Application of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section

ObjectiveThis study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section.MethodsWe performed a retrospective analysis of the clinical data for 623 patients who experienced pernicious placenta previa complicated with placenta accreta and received treatment in our hospital from January 2013 to January 2019. All patients underwent abdominal aortic balloon occlusion before their cesarean section. Seventy-eight patients received bilateral uterine artery embolization, and among them, placenta accreta was found at the opening of the cervix in 13 patients. Due to suturing difficulty after the removal of the placenta, gauze packing was used to temporarily compress the hemorrhage. As soon as the uterus was sutured, emergent bilateral uterine artery embolization was performed. Active bleeding was noted in the remaining 65 patients when the lower part of the uterus was pressed after the placenta was removed and the uterus was sutured, therefor, bilateral uterine artery embolization was performed urgently.ResultsOf the 623 patients, 545 patients underwent only abdominal aortic balloon occlusion and 78 patients underwent additional emergent bilateral uterine artery embolization due to hemorrhaging during or after their cesarean section. No hysterectomies were performed. In the 78 patients, the amount of bleeding was 800-3,200 ml with an average of 1,650 ml during the operation; the volume of blood transfused was 360-1,750 ml (average: 960 ml). The fetal fluoroscopy time was 3–8 s (average: 5 s). The dose of radiation exposure was (4.2 ± 2.9) mGy. Fetal appearance, pulse, grimace, activity, and respiration (Apgar) score were normal. No serious complications were observed during or after the operation in the follow-up visits. Conclusion: For patients with pernicious placenta previa complicated with placenta accreta who experience active bleeding after cesarean section and abdominal aortic balloon occlusion, bilateral uterine artery embolization can effectively reduce blood loss and requirement of blood transfusion during the operation, and lowers the risk of hysterectomy.     

自噬在围着床期小鼠子宫内膜中作用初探

目的: 探索围着床期小鼠子宫内膜自噬情况。方法: 选择36只ICR妊娠小鼠随机分为空白组、胚胎着床障碍模型组,每组小鼠18只。模型组采用米非司酮制备,每组每日予以生理盐水灌胃,分别于妊娠第4、5、6天脱颈处死小鼠各6只。观察子宫形态,计算各组平均胚胎着床位点数,检测自噬标志物微管相关轻链蛋白3-Ⅱ（LC3-Ⅱ）,透射电镜观察子宫内膜细胞中自噬小体的表达。结果: 空白组妊娠第4天（pd4）子宫无明显串珠样改变,妊娠第5天（pd5）、妊娠第6天（pd6）子宫串珠样改变明显且分布均匀。模型组pd4、pd5未见明显串珠样改变,pd6可见少量串珠稀疏分布。空白组pd6的胚胎着床位点数较pd4增多,差异有统计学意义（P<0.05）;而pd5的胚胎着床位点数与pd4比较有增多,但差异无统计学意义（P>0.05）。模型组pd5、pd6平均胚胎着床位点数分别低于空白组pd5、pd6（P<0.05,P<0.01）。2组LC3-Ⅱ蛋白水平差异无统计学意义（P>0.05）。透射电镜下空白组小鼠子宫内膜细胞完整,pd5自噬小体数量较pd4减少,pd6又增多。模型组部分细胞损伤、坏死,pd4自噬小体表达较空白组多,亦较模型组pd5、pd6多。结论: 自噬参与并调控胚胎着床过程,自噬异常可能破坏子宫内膜细胞活性和功能,影响胚胎着床。     

Role of transperineal sonography in diagnosis of placenta previa/accreta: A prospective study

Purpose

To evaluate the role of transperineal ultrasound (TPS) in the detection of morphological and vascular manifestations of placenta previa (PP)/accreta and to compare it with transabdominal sonography (TAS) and transvaginal sonography (TVS), with the clinical outcomes as the reference standards.

Materials and methods

TPS, TVS, and TAS were carried on 134 patients after 28 weeks’ gestation presented with antepartum hemorrhage. The final diagnosis was obtained from the obstetrician at time of delivery and from histopathological reports.

