Efficacy of uteroplasty aided with temporary balloon occlusion of abdominal aorta in management of pernicious placenta previa combined with placenta percreta

Abstract

Objective To investigate the therapeutic effect of uteroplasty aided with temporary balloon occlusion of abdominal aorta in treating pernicious placenta previa combined with placenta percreta. Methods Sixty-two third-trimester gravidas who were diagnosed as pernicious placenta previa combined with placenta percreta by prenatal ultrasound and magnetic resonance imaging (MRI) in the First Affiliated Hospital of Zhengzhou University from January 1, 2013 to May 31, 2016 were enrolled in this study. All of them received cesarean section and then underwent uteroplasty following temporary balloon occlusion of abdominal aorta. Efficacy of that treatment was evaluated from the perspectives of blood loss, operation time, complications and postoperative recovery. All data were analyzed by descriptive analysis. Results All of the 62 cases were diagnosed with placenta percreta during operation including 10 cases (16.1%) with perimetrium invasion, 46 cases (74.2%) with invasion to the muscular layer of bladder and six cases (9.7%) with bladder invasion. The average blood loss of all cases during and within 24 hours after operation was (1 377.3±605.2) ml and (140.6±66.3) ml, respectively. The average operation time was (72.3±24.5) min and the average length of postoperative hospital stay was (5.8±1.6) d. The six cases of placenta percreta with bladder invasion received bladder repair. Sixty-one cases had their uterus preserved and the other one case had a sub-total hysterectomy due to amniotic fluid embolism. One woman developed phlebothrombosis in her lower limbs after operation. No intestinal or ureteral injury, puerperal infection, uterine ischemia necrosis or death was reported. In addition to three cases lost to follow-up, the other 59 patients were followed up to May 31, 2017. Results of physical examination indicated that the 59 cases had normal uterine involution after operation. Menses returned in 58 of the 59 cases without any difference from before, and did not return in one case due to breastfeeding. Conclusion Uteroplasty aided with temporary balloon occlusion of abdominal aorta is a safe and effective uterus-preserving surgery for patients with pernicious placenta previa combined with placenta percreta. Key words: Placenta previa; Placenta accreta; Aorta, abdominal; Balloon occlusion; Reconstructive surgical procedures