non-comparative retrospective study of 188 patients diagnosed with pernicious placenta previa who underwent cesarean section in The First Hospital of Jilin University, China, from 1 January 2013 to 1 January 2018. Successful group was defined as those in which the intraoperative bleeding was managed by either modified CHO or by B-lynch suture technique and those who had further intervention including hysterectomy were designated as failure group. Results: Out of 217 patients, 188 met inclusion criteria and 29 patients were excluded. In 188 cases, 183 (97.34%) cases successes and 5 (2.65%) cases had hysterectomy. Among included group, 118 patients (62.76%) had undergone emergency cesarean section and 70 patients (37.23%) underwent elective cesarean section. The emergency group had significantly lesser gestation period of gestation at the time of cesarean section (P = 0.021) and lower neonatal weight (P = 0.001) than that of elective group. The estimated blood loss during surgery was 500 - 3200 ml (mean: 925 ml). Additionally, the amount of bleeding was found to be significantly more in patient with intraoperative complication (P = 0.007) and in patient with implanted placenta (P 0.001). Conclusion: The conservative compression suture technique including modified CHO and B-lynch suture technique during the cesarean delivery is a feasible, safe and effective alternative conservative surgical technique for the management of bleeding in case of pernicious placenta previa. Besides good surgical outcome and proper neonatal result this technique also reduces the rate of hysterectomy, thus conserving the fertility.

A Seven-Step Approach to Control Severe Hemorrhage in Cesarean Delivery with the Placenta Accreta Spectrum Disorders Avoiding Hysterectomy

Objectives: To describe a novel procedure to treat hemorrhage of placenta accreta spectrum disorders (PAS) or cesarean-scar pregnancy (CSP). Methods: This was a retrospective study of women under cesarean delivery with PAS or placenta previa. Patients’ information was acquired from hospital records. A novel procedure of surgery is developed with seven major steps, including avoiding placenta incised, elevating upward the uterine, clamping the uterine arteries with sponge forceps, removing the placenta, opening the vesicouterine space and suture techniques. Results: A total of 38 patients were reviewed. Twenty-one patients diagnosed with placenta accrete syndrome and 3 patients with CSP were underwent surgery with the novel procedure of surgery and all severe hemorrhage was controlled without hysterectomy. There were 2 women with bladder injuries needing primary repair. Fourteen patients with placenta previa underwent cesarean delivery and there was no intraoperative complication of the total 14 patients. Conclusion: The seven-step approach is more secure and effective to control severe hemorrhage without other invasive procedures in cesarean delivery with PAS. It is technically easier to maintain and improve surgical skills.

Conservative Management of Placenta Accreta of Seven Cases

Introduction: Placenta accreta is a potentially life threatening obstetrical condition. The incidence has increased. Diagnosis before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Prenatal ultrasonography is used to support the diagnosis and guide clinical management leading probably to favorable outcomes. Actually a conservative option which includes leaving all or part of the placenta in situ when fertility preservation is desired is recommended. Methods: We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta in gynecology-obstetrics department of the university hospital Mohammed the VI of Marrakesh;Morocco;from January the first 2014 to January the second 2016. Results: We found seven cases. We described: The epidemiological characteristics, risk factors, management of placenta accreta, outcomes and prognosis. The incidence of placenta accreta was 1/3847 deliveries. The mean term of delivery was 35 weeks. We have adopted a successful conservative treatment in six cases (71.4%). The radical treatment was adopted in one patient initially admitted for severe post-partum hemorrhage;the prognosis was good in 85.7% cases. Conclusion: Conservative management of placenta accreta is a safe and efficient and is an interesting alternative for hysterectomy.