Results

One hundred and three patients had PP, the sensitivity, specificity, and accuracy in diagnosing PP were 97.1%, 75% and 94% for TPS, 94.2%, 75% and 91.5% for TAS, and 98.1%, 93.8% and 97.4% for TVS respectively. PP accreta was present in 39 patients. The sensitivity, specificity, and accuracy in diagnosing PP accreta were 89.7%, 100% and 96% for TPS, 87%, 95% and 92.2% for TAS, and 94.9%, 100% and 98% for TVS respectively.

Conclusion

TPS is a valuable approach for evaluating patients with high risk of PP & PP accreta, it is a safe, rapid, & accurate technique with little patient discomfort.     

凶险性前置胎盘32例临床分析

目的探讨凶险性前置胎盘的孕期、围手术期临床特点。方法53例前置胎盘患者,其中凶险性前置胎盘32例（凶险前置胎盘组）,初次剖宫产前置胎盘21例（初次前置胎盘组）;比较2组一般资料、围手术期资料、围产儿资料等。结果2组年龄、确诊时孕周、分娩时孕周、文化程度、职业、Apgar评分〈7比例、出生体质量、是否转NICU比较差异无统计学意义（P〉0．05）;2组孕次、产次、产后出血量、产后出血率、手术时间、子宫切除率、肠粘连松解率、输血率、胎盘植入率、早产发生率比较差异有统计学意义（P〈0．05）。结论凶险性前置胎盘的产后出血率、胎盘植入率、子宫切除率、输血率及早产率较高,早期干预可降低母婴致病率及病死率。     

叙事心理疗法对前置胎盘孕妇期待治疗期间负性心理的影响

目的：分析叙事法改善前置胎盘孕妇期待治疗期负性心理的效果。方法选择2011年3月-2013年7月北京五洲妇儿医院妇产科收治,B超确诊为前置胎盘的孕妇82例,以随机数表法分为对照组40例,研究组42例,对照组给予常规心理干预,研究组采用叙事心理干预法,采用焦虑自评量表（SAS）和抑郁自评量表（SDS）评估患者的焦虑和抑郁水平,采用爱丁堡产后抑郁量表（EPDS）评估患者产后抑郁程度。结果对照组入院时SAS评分为（72．41±8．45）分,SDS评分为（65．21±6．47）分,研究组分别为（71．66±9．80）,（67．33±4．59）分,两组比较差异无统计学意义（t分别为2．007,2．613;P＞0.05）;经干预后,对照组术前SAS评分为（60．45±4．21）分,SDS评分为（57．08±5．11）分,研究组分别为（52．69±2．77）,（50．49±2．70）分,两组比较差异有统计学意义（t分别为11．629,9．735;P＜0．01）。研究组产后抑郁发生率为11．89％,EPDS评分为（3．07±1．14）分,对照组为37．50％,（5．12±2．45）分;研究组低于对照组,且差异有统计学意义（Z＝-3．019,t＝5．097;P＜0．05）。结论叙事心理干预法可更有效的降低前置胎盘孕妇期待治疗期的焦虑、抑郁程度,减少产后抑郁症的发生率。     

高龄初产妇前置胎盘的高危因素与妊娠结局分析

目的：了解高龄初产妇前置胎盘的发生率、高危因素及妊娠结局。方法以医院为基础收集资料,共纳入1065人为研究对象。用χ2检验分析比较高龄初产妇在人口学资料、妊娠分娩因素及妊娠并发症等条件下前置胎盘的发生率,用多因素Logistic回归模型分析前置胎盘的高危因素及不良结局。结果所有1065名高龄初产妇中,905人（85．0％）未发生产后出血,160人（15．0％）发生产后出血。160名产后出血的高龄初产妇中,13人（8．13％）发生前置胎盘;950名未产后出血的高龄初产妇中,12人（1．33％）发生前置胎盘。所有高龄初产妇中,前置胎盘发生率在是否产后出血、是否宫缩乏力者间的比较,差异有统计学意义（χ2值分别为24．53,12．10;P＜0．05）,在其他妊娠并发症中前置胎盘的发生率比较,差异无统计学意义（ P＞0．05）。在所有高龄初产妇中,未发现人口学及妊娠产前相关因素,前置胎盘的不良结局为早产（AOR：3．26,95％CI：1．43∽7．44）、产后出血（AOR：5．38,95％CI：2．37∽12．23）;在产后出血的高龄初产妇中,前置胎盘的不良结局为早产（AOR：6．28,95％CI：1．65∽23．82）。结论高龄初产妇是前置胎盘的高危人群,应尽快确认不良结局,以便及早采取应对措施。     

