Predicting Risks of Preeclampsia and Small for Gestational Age Infant by Uterine Artery Doppler

Objective: To assess the value of uterine artery Doppler as a screening test for preeclampsia and/or having a small-for-gestational-age (SGA) infant in healthy pregnant women. Methods: Color Doppler ultrasound was used to examine both uterine arteries in 400 healthy pregnant women at 24.8 ± 2.0 (range, 22 to 28) weeks of gestation. The mean pulsatility index of both uterine arteries was calculated and the presence of an early diastolic notch in the waveform was noted. Results: Twenty-six (6.5%) of the 400 women developed preeclampsia and/or had an SGA infant. The optimal cutoff value for the mean pulsatility index in predicting preeclampsia and/or having an SGA infant was 0.857. When using a high mean pulsatility index and/or the presence of any early diastolic notch, the detection of preeclampsia and/or having SGA infant were a sensitivity of 76.9%, a specificity of 52.9%, a positive predictive value of 10.2%, and a negative predictive value of 97.1%, respectively. Conclusion: Women with an abnormal uterine artery Doppler great a considerably higher risk for developing preeclampsia and/or having an SGA infant.     

Circulating Angiogenic Factors and Abnormal Uterine Artery Doppler Velocimetry in the Second Trimester

Objective: Circulating angiogenic growth factors (such as vascular endothelial growth factor [VEGF] and placental growth factor [PlGF]) and their interaction may be associated with vascular remodeling of spiral arteries in normal pregnancy. Soluble Flt-1, an antagonist of both VEGF and PlGF, has been shown to be increased, while PlGF is decreased in women prior to the onset of preeclampsia. The purpose of this study was to compare maternal soluble Flt-1 and PlGF levels in the second trimester with a marker of abnormal placentation, abnormal uterine artery Doppler (UAD). Method: A prospective cohort of women, 16 to 24 weeks estimated gestational age (EGA), with singleton pregnancies, underwent UAD and phlebotomy. Maternal soluble Flt-1 and free PlGF were measured by ELISA in samples from women with abnormal UAD with a group, controlled for EGA, with normal UAD. Mann-Whitney Rank-Sum test was used to compare maternal serum levels of both soluble Flt-1 and PlGF between women with abnormal uterine artery Doppler versus women with normal uterine artery Doppler. Results: Of the 222 study subjects enrolled, 34 (15%) had abnormal UAD. The mean EGA at enrollment of subjects in each group was 18 weeks. There was no difference in PlGF between subjects with abnormal UAD (median, 191 pg/mL; range, 187 to 337 pg/mL) versus controls (median, 171 pg/mL; range, 169 to 289 pg/mL) (p = 0.59) or soluble Flt-1 (median, 780 pg/mL; range, 280 to 3200 pg/mL) or between subjects with abnormal UAD versus controls (median, 720 pg/mL; range, 220 to 1980 pg/mL) (p = 0.36). Conclusion: Concentrations of maternal soluble Flt-1 and free PlGF in the second trimester do not appear to be altered in women with abnormal UAD. This suggests that these biochemical markers are independent of the increased placental resistance seen with abnormal uterine artery Doppler.     

Prediction of Preeclampsia by Midtrimester Uterine Artery Doppler Velocimetry in High-Risk and Low-Risk Women

Objective

To observe the role of uterine artery Doppler flow velocimetry at midtrimester in prediction of preeclampsia.

Method

179 women carrying <16 weeks of pregnancy, with singleton fetus and without any fetal anomaly were recruited and were divided in high-risk and low-risk group. Doppler velocimetry of uterine artery was done at 24–26 weeks. Any notch in uterine artery, unilateral or bilateral, or RI > 0.6, was considered abnormal. Women were followed up and development of preeclampsia noted.

Result

Sensitivity and specificity of abnormal uterine artery Doppler study for prediction of preeclampsia were 73.33 and 86.48 % in high-risk and 57.14 and 95.83 % in low-risk group, respectively. Relative risk with 95 % confidence interval was 5.427 (2.272–12.958) in high-risk and 13.65 (5.669–32.865) in low-risk women.

Conclusion

Doppler velocimetry of uterine artery at 24 weeks can be used as a reliable screening test for prediction of preeclampsia in both high-risk and low-risk women.     

A Prospective Analysis of the Role of Uterine Artery Doppler Waveform Notching in the Assessment of At-Risk Pregnancies