Blood Consumption in Placental Abnormalities

Introduction: Hemorrhage is one of the most common causes of maternal morbidity and mortality. This study was conducted to investigate how much abnormal placentation can affect blood bank capacity and to measure the burden on the blood bank caused by excessive use of blood and blood products. Methodology: This is a retrospective study conducted at King Saud Medical City Maternity Hospital in Riyadh, Kingdom of Saudi Arabia, from January 2019-September 2020. It includes 170 cases diagnosed with abnormal placentation (low-lying placenta or placenta previa, accreta, increta, or percreta). The primary purpose was to measure consumption of blood and blood products in cases of placental abnormalities and to investigate how much this affects blood bank capacity. A secondary aim was to report rates of admission to the ICU and maternal mortality. Results: This study included 170 women with placental abnormalities. Placental previa had occurred in 96 cases, followed by placenta accreta in 46 cases, placenta increta in 13 cases, placenta percreta in 8 cases, and low-lying placenta in 7 cases. Most patients (93) were treated with a Bakri balloon to prevent hemorrhage, but 38 patients had a hysterectomy. The average estimation of blood loss was 2210 ml, with no maternal mortality. An average of 3.39 units of packed red blood cells (PRBC) with a maximum of 20 units, 2.12 units of fresh frozen plasma (FFP) with a maximum of 20 units, and 0.7 units of packed platelets (PP) with maximum of 12 units consumed per patient. Eighty-seven patients (51.2%) were admitted to the ICU and 83 others (48.8%) were admitted to the high dependency unit. Conclusion:<span style="font-family: "> Blood and blood product volumes had a linear relationship with the severity of placental abnormalities and estimated blood loss. Therefore, blood bank services should be available to save mothers’ life.

凶险性前置胎盘MRI表现及诊断意义

目的探讨凶险性前置胎盘(PPP)核磁共振(MRI)表现及诊断意义。方法回顾性分析67例前置胎盘患者资料,术前均接受MRI检查,经剖宫产术和病理确诊,分析MRI诊断PPP和伴有胎盘植入的诊断效能,观察PPP合并胎盘植入的不同分型诊断结果。结果手术病理诊断PPP患者有60例,非凶险性前置胎盘(nPPP)患者有7例,PPP并发胎盘植入有59例,“金标准”以手术病理诊断结果为准,分析结果显示,MRI诊断PPP的阳性预测值最高,可达96.43%,其次灵敏度可达90.00%%,特异度、精确率则在71.43%、88.06%,阴性预测值最低,为45.45%;MRI诊断PPP并发胎盘植入的阳性预测值最高,可达97.87%,其次特异度可达87.50%,灵敏度、精确率则在77.97%、79.10%,阴性预测值最低,为35.00%;以手术病理诊断PPP合并胎盘植入结果为金标准,MRI的诊断正确率为79.66%,其中粘黏型、植入型及穿透型胎盘植入的诊断正确率分别为50.00%、87.10%及100.00%。结论术前MRI诊断PPP的诊断价值高,能正确评估PPP伴有胎盘植入程度,充分评估胎盘组织与子宫肌层的关系,为产前检查和制定适合治疗方案提供有效信息。

不同位置动脉球囊阻断在凶险性前置胎盘术中的应用价值

目的评估不同位置动脉球囊阻断术在凶险性前置胎盘合并胎盘植入剖腹产术中应用临床效果及安全性的对比研究。方法本院2015年9月至2022年8月共有57例经多普勒超声和/或核磁共振证实凶险性前置胎盘合并胎盘植入,在剖腹产术前行动脉球囊阻断术,其中腹主动脉球囊阻断术(A组)26例,髂总动脉球囊阻断术(B组)31例。结果A、B两组合计子宫保有率100%(57/57),剖宫产手术时间、新生儿Apgar评分(1 min、5 min)两组之间差异无统计学意义(P>0.05),A组术中出血量显著低于B两组术中出血量(P<0.05),放射防护安全性方面,A组明显优于B组(P<0.05)。A组分别出现1例球囊回撤失败,B组分别出现1例动脉血栓和1例下肢静脉血栓,两组之间差异无统计学意义(P>0.05)。结论腹主动脉球囊阻断术和髂总动脉球囊阻断术均可降低子宫切除率,保留患者生育功能,但是腹主动脉球囊阻断术中出血量及放射防护安全性均优于髂总动脉球囊阻断术。

