Clinical Analysis Of Interventional Embolization Treatment To Obstetric Hemorrhagic Diseases

Objective: Maternal obstetric hemorrhage is a common serious complication, ranked first in four reasons of maternal mortality. Interventional embolization has been widely used in the treatment of obstetric hemorrhagic diseases as a conservative treatment of minimally invasive techniques in recent years. This paper analyzes the effect and prognosis of obstetric hemorrhagic disorders by interventional embolization, which explores the value of embolization in obstetric hemorrhagic diseases.Methods: 39 cases of obstetric hemorrhagic diseases which do interventional embolization of of maternal in the First Affiliated Hospital of Dalian Medical University from January 2005 to January 2015 were collected. including: group A( 20 cases): 17 cases of scar pregnancy and 3 cases of cervix pregnancy in the early pregnancy, group B( 4 cases): placenta previa state in mid-pregnancy, group C(10 cases): pernicious placenta previa with placenta increta in late and term pregnancy, group D(5 cases): 2 cases of postpartum hemorrhage and 3cases of placenta increta, General clinical data, therapy method, blood loss, treatment effect and prognostic of these cases were retrospectively analyzed. 13 cases with preventive embolism and negative pressure suction palace in 17 cases of scar pregnancy in the early pregnancy was made as intervention group, collecting 12 cases of scar pregnancy which did the negative pressure suction palace without interventional embolization in advance in the same period as control group, compared two groups of intraoperative bleeding.Results:1. The number of interventional embolization maternal was continually increasing inthe past 10 years.2. 20 cases in group A, including 14 cases with preventive embolism(13 cases of scar pregnancy and 1 case of cervical pregnancy), which had negative pressure suction palace in24~72 hours after embolization, bled 16.43±38.5 ml in the average; and the other 6 cases with therapeutic embolization because of massive hemorrhage(4 cases of scar pregnancy and 2cases of cervical pregnancy), bled 366.67±314.11 ml in the average and bleeding stopped after intervention; The difference between preventive embolism and therapeutic embolization patients in age, menopause days, pregnancy time, delivery time, β-HCG value and cases of ultrasonic cardiac appear and cases of gestational sac round by rich blood flow was no statistically significance(P > 0.05); there was statistically significance in the difference in intraoperative blood loss(P < 0.05). The difference between scar pregnancy intervention group and control group in age, menopause days, pregnancy time, previous cesarean delivery times,cases of ultrasonic germ appear, intraoperative blood loss was no statistically significance(P >0.05); there was statistically significance in the difference in β-HCG value, cases of ultrasonic cardiac appear and cases of gestational sac round by rich blood flow(P < 0.05).3. 4 cases in group B, including 2 cases of preventive embolism, intrapartum and postpartum hemorrhage 100 ml, 600 ml after embolism; the other 2 cases with bleedingduring induced labor(blood loss 700 ml, 1200 ml),therapeutic embolization was applied, blood check after intervention.4 cases were induced labor delivery.4. 10 cases in group C, cesarean section with interventional embolization together in DSA room(9 cases of pernicious placenta previa, 1 case of complete placenta previa with placenta implantation), interventional embolization were applied immediately after the birth of fetus, intraoperative bleeding 3640 ± 2162.92 ml in the average, surgery time 149 ± 69.35 min in the average; 1 cases of hysterectomy. 9 cases of neonatal survived, and 1 case died.5. 5 cases in group D, including 4 cases therapeutic embolization(2 cases of postpartum hemorrhage and 2 cases of placenta implantation curettage intraoperative bleeding), bleeding1400 ± 1134.31 ml in the average, bleeding stopped after intervention; another 1 case of placenta implantation curettage surgery after preventive embolism after 52 days line,intraoperative hemorrhage 80 ml.6. Lower limb dorsalis pedis artery of 39 cases was observed postoperative,all pulsestrong, no serious complications such as bleeding again, necrosis of pelvic cavity viscera,ectopic embolism and so on was found.7. Followed up to 33 people, from 3 months to 5 years after discharge, No serious complications such as the pelvic viscera necrosis, thrombosis of lower limb, pelvic infection and so on was found; Menstruation of 32 cases with uterus recover.Conclusions:1.Individualized assessment of higher risk of bleeding scar pregnancy, the scar pregnancy patients with high β-HCG value, ultrasonic cardiovascular pulsation appear and rich blood flow around gestational sac, interventional embolization in advance combined with negative pressure suction palace can reduce the risk of intraoperative bleeding.2.Interventional embolization can effectively control the mid-pregnancy induced labor placenta previa state in the process of bleeding, induced labor delivery within 24 to 72 hours after interventional embolization can avoid the risk of bleeding.3.Sufficient preoperative assessment, preoperative preparation and perfect multidisciplinary cooperation provide the opportunity to pernicious placenta previa patients do cesarean section with interventional embolization at the same time, reducing intraoperative bleeding and reduce the risk of hysterectomy.4. Interventional embolization is an effective, minimally invasive and less complications treatment in obstetric hemorrhagic diseases such as scar pregnancy, mid-pregnancy induced labor placenta previa state, pernicious placenta previa, intractable postpartum hemorrhage and so on.