前置胎盘阴道流血加强护理观察的效果探讨

目的探讨前置胎盘阴道流血加强护理观察的临床效果。方法选取我院2009年12月-2011年12月收治的42例前置胎盘阴道流血患者,随机分成观察组21例,对照组21例,对照组进行常规护理,观察组在常规护理同时给予加强护理观察,比较两组的新生儿存活率和新生儿窒息状况。结果两组均无孕妇死亡发生,两组在新生儿存活率和新生儿出生1分钟后新生儿窒息状况评分上具有显著性差异,P<0.05,具有统计学意义。结论对前置胎盘阴道流血患者加强护理观察,可有效提高围产儿的存活率,值得临床推广。     

多学科联合救治植入性凶险型前置胎盘策略探讨

目的 探讨植入性凶险型前置胎盘的救治策略,提高孕产妇术中出血抢救成功率.方法 回顾性分析2012年8月至2014年6月收治的23例植入性凶险型前置胎盘的救治及处理方法.结果 23例患者无1例死亡,3例因3次剖宫产术后胎盘植入穿透膀胱,行子宫切除及泌尿外科协助行膀胱修补术;5例因胎盘植入面积过宽保守治疗无效后行子宫全切术,其余全部成功保留子宫.手术持续时间（94.8±33.2） min,术中平均失血（1600±558） mL.结论 提高产前诊断率,围术期麻醉科应联合产科、泌尿外科、介入科、输血科、检验科等多个学科,安全、有效的综合治疗是保障手术成功的关键.     

介入治疗用于凶险性前置胎盘临床分析

目的：分析介入治疗用于凶险性前置胎盘临床效果。方法回顾性分析2011年1月至2013年6月我院共收治24892例分娩孕妇的临床资料。结果在凶险性前置胎盘及胎盘植入的发生率方面,孕周≥37周的孕妇明显比〈37周的孕妇低,中央型前置胎盘孕妇的发生率明显比部分型和边缘型孕妇高,妊娠次数≥3次的孕妇的发生率明显比妊娠次数为1次、2次的孕妇高（P〈0．05）;凶险性前置胎盘及胎盘植入患者经介入治疗后的弥散性血管内凝血（DIC）、子宫切除、产后出血＆gt;2000ml、产褥感染、早产、新生儿窒息、新生儿死亡发生率均明显比非介入治疗低（P〈0．05）。结论介入治疗用于凶险性前置胎盘的临床效果良好,值得推广。     

米索前列醇联合催产素预防前置胎盘产后大出血疗效观察

目的：为了进一步研究和比较采用米索前列醇联合催产素预防前置胎盘产后大出血的临床实际效果,从而为关于前置胎盘产后大出血预防的相关研究提供借鉴和参考。方法 本文以我院2010－12～2012－12间收治的224例前置胎盘剖宫产术孕妇为研究对象,随机将其分成治疗组和对照组,每组各112例。对照组采用催产素治疗,治疗组采用米索前列醇联合催产素预防治疗。结果 在术后2 h出血量和产后24 h出血量组间比较,治疗组孕妇的出血量显著低于对照组孕妇的出血量,均P＜0．05,差异具有统计学意义。结论 在临床上预防前置胎盘产后大出血的实践过程中,采用米索前列醇联合催产素预防方法的临床实践效果显著,是临床预防前置胎盘产后大出血的可靠选择。