子宫血管缝扎术及宫颈环状缝扎术联合双侧髂内动脉球囊阻断治疗PPP合并胎盘植入效果

目的:探讨凶险性前置胎盘(PPP)合并胎盘植入治疗效果。方法:选取2019年3月-2023年5月本院就诊治疗的PPP合并胎盘植入患者56例临床资料,根据治疗方式不同分为两组,采用子宫血管缝扎术及宫颈环状缝扎术联合双侧髂内动脉球囊阻断治疗为观察组26例,采用单纯双侧髂内动脉球囊阻断治疗为对照组30例,分析两组相关指标。结果:治疗后两组甲胎蛋白及绒毛膜促性腺激素水平均较术前降低,且观察组(82.6±26.3 ng/ml、122.3±56.3 mIU/ml)低于对照组(113.0±41.1 ng/ml、649.5±86.5 mIU/ml),总并发症发生率观察组(3.8%)低于对照组(23.3%)(均P<0.05);两组新生儿Apgar评分(9.6±0.3分、9.3±0.6分)无差异(P>0.05)。观察组住院时间(6.6±1.2d)及住院费用(3.2±0.6)万元均低于对照组(7.9±1.5d)(4.3±1.0)万元(P<0.05)结论:采取子宫血管缝扎与宫颈环状缝扎术、双侧髂内动脉球囊阻断治疗PPP合并胎盘植入可效果更佳,且可降低术后并发症,术后恢复更快,对新生儿未产生不良影响。

腹主动脉球囊阻断术与改良后子宫血管阻断术在胎盘植入性疾病患者再次剖宫产中的应用比较

目的研究预置腹主动脉球囊阻断术与改良后子宫血管阻断术在前置胎盘伴胎盘植入性疾病再次剖宫产中的应用效果。方法选取2016年4月至2022年12月在合肥市妇幼保健院行再次剖宫产手术治疗的前置胎盘伴胎盘植入性疾病的瘢痕子宫患者97例。术前行腹主动脉球囊阻断术48例为对照组,术中行改良后子宫血管阻断术49例为观察组。观察比较两组患者术中、术后情况。结果观察组的术后行双侧子宫动脉栓塞术数、人均住院费用均小于对照组,差异均有统计学意义(P<0.05);两组的术中平均出血量、输注红细胞悬液量、子宫切除率、膀胱破裂率差异无统计学意义(P>0.05)。结论两种手术方式在完全性前置胎盘伴胎盘植入患者的再次剖宫产手术治疗中均能有效减少术中出血,而使用改良后子宫血管阻断术,未出现血管介入手术并发症,无需X线暴露,母儿安全性高,同时降低了住院费用,具有临床推广潜力。

1例凶险性前置胎盘行双侧骼内动脉球囊封堵联合剖宫产术后并发DIC的护理

总结1例凶险性前置胎盘行双侧骼内动脉球囊封堵联合剖宫产术后并发弥散性血管内凝血(DIC)的护理。通过多学科团队的联合诊治及护理,病人病情平稳出院。随访半年,病人状况良好。

子宫下段前后壁提拉缝合术联合子宫双侧壁加固缝合法在凶险性前置胎盘剖宫产中止血的应用

目的探讨子宫下段前后壁提拉缝合术联合子宫双侧壁加固缝合法在凶险性前置胎盘剖宫产中的止血效果和应用。方法回顾性选择运用子宫下段前后壁提拉缝合联合子宫双侧壁加固缝合术治疗的凶险性前置胎盘患者11例,观察患者一般情况、围手术期指标、术后情况及新生儿结局等,评价手术效果。结果11例患者术中证实均有胎盘植入,有5例胎盘植入深度达到子宫浆膜层。11例患者均实行子宫下段宫颈提拉缝合联合子宫双侧壁加固缝合术,无一例失败。患者术中出血量中位数为400(300~700)mL。平均手术时间为(65±14)min。11例患者中10例患者术后恶露及体温正常,无明显感染征象,术后住院时间均≤7 d。1例术后出现发热,原因不明,恶露正常,血常规及感染指标正常,复查妇科彩超提示宫腔内少量积液,无明显胎盘组织,术后8天自动出院。出院后随访,无产褥期感染。11例新生儿无窒息。5例早产儿转新生儿科后均未行气管插管辅助呼吸,均治愈出院。结论子宫下段前后壁提拉缝合联合子宫双侧壁加固缝合术在凶险性前置胎盘手术中止血效果好,可行性强,术中及术后均无明显产后出血及其他术后并发症。

