| Objective :To investigate the safety and effectiveness of interventional embolization in cesarean section of patients with pernicious placenta previa;to explore the different surgical methods of interventional embolization and whether it will have adverse effects on the fetus and the mother.Methods:From March 2014 to February 2018,17106 pregnant women were delivered at the First Affiliated Hospital of Soochow University.Among them,233 were patients with placenta previa and 56 patients with pernicious placenta previa.According to the diagnostic results in cesarean section,it was divided into placenta accreta group and non-placenta accreta group.According to the different types of intraoperative interventional embolization,it was divided into uterine artery embolism group(13 cases in UAE group)and internal iliac artery embolization group(16 cases in IIAE group).The amount of intraoperative blood loss,time of cesarean section,hemoglobin change before and after surgery,neonatal Apgar score,blood transfusion of intraoperative and the first day after the operation,hysterectomy,disseminated intravascular coagulation(DIC),postoperative hospital stay were recorded in the placenta accreta group and the non-placenta accreta group,the uterine artery embolism group and the internal iliac artery embolism group.The doses of irradiated fetuses and pregnant women were recorded in patients with uterine artery embolization(10 cases)or internal iliac artery embolization(5 cases)from November 2016 to February 2018,and the incidence of complications after vascular embolization was observed in all patients.P < 0.05 was considered statistically significant difference.Results:1.For 17106 pregnant women,233 cases were placenta previa patients,the incidence was 1.36%,56 cases were pernicious placenta previa patients,the incidence was 0.33%,29 cases had placenta implantation,The placenta implantation rate of the pernicious placenta previa patients is 51.78%.2.Comparability of pre-treatment clinical data between placenta and non-placental implanted patients: There was no statistically significant difference in age composition,number of days of pregnancy,number of gestational events,number of cesarean section,and number of artificial abortion between the two groups.(P>0.05).The comparability of pre-treatment clinical data between UAE and IIAE patients: There was no statistically significant difference in age composition,number of days of pregnancy,number of pregnancies,number of cesarean delivery,number of artificial abortion,and number of cases of combined placental implants between the two groups.(P>0.05).3.Comparison of the amount of blood loss and blood loss during operation: In the placenta implanted group,operation bleeding was 1667.93±1022.35 ml,blood loss was 34.50±20.28g/L,in the non-placental implanted group,the bleeding was 667.78±357.73 ml,blood loss was 12.74±9.90g/L.Compared the data of the two group,the amount of blood loss and blood loss in the placenta implant group was significantly higher than in the non-placental implanted group(P<0.05).In UAE group,the operation bleeding was 1276.15±573.86 ml,and the blood loss was 28.96±17.22g/L.In IIAE group,the operation bleeding was 1674.38±1063.79 ml,and the blood loss was 32.19±19.55g/L.The amount of bleeding and blood loss was similar in the IIAE group and the UAE group(P>0.05).4.Comparison of operation time:The operation time of placenta implanted group was 114.31±48.98 min and the non-placental implanted group was 71.70±24.05 min.The operation time of the placental implanted group was significantly higher than that of the non-placental implanted group.The difference was statistically significant(P<0.05).The operation time of the IIAE group was 117.44±42.02 min,and the UAE group was 96.23±20.58 min.Comparing the two groups of data: the operation time between the IIAE group and the UAE group was same(P>0.05).5.Comparison of postoperative hospital days :The length of hospital stay was 7.48±2.99 days in the placenta implanted group,the non-placental implanted group was 4.7±2.14 days,the postoperative hospital stay of placenta implanted group was significantly higher than the non-placental implanted group(P < 0.05).The length of hospital stay was 9.29±2.97 days in the IIAE group and the UAE group was 5.54±1.45 days,and the operative hospital stay of the UAE group was significantly lower than the IIAE group(P<0.05).6.The comparison of blood transfusion:The blood transfusion was 906.90±727.48 ml in the placenta implanted group,the non-placental implanted group was 170.37±252.39 ml,the placenta implanted group in blood transfusion was higher than non-placental implanted group,the difference was statistically significant(P <0.05).The IIAE group,it was 812.50±576.05 ml and the UAE group was 676.92±617.99 ml.Comparing the two groups of data: the amount of blood transfusion in the IIAE group was equal to that of the UAE(P>0.05).7.Comparison of the rate of hysterectomy and the incidence of DIC:In the placenta implanted group,the rate of hysterectomy was 3.44%(1/29),the incidence of DIC was 6.89%(2/29).Hysterectomy and DIC did not occur in the non-placental group.There was no significant difference between the two groups(P>0.05).In the IIAE group,the incidence of hysterectomy was 6.2%(1/16),the incidence of DIC was 12.5%(2/16).There was no DIC or hysterectomy in the UAE group.There was no significant difference between the two groups(P>0.05).8.Comparison of neonatal Apgar score:In the placenta accreta group,neonatal Apgar score of 1 minute and 5 minutes was 9.24±1.15 points,9.69±0.71 points.Non-placenta accreta group was 9.26±1.19 points,9.85±0.36 points,there was no statistical difference between the two groups(P>0.05).In the IIAE group,neonatal Apgar score of 1 minute and 5 minutes was 9.13±1.08 points and 9.69±0.79 points.UAE group was 9.08±1.38 points and 9.77±0.59 points,there was no statistical difference between the two groups(P>0.05).9.Comparison of UAE and IIAE groups of fetal and maternal exposure doses:The dose of fetal radiation in UAE group was 26.50 m Gy-60.50 m Gy,with an average of 57.52±23.22 m Gy.The dose of fetal in IIAE group was 22.00-42.00 m Gy,with an average of 31.90 m Gy±7.28 m Gy.The dose of fetal in IIAE group was lower than that in UAE group(P <0.05).Maternal exposure to irradiation dose of IIAE group was 452.00-980.00 m Gy,with an average of 748.20±199.75 m Gy,and UAE group was 150.00-762.00 m Gy,with an average of 549.40±182.40 m Gy.there was no statistical difference between the two groups(P>0.05).10.Observation of complications after interventional embolization:In IIAE group,93.75%(15/16)patients had different degree of hip pain after operation.Among them,18.75%(3/16)patients had lower limb pain associated with numbness,and the duration of pain was 3 to 20 days,with an average of 7.87±4.73 days.93.75%(15/16)of patients had postoperative fever(T>38℃).In the UAE group,15.38%(2/13)of the patients had different degree of hip pain after operation.The duration of pain was 2 to 5 days,and the average time was 3.5±2.12 days.26.67%(4/15)of patients had postoperative fever(T>38℃).The number of pain and duration of pain in the IIAE group were higher than those in the UAE group(P<0.05).There was no significant difference in the number of postoperative fever between the UAE group and the IIAE group(P>0.05).Conclusions:1.Patients with pernicious placenta previa,especially with placenta accreta,had more bleeding in cesarean section.Try to reduce the incidence of non-indicated cesarean section,thereby reducing the incidence of pernicious placenta previa.2.In the cesarean section,bilateral bilateral uterine artery embolism or internal iliac artery embolization can effectively reduce the intraoperative blood loss and reduce the incidence of adverse maternal events.3.The radiation effects of bilateral uterine artery embolization and internal iliac artery embolization on the fetus and pregnant women are controlled within a safe threshold,which will not cause fetal radiation damage and will not affect the ovarian function of pregnant women.4.Compared with bilateral internal iliac artery embolization,bilateral uterine artery embolization has fewer postoperative complications. |
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