Objective. To determine the value of second trimester uterine artery Doppler waveform notching in the prediction of adverse pregnancy outcome in a high-risk group. Design. Analysis of data from a consecutively collected cohort. Setting. St. James University Hospital, Leeds, UK. Population. Three hundred thirty women known to be at risk of preeclampsia (PET) or intrauterine growth restriction (IUGR) were assessed for notching of the uterine artery Doppler waveform between 24–30 weeks of pregnancy. Main Outcome Measures. Preeclampsia (PET), small-for-gestational-age at birth (SGA), preterm delivery (PTD), perinatal death. Results. Two hundred thirty-two women (70.3%) had a normal uterine artery Doppler waveforms, and 98 (29.7%) demonstrated either unilateral or bilateral notching. In women where notching was present, 20 (20%) developed PET compared with 8 (3.5%) in the normal group [Odds ratio (OR) 7.2, CI 3–17]; SGA birthweight was present in 24 (24.5%) of the notched group and in 21 (9%) of normal group (OR 3.3; CI 1.7–6.2); 40 (41%) of the notched group delivered preterm ( < 37 weeks) as compared with 37 (16%) of the normal group (OR 7.9; CI 4.6–13). This difference was even more marked when delivery before 32 weeks was considered, occurring in 8 (8%) of the notched group and 4 (1.7%) of the normal group (OR 11.5; CI 4.5–29.4). Of the six perinatal deaths, five (5.1%) occurred in the notched group (OR 12.4; CI 1.4–108). Conclusion. This study demonstrates that the addition of uterine Doppler waveform analysis to the monitoring profile of women at risk of PET, SGA, IUD and preterm delivery can further define those in a higher risk group and the majority that have a risk no higher than the background.     

An integrated model for the prediction of preeclampsia using maternal factors and uterine artery Doppler velocimetry in unselected low-risk women

OBJECTIVE: The purpose of this study was to develop a predictive model for preeclampsia. STUDY DESIGN: This was a prospective screening study for preeclampsia using uterine artery Doppler ultrasound in unselected low-risk singleton pregnancies at community hospitals in the UK (n = 32,157). Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve (AROC). RESULTS: Six hundred twelve (2.0%) women developed preeclampsia, and 144 (0.5%) required early delivery (<34 weeks). A model using both maternal and ultrasound factors had an AROC of 0.798, which was higher than ultrasound alone (0.729, P < .0001) or maternal factors alone (0.712, P < .0001). In early onset disease, the ROC of ultrasound alone (0.922) was not significantly improved by adding maternal predictors (0.945, P = .27). In contrast, late onset disease was better predicted by the combined model (AROC 0.798) than ultrasound alone (AROC 0.729, P < .0001) or maternal factors alone (AROC 0.712, P < .0001). CONCLUSION: The combination of uterine artery Doppler ultrasound and maternal factors provided the best estimate of risk.     

Uterine artery Doppler velocimetry with leiomyomas

The study was conducted to establish a correlation between Doppler velocimetry in relation to uterine weight in any phase of the menstrual cycle and symptoms in women who have leiomyomas. Doppler velocimetry was carried out on both uterine arteries in 18 pre-menopausal women and one post-menopausal woman prior to undergoing abdominal hysterectomy at Winthrop University Hospital in Mineola, NY and at Ioannina University Hospital. The t-test was used for statistical analysis. Changes in flow velocity correlatd directly with uterine size. When a division at 500 g was used, S/D ratio was 2.74±0.53 for larger uteri vs. 4.2±1.24 for smaller uteri, p<0.006. Eight women presented heavy bleeding and the mean S/D ratio was 3.75±1.36 while eleven women presented mild bleeding and the mean S/D ratio was 3.51±1.2 (p>0.5). Thus the study has demonstrated that in cases of uterine leiomyomas, the uterine artery flow increases although angiography had previously shown decreased vascularity within the tumor. Received: 9 April 1997 / Accepted: 22 December 1997     

Mid-Trimester Placentation Assessment in High-Risk Pregnancies Using Maternal Serum Screening and Uterine Artery Doppler

Objective. To determine the value of uterine artery velocimetry and mid-trimester maternal serum AFP/hCG measurements in predicting pregnancy complications in a high-risk group of pregnant patients. Methods. Eighty-eight patients with chronic hypertension, previous preeclampsia, and thrombophilia were included. Maternal serum AFP/hCG was examined between 15–16 weeks gestation. Levels > 3 multiple of median (MoM) for hCG and > 2 MoM for AFP were considered abnormal. Color Doppler ultrasound was performed at 23–24 weeks gestation. Diastolic notching and pulsatilty index (PI) above the 95th percentile were considered abnormal. Results. Thirty-three patients had abnormal uterine artery waveform: 8 patients had abnormal maternal serum hCG and 5 had abnormal maternal serum AFP. Bilateral abnormal uterine artery waveform was associated with pregnancies complicated by lower gestational age at delivery (p = 0.05) and birth weight (p < 0.01), higher rates of preeclampsia (p = 0.006), SGA (p = 0.0001), preterm delivery (p = 0.0001), and cesarean section rate (p < 0.0001) in comparison to patients with normal uterine artery Doppler. Pregnant women with elevated hCG had higher rates of preeclampsia (p = 0.006); preterm delivery (p = 0.005) and SGA (P = 0.03) and, lower birth weight (p = 0.001). No significant differences were noted for clinical outcomes according to AFP data. Conclusions. Abnormal uterine artery waveform is superior to maternal serum hCG for identification of placental pathology leading to preterm delivery, low birth weight, and preeclampsia in high-risk pregnant patients.     

Transcranial Doppler Findings of Cerebral Vasospasm in Preeclampsia

The objective of this study was to evaluate the effect of preeclampsia and its severity on maternal mean middle cerebral artery blood flow velocity (mean MCA-CBFV) using transcranial doppler sonography (TCD), as well as the effect of magnesium on mean MCA-CBFV in preeclampsia.

This study used a prospective, comparative design. TCD was used to examine