产前胎盘超声评分法联合MRI对前置胎盘合并胎盘植入的诊断价值研究

目的分析产前胎盘超声评分法联合核磁共振成像(MRI)对前置胎盘合并胎盘植入的诊断价值。方法选取2021年6月~2023年12月在中山市博爱医院产科门诊就诊的102例既往有剖宫产史或宫腔操作史、中晚孕期前置胎盘且疑似胎盘植入患者为研究对象,在晚孕期(≥28周)分别对所有研究对象进行产前胎盘超声、MRI检查。以病理诊断结果为金标准,分析胎盘超声评分法、MRI、胎盘超声评分+MRI(联合诊断)三种检查方式对前置胎盘合并胎盘植入的诊断价值。结果术后病理诊断结果显示,102例疑似胎盘前置合并胎盘植入患者中,66例确诊,36例为非胎盘前置合并胎盘植入患者;胎盘超声评分法诊断确诊63例胎盘前置合并胎盘植入患者;MRI诊断确诊62例,联合诊断确诊79例。三种检查方式对比,特异度、准确度、阳性预测值无明显差异(P>0.05),灵敏度、阴性预测值存在显著差异(P<0.05)。联合诊断的灵敏度、阴性预测值显著高于胎盘超声评分法、MRI诊断(P<0.05);联合诊断的准确度高于MRI诊断(P<0.05)。胎盘超声评分法、MRI诊断对比,灵敏度、特异度、准确度、阴性预测值均无显著差异(P>0.05)。ROC曲线分析结果表明,三种检查方式的AUC均>65%,联合诊断的AUC最大(81.23%)。结论产前胎盘超声评分法联合MRI对前置胎盘合并胎盘植入具有较高的诊断价值。

不同性质球囊髂内动脉阻断术在凶险性前置胎盘剖宫产中的对比研究

目的 比较不同性质球囊髂内动脉阻断术在凶险性前置胎盘(PPP)剖宫产中的应用效果。方法 回顾性分析82例PPP患者的临床资料,其中观察组40例,给予双侧髂内动脉顺应性Fogarty球囊阻断术;对照组42例,给予非顺应性球囊髂内动脉阻断术。比较两组患者在髂内动脉阻断术前、术后收缩压及心率、X线透视时间、胎儿体表辐射剂量、剖宫产时间、术中出血量及输血量、子宫动脉栓塞率、子宫切除率和1、5、10 min新生儿Apgar评分以及术后住院时间及手术相关并发症。结果 两组患者子宫均成功保留,均成功行双侧髂内动脉球囊阻断术辅助剖宫产手术顺利完成。撤出球囊导管,部分患者行子宫动脉栓塞术,无患者行卵巢动脉栓塞及子宫切除术。两组患者术前、术后收缩压和心率组间比较差异均无统计学意义,但两组术后收缩压、心率低于术前,均P<0.05。两组X线透视时间、胎儿体表辐射剂量、子宫动脉栓塞率、子宫切除率和1、5、10 min新生儿Apgar评分以及术后住院时间对比差异均无统计学意义,观察组剖宫产时间、术中出血量、术中输血量低于对照组,均P<0.05。两组患者球囊阻断术后其相关并发症发生率比较差异均无统计学意义。结论 不同性质髂内球囊动脉阻断术辅助在PPP剖宫产均安全有效,但双侧髂内动脉顺应性球囊阻断术在减少剖宫产手术时间、术中出血量、术中输血量等方面更具优势。

