Abstract
Objective: To evaluate the effect of artery sequential interventional therapy (internal iliac artery catheterization and occlusion/ uterine artery or internal iliac artery embolization) on the hemorrhage of pernicious placenta previa. Method: The total of 29 patients with pernicious placenta previa and risk factor of placenta accreta from March 2012 to June 2013 in our hospital were included as control group, who were given traditional method of treatment, while 40 patients with the same disease status from July 2013 to October 2014 as treatment group with artery sequential interventional therapy. The amount of blood loss during operation and red blood cell suspension transfusion, the rate of hysterectomy cesarean time, the amount of cesarean section hemorrhage after 24 hours, duration of postopera tive hospital stay, the time of postoperative antibiotic usage and the prevalence of complications (pain, fever, infection and others) of patients in two groups were evaluated, respectively. Result: The significant difference of amount of blood loss during operation [(868.5±549.77) ml vs. (1506.90±1417.39) ml for treatment group and control group, respectively)] and red blood cell suspension transfusion [(1.50±1.40) U vs. (2.72±2.00) U], the rate of hysterectomy (2.50% vs. 17.24%), cesarean time [(58.86±20.33) min vs. (70.83±29.26) min)] and the prevalence of pain (81.25% vs. 48.28%) and other complications (0.00% vs. 10.35%) (all p values 0.05). All patients resumed normal menstruation after weaned for 1 to 3 month and the routine newborn physical examination on 42 days after birth, blood analysis, liver function and neurological examination of infants were normal without blood diseases. Conclusion: Artery sequential interventional therapy for patients with pernicious placenta previa was safe, effective and feasible for pregnant and newborn.
Highlights
Pernicious placenta previa (PPP) is proposed for the first time by Chattopadhyay, etc. [1] and it is assumed to be a special kind of placenta previa because the placenta is attached to the previous cesarean section scar of the uterus, which may cause placenta implantation, up to 40% ~ 50% [2, 3]
For patients with PPP, artery sequential interventional therapy could significantly reduce the amount of blood loses during operation, the occurrence rate of hysterectomy and other complications
Althrough the amount of cesarean section hemorrhage after 24 hours, the time of postoperative antibiotic usage, the prevalence of fever was increased in the treatment group, duration of postoperative hospital stay, the pain score, the prevalence of fever and inflammation was less in control groups, and there was no significant difference among all of them
Summary
Pernicious placenta previa (PPP) is proposed for the first time by Chattopadhyay, etc. [1] and it is assumed to be a special kind of placenta previa because the placenta is attached to the previous cesarean section scar of the uterus, which may cause placenta implantation, up to 40% ~ 50% [2, 3]. The main performances [4, 5] of PPP are increased placenta implantation and postpartum hemorrhage, which are related to intractable postpartum hemorrhage, shock, diffuse intravascular coagulation (DIC) and directly threatens the safety of mothers and babies [6]. The massive loss of blood at the moment of baby-birth and the stripping of the placenta during cesarean section always lead to little time to take the relevant treatments and in order to resave the lives of the mothers, immediately hysterectomy is essential. Radiological vascular interventional therapy is mainly used in postpartum in the field of obstetrics [7], but it would lose the best chance because of time delay after the conventional treatment of postpartum hemorrhage
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