Effect of uterine artery embolization and placenta preservation in situ in the treatment of dangerous placenta previa with placenta implantation

Abstract

Objective To investigate the clinical effects of uterine artery embolization and placenta preservation in situ in the treatment of dangerous placenta previa with placenta implantation. Methods Thirty-four pregnant women with dangerous placenta previa and placenta implantation who delivered in the First Affiliated Hospital of Soochow University and Suzhou Municipal Hospital from January 2010 to December 2015 were enrolled in the study. All objects were divided into two groups by treatment methods. Eighteen pregnant women in group A underwent cesarean section, and then were given uterine artery embolization and placenta dissection successively after delivery. Sixteen pregnant women in group B underwent cesarean section to preserve the placenta in situ after delivery, and then they were given one intramuscular injection of MTX 1 mg/kg and orally took mifepristone 50 mg/time, twice a day for 7 days after operation. The clinical features, efficacy and complications of the two groups were compared. Results The human chorionic gonadotropin (HCG) negative time, hospitalization time, antibiotic use time, hysterectomy, puerperal infection rate, intraoperative bleeding, hemorrhage 24 hours after delivery in group A were significantly different from those in group B (P<0.05). In group B, 3 cases failed to discharge placenta. Due to the increase in hemogram and body temperature, the 3 pregnant women developed bacteremia. The culture of uterine secretions showed bacterial growth, and severe infection occurred in uterine cavity and the treatment was ineffective. Subtotal hysterectomy was performed. Conclusions The most important reason of placental left in situ failure is infection. Uterine artery embolization in the treatment of pernicious placenta previa with placenta accreta can effectively control of bleeding, reduce puerperal infection, largely retained the uterus and improve the patients’ quality of life. Key words: Pernicious placenta previa; Placenta accreta; Placenta left in situ; Uterine artery embolization