前置胎盘合并胎盘植入性疾病发生早产的影响因素分析

目的回顾性分析前置胎盘合并胎盘植入性疾病(placenta accreta spectrum,PAS)产妇早期早产(early preterm birth,EPB)和晚期早产(late preterm birth,LPB)的影响因素及母婴预后。方法纳入590例在2018年1月至2021年6月期间于武汉市及咸宁市共五家医院行剖宫产分娩的前置胎盘合并PAS产妇。根据分娩孕周将产妇分为EPB组、LPB组和足月分娩(term birth,TB)组。采用多项logistic回归模型分析发生EPB和LPB的危险因素,并分析早期母婴预后在组间的差异。结果590例前置胎盘合并PAS产妇EPB和LPB的比例为9.7%和54.4%。剖宫产术前使用宫缩抑制剂、术前阴道出血以及既往剖宫产次是EPB和LPB的危险因素。EPB组与LPB组产妇发生严重产后出血的比例相近,而EPB组的新生儿窒息、低出生体重儿及剖宫产术后24 h内转入NICU的比例均显著高于LPB组(P<0.001)。结论前置胎盘合并PAS主要发生LPB。既往剖宫产次、剖宫产术前子宫收缩与阴道出血与EPB和LPB显著相关。应在围产期严密监测下尽量延长产妇分娩孕周,减少早产的发生,改善母婴早期预后。

高场强磁共振HASTE序列与高频彩超诊断凶险型前置胎盘及胎盘植入的对比研究

目的对比高场强磁共振半傅里叶单次激发快速自旋回波(HASTE)序列与高频彩超诊断凶险型前置胎盘(PPP)及胎盘植入的价值。方法回顾性分析2017年—2022年保定市第二医院收治的116例行剖宫产终止妊娠并经术后病理检查诊断为PPP的患者临床资料,所有患者均接受高场强磁共振与高频彩色多普勒超声检查,以术后病理检查结果为金标准,对比两者在PPP患者胎盘植入中的诊断价值。结果术后病理检查结果显示,116例患者中胎盘植入共81例,其余35例患者非胎盘植入;高场强磁共振HASTE序列检查结果显示:116例患者中诊断为胎盘植入68例,其余48例非胎盘植入;高频彩超检查结果显示:116例患者中诊断为胎盘植入66例,其余50例非胎盘植入;两者联合诊断结果显示:116例患者中诊断为胎盘植入84例,其余32例为非胎盘植入;以术后病理检查结果为对照,高场强磁共振HASTE序列诊断PPP患者胎盘植入的灵敏度、特异度、阳性预测值、阴性预测值、kappa值分别为81.48%、94.29%、85.34%、97.06%、0.685;高频彩超诊断PPP患者胎盘植入的灵敏度、特异度、阳性预测值、阴性预测值、kappa值分别为75.31%、85.71%、78.45%、92.42%、0.544;两种方式联合诊断PPP患者胎盘植入的灵敏度、特异度、阳性预测值、阴性预测值、kappa值分别为96.30%、82.86%、92.24%、90.63%、0.811。结论在PPP患者合并胎盘植入的诊断中,高场强磁共振HASTE序列较高频彩超具备较高的诊断价值,但两者联合可显著提升诊断效能,临床可将两者联合作为诊断PPP患者合并胎盘植入的方式。

子宫下段前壁叠瓦式缝合术治疗瘢痕子宫合并前置胎盘伴胎盘植入产妇产后出血的临床效果

目的观察子宫下段前壁叠瓦式缝合术治疗瘢痕子宫合并前置胎盘伴胎盘植入产妇产后出血的临床效果。方法回顾性选取2020年1月至2023年1月诊断为瘢痕子宫合并前置胎盘伴胎盘植入的100例产妇,按照手术治疗方法将其分为试验组(50例,子宫下段前壁叠瓦式缝合术)和对照组(50例,传统局部“8”字缝合术)。比较两组的止血效果、临床指标、血红蛋白水平及术后并发症发生情况。结果试验组的止血总有效率高于对照组,差异具有统计学意义(P<0.05)。试验组的手术时间短于对照组,红细胞输注量、血浆输注量、术后24 h总出血量、术中及术后缩宫素使用剂量、术中及术后欣母沛使用剂量少于对照组(P<0.05)。试验组的术后并发症总发生率明显低于对照组(P<0.05)。结论相较于传统局部“8”字缝合术,子宫下段前壁叠瓦式缝合术可为瘢痕子宫合并前置胎盘伴胎盘植入产妇产后出血的治疗提供一些新思路,是治疗此类患者的一种安全、有效的方法。

