| Objective: To study whether interventional embolization in cesarean section is beneficial to reduce the amount of bleeding during operation,reduce the rate of hysterectomy and the incidence of DIC for patients with pernicious placenta previa.And further discuss operation methods of interventional embolization,and the interventional embolization itself can affect the health of fetus and maternal.Method: 1784 pregnant women who were in Obstetrics Department of Mianyang Central Hospital from June 2015 to February 2016 were collected as samples,among which 162 cases are with placenta placenta,45 cases with pernicious placenta previa were included in study in accordance with various standards.According to the principle of voluntary and random,45 patients were divided into conventional surgery group,internal iliac artery embolization group(IIAE group)and uterine artery embolization group(UAE group).Traditional surgery group of 16 patients were treated with conventional cesarean section.In the operation,the uterine cavity packing gauze,the ligation of the ascending branch of uterine artery,and the improved B-lynch suture were used to stop the bleeding.Internal iliac artery embolization group had bilateral femoral artery puncture before cesarean section.5F single curved catheter was inserted into the anterior trunk of bilateral internal iliac arteries and indwelling catheter.In the expulsion of the fetus,use gelatin sponge particles for embolization of bilateral anterior trunk of internal iliac artery.Peel placenta and continue surgical operation;The operation method of uterine artery embolization group was same as that of the internal iliac artery embolization group,The catheter was inserted into bilateral uterine arteries,after delivery of fetus,have embolization of bilateral uterine arteries with gelatin sponge.Record bleeding,cesarean section operation time,pre and postoperative changes of hemoglobin,neonatal Apgar score,intraoperative and postoperative blood transfusion at first day,hysterectomy rates,diffuse intravascular coagulation(DIC)incidence rate,postoperative hospitalization days for three groups.IIAE group and UAE group were recorded on the irradiated dose of fetus and pregnant women during operation.To observe the incidence of postoperative complications.Result: 1.For 1784 pregnant women,162 cases were placenta previa patients,the incidence was 9.1%,45 cases were pernicious placenta previa patients,the incidence was 2.5%,19 cases had placenta implantation.Placenta implantation rate of pernicious placenta previa patients was 42.2%.2.Comparability of clinical data before treatment for three groups: for age,pregnancy,times of pregnancy,number of cesarean section,comparison of artificial abortion times and the number of cases with placenta implantation,there was no statistical significant difference,which had comparability(P > 0.05).3.Comparison of the amount of blood loss and blood loss during operation: Traditional surgery group in cesarean section operation bleeding volume 4888.22±2603.56 ml,blood loss was 120.16±62.07g/L,IIAE group,the bleeding volume was 1637.04±379.11 ml,blood loss was 40.82±10.11g/L,UAE group,the bleeding volume was 1224.32±473.59 ml,blood loss volume 29.96±11.4267g/L.Compare the data of the three groups,the amount of bleeding and blood loss in group IIAE and group UAE was significantly lower than that in conventional surgery group(P<0.05).The amount of bleeding and blood loss in group UAE was lower than that in IIAE group(P<0.05),with statistical difference.4.Comparison of operation time: The operation time of the traditional operation group was 129.41±33.57 min,and the IIAE group was 87.63±11.52 min,and the UAE group was 86.58±11.46 min.Comparison of three sets of data: IIAE group and UAE group's cesarean section operation time(P>0.05)was same and significantly lower than the traditional operation group(P<0.05).5.Comparison of postoperative hospital days: The length of hospital stay was 10.47±4.75 days in the traditional operation group,IIAE group was 7.30±2.22 days,UAE group was 4.48±0.67 days.Comparison of the three groups of data: postoperative hospital stay of the IIAE group and the UAE group was significantly lower than the traditional surgery group(P<0.05),and postoperative hospital stay of the UAE group was less than that of IIAE group(P<0.05).6.Comparison of blood transfusion: traditional surgery group input erythrocyte suspension was 15.79±8.56 U and IIAE group was 5.38±1.46 U,UAE group was 5.04±2.15 U.Comparison of three sets of data: IIAE group and UAE group in the operation of red blood cell suspension input amount was same(P>0.05),and significantly lower than the traditional surgery group(P<0.05).7.Comparison of the rate of hysterectomy and the incidence of DIC: The rate of hysterectomy was 31.3%(5/16),and the incidence of DIC was 25%(4/16)in the traditional operation group.DIC and hysterectomy were not occurred in group IIAE and group UAE.Comparison of three groups of data: IIAE group and UAE group hysterectomy rate and the incidence of DIC(P>0.05)were same,and significantly lower than the traditional surgery group(P<0.05).8.Comparison of neonatal Apgar score: In traditional operation group,neonatal Apgar score of 1 minute and 5 minutes was 9.77±0.42 points,9.94±0.23 points.Group IIAE was 9.80±0.40 points,9.94±0.25 points,UAE group was 9.70±0.57 points,9.94±0.24 points,there was no statistical difference in each group(P>0.05).9.Comparison of IIAE and UAE groups of fetal and maternal exposure doses: In group IIAE,the fetus was irradiated with a dose of 2.8mGy~70.0mGy.The average was 33.43±27.23 mGy.In group UAE,the fetus was irradiated with a dose of 2.2m Gy~113.6mGy.The average was 62.05±34.12 mGy.The exposure dose of UAE group was significantly lower than that of IIAE group(P<0.05).Maternal exposure to irradiation dose of IIAE group was 463~769mGy,the average was 639.38±95.12 mGy,UAE group was 312~568mGy,with an average of 463.93±88.55 mGy,IIAE group was significantly higher than the UAE group(P<0.05).10.Complications after interventional embolization: In IIAE group,92.9% patients(13/14)had hip pain,50%(7/14)had the lower abdominal pain,and the duration of pain was 4~10 days,with an average of 6.55±2.15 days.71.4%(10/14)had postoperative fever;in UAE group,53.3%(8/15)had lower abdominal pain,and the duration of pain was 2~5 days,with an average of 3.71±0.85 days.26.7%(4/15)had postoperative fever.The number of patients with pain and postoperative fever and the days of duration of pain in IIAE group was significantly more than that in UAE group,and the difference was statistically significant(P<0.05).Conclusion: 1.The high incidence of pernicious placenta pervia,with the opening of the two child policy has the trend of increasing.The prenatal diagnosis is an important basis for a reasonable choice of termination of pregnancy approach.2.The patients of pernicious placenta pervia(especially the patients with placenta implantation)more likely faced the larger blood loss.The traditional hemostasis method in cesarean section and the postoperative interventional embolization will lead to the poor hemostasis and a higher hysterectomy rate.3.Bilateral uterine artery embolization indwelling uterine artery before operation,and using absorbable gelatin sponge particles with diameter of 1000?m~1400?m embolization in cesarean section can effectively reduce the hemorrhage during cesarean section,reducing the incidence of disseminated intravascular coagulation(DIC),the rate of hysterectomy,and shortening the operation time and the average hospitalization time,and it is better than the internal iliac artery embolization to stop bleeding.4.The Bilateral uterine artery embolization indwelling uterine artery before operation can effectively control the radiation intensity on the fetus and puerperas within a safety threshold value and will not cause radiation damage on the fetus and the ovarian function of the puerperas.5.Compared with the bilateral internal iliac artery embolization,the postoperative complications of the bilateral uterine artery embolization indwelling uterine artery before operation were less. |
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