Cervical internal os plasty in cesarean section of pregnant women with complete placenta previa and placenta accreta: a new surgical technique

Abstract

Objective To investigate the effectiveness and safety of cervical internal os plasty in treating hemorrhea during cesarean section of pregnant women with complete placenta previa and placenta accreta. Methods From January 2012 to May 2018, a total of 56 pregnant women who were diagnosed as complete placenta previa with placenta accreta in West China Second University Hospital, Sichuan University and underwent cervical internal os plasty for hemostasis during cesarean section were selected as research subjects and included in study group. According to the random number table method, another 60 pregnant women who were delivered by cesarean section due to complete placenta previa with placenta accreta and received other suture hemostasis techniques during the same period in the same hospital were randomly selected and included in control group. The perioperative outcomes of two groups were retrospectively analyzed and compared. And chi-square test was used to compare postpartum hemorrhage rate, intraoperative blood transfusion rate and effective rate of hemostasis between two groups. Independent-samples t test was used to compare the operation duration, length of stay after operation and hospitalization expenses between two groups. The procedure of this study was consistent with ethical standard established by the committee of investigation in human beings of West China Second University Hospital, Sichuan University [Approval No. 2014(27)]. Results ①There were no significant differences between two groups in age, gravidity, parity, gestational age, and the proportion of cesarean section history, previous uterine cavity operation history and emergency cesarean section (P>0.05). ②The effective rate of hemostasis in study group was 92.9% (52/56), which was significantly higher than 73.3% (44/60) in control group, and the difference between two groups was statistically significant (χ2=8.773, P=0.003). ③The postpartum hemorrhage rate, intraoperative blood transfusion rate, operation duration, length of stay after operation and hospitalization expenses in study group were 41.1% (23/56), 28.6% (16/56), (66.7±22.5) min, (4.6±1.1) d and (2.09±0.09) × 104 yuan, respectively, and these five indexes were 43.3% (26/60), 25.0% (15/60), (69.5±22.0) min, (5.1±1.6) d and (2.22±0.11) × 104 yuan, respectively in control group, and all the differences between two groups were not statistically significant (χ2=0.062, P=0.805; χ2=0.194, P=0.661; t=0.661, P=0.510; t=1.852, P=0.067; t=0.935, P=0.356). No complications related to surgery or massive hemorrhage occurred in two groups. Conclusions Cervical internal os plasty is a safe and effective hemostatic technique in cesarean section for pregnant women with complete placenta previa and placenta accreta. As the sample size of this study is relatively small, whether this hemostatic technique is worthy of clinical application or not, it still needs to be confirmed by large-sample, multi-center and randomized controlled studies. Key words: Placenta previa; Placenta accreta; Cesarean section; Hemostatic techniques; Cervical internal os plasty; Postpartum hemorrhage; Hysterectomy; Pregnant women