PDCA护理管理模式在凶险性前置胎盘患者中的应用效果

目的观察PDCA护理管理模式在凶险性前置胎盘患者中的应用效果。方法选取2020年6月至2023年6月费县人民医院收治的60例凶险性前置胎盘患者,以随机数字表法分为对照组、观察组,每组30例。对照组给予常规护理,观察组给予PDCA护理管理模式,比较两组的情绪状态和护理满意度。结果护理后,两组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均降低,其中观察组SAS、SDS评分低于对照组(P<0.05);观察组对宣教、态度、服务、消毒灭菌及环境方面的护理满意度高于对照组(P<0.05)。结论PDCA护理管理模式在凶险性前置胎盘患者中应用效果显著,能够缓解负面情绪、提高护理满意度,值得推广。

子宫下段螺旋式缝合成形术在凶险性前置胎盘剖宫产患者中的应用效果

目的:观察子宫下段螺旋式缝合成形术在凶险性前置胎盘(PPP)剖宫产患者中的应用效果。方法:选取2022年1月至2023年10月该院收治的68例PPP患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各34例。两组均行剖宫产术,对照组采用B-Lynch缝合联合子宫下段纱布填塞止血,观察组采用子宫下段螺旋式缝合成形术止血。比较两组止血效果、围术期指标(手术时间、住院时间、术后24 h出血量)水平、手术前后血红蛋白(Hb)水平、子宫切除率、子宫动脉栓塞率和并发症发生率。结果:观察组止血总有效率为97.06%(33/34),高于对照组的76.47%(26/34),差异有统计学意义(P<0.05);观察组手术时间、住院时间短于对照组,术后24 h出血量少于对照组,差异均有统计学意义(P<0.05);术后3 d,观察组Hb水平高于对照组,差异有统计学意义(P<0.05);两组子宫切除率和子宫动脉栓塞率比较,差异均无统计学意义(P>0.05);观察组并发症发生率为5.88%(2/34),低于对照组的26.47%(9/34),差异有统计学意义(P<0.05)。结论:子宫下段螺旋式缝合成形术应用于PPP剖宫产患者可提高止血效果,改善围术期指标水平和Hb水平,降低并发症发生率,效果优于B-Lynch缝合联合子宫下段纱布填塞止血。

前置胎盘伴胎盘植入的高危因素分析及其列线图预测模型的构建

目的 探讨前置胎盘伴胎盘植入的高危因素并构建列线图预测模型。方法 回顾性选取2020年5月至2023年1月入同济大学附属妇产科医院产检并剖宫产分娩的前置胎盘妊娠孕妇306例作为研究对象。根据是否伴有胎盘植入分为单纯前置胎盘组和前置胎盘伴胎盘植入组。收集研究对象的一般资料(年龄、体重指数、孕次、人工流产次数、剖宫产次数、原手术医院等级)、既往妊娠情况(剖宫产分娩史、宫腔操作史、保胎史)、孕期临床表现(产前有无阴道流血)、B超检查结果(前置胎盘类型、胎盘厚度)。采用Logistic回归分析患者发生前置胎盘伴胎盘植入的高危因素,根据高危因素构建列线图预测模型,并采用受试者工作特征(ROC)曲线验证列线图预测模型。结果 纳入的306例前置胎盘妊娠孕妇患者中,单纯前置胎盘组211例,占比68.95%,前置胎盘伴胎盘植入组95例,占比31.05%。单因素分析结果显示,两组患者年龄、人工流产次数、孕次、剖宫产次数、有无剖宫产分娩史、有无宫腔操作史、前置胎盘类型、胎盘厚度方面比较,差异均有统计学意义(P<0.05)。年龄≥35岁、人工流产次数≥2次、有剖宫产分娩史、前置胎盘类型(完整性)、胎盘厚度≥50 mm是前置胎盘伴胎盘植入的独立危险因素(P<0.05)。基于上述因素构建前置胎盘伴胎盘植入列线图,利用ROC曲线对列线图预测模型进行验证,曲线下面积值为0.864(95%CI:0.821~0.908),H-L检验结果显示,该模型具有较好的拟合度(χ^(2)=1.136,P=0.793)。结论 年龄、人工流产次数、前置胎盘类型、有剖宫产分娩史、胎盘厚度是前置胎盘伴胎盘植入的独立危险因素。据此构建的列线图预测模型具有良好的特异度和敏感度,可用于临床指导,制定最佳的临床干预计划,对于改善母婴结局具有重要意义。