| ObjectiveThe purpose of this study is to establish a predictive model of pernicious placenta previa(PPP)with implantation,and to analyze the clinical application value of intraoperative aortic balloon occlusion in patients with PPP with implantation,so as to provide the basis for the selection of diagnosis and treatment scheme.MethodRetrospective analysis of 237 cases of maternal data of pernicious placenta previa in Northwest women’s and children’s Hospital from January 2015 to January 2020,this study is divided into two parts.The section one:according to whether combined with placenta accreta,they were divided into PPP without placenta accreta group(control group)and PPP with placenta accreta group(case group).The risk factors of PPP with placenta accreta were analyzed and logistic regression model was established to predict the occurrence of PPP with placenta accreta.The section two:compare the maternal and infant outcomes of PPP with implantation group and without implantation group(simple group),and then divide 177cases of PPP with implantation into 60 cases of mild implantation group(PA)and 117 cases of severe implantation group(PI+PP),according to the degree of implantation,objective to compare the effects of intraoperative aortic balloon occlusion on maternal and infant outcomes in patients with mild and severe implantation.All data were processed by SPSS 22.0 statistical software,The measurement data in accordance with the normal distribution were expressed by(x±S),and the comparison between groups was performed by independent sample t test;the measurement data not in accordance with the normal distribution were expressed by the interquartile distance[M(P25～p75)],and the comparison between groups was performed by Mann-Whitney U test.The counting data were expressed by frequency,and the comparison between groups was performed byc~2test,or correctedc~2test.The risk factors were analyzed by univariate analysis and multivariate logistic regression analysis.The prediction model was established according to the results of logistic regression analysis.The ROC curve was used to evaluate the model.P<0.05 means that the difference was statistically significant.ResultSection one:Risk factors of placenta accreta in patients with PPPHigh risk factors of PPP combined with placenta accreta:pregnancy times,labor times,previous cesarean section times,intrauterine operation times and placental location were the high risk factors of PPP combined with placenta accreta(P<0.05).Previous cesarean section times≥2(OR=7.656),history of intrauterine operation(OR=4.418)and placenta main body attached to the anterior wall(OR=3.162)were the independent risk factors of PPP combined with placenta accreta.Establishment of prediction model:the prediction model of PPP combined with implantation based on high-risk factors,the area under the curve is 0.767,which is statistically significant,superior to the single index prediction value,and the model has good prediction efficiency.When Y value>0.422,we should be alert to the occurrence of PPP with placenta accreta.Section two:Application value of intraoperative aorta balloon occlusionMaternal and infant outcomes:Whether the blocking technique is applied or not,the difference in bleeding,operation time,transfusion and intraoperative fluid supplement,ICU and total hospitalization time,hysterectomy rate and hemoglobin drop value,and Apgar(1minute)score of newborn are statistically significant compared in PPP patients with placenta accreta with the simple group.Application value of intraoperative aorta balloon occlusion:for 60 patients with mild placenta accreta,the comparison of each index between the occlusion group and the non occlusion group:except for the cost,the other items were not statistically significant;for 117patients with severe placenta accreta,the comparison of the occlusion group and the non occlusion group:intraoperative blood loss,blood transfusion and fluid replacement,hysterectomy rate,hemoglobin decline value and hospital stay There was no significant difference in neonatal weight,Apgar score,preterm birth rate and operation time.Application value of prediction model:according to the probability value calculated by the prediction model,the difference between PPP group(0.62±0.20)and mild implantation group(0.75±0.17)was statistically significant(P<0.05),and the difference between mild implantation group(0.62±0.20)and severe implantation group(0.81±0.13)was statistically significant(P<0.05).It can be seen that with the increase of probability value,patients are more likely to have severe placenta accreta.Conclusion1.The incidence of the pernicious placenta previa and placenta implantation has a great influence on the outcome of mother and baby,which is closely related to the number of cesarean section,the history of uterine cavity operation and the attachment of placenta body to the anterior wall.2.For PPP combined with severe implantation group,intraoperative aortic balloon occlusion can significantly reduce the bleeding,blood transfusion and fluid supplement,hysterectomy rate,hemoglobin drop value and hospitalization time,and have no significant impact on the birth status of newborn,and have a good clinical application price.However,For PPP combined with mild implantation group,each index has no significant improvement,but increases the economic benefits of patients burden.3.The prediction model based on high risk factors established in this study has certain prediction effect on clinical PPP combined with implantation,which can provide reference for clinical diagnosis of PPP patients with placenta implantation.The more probability values obtained from the prediction model,the heavier the placental implantation degree.It is recommended that the intraoperative aortic balloon be pre-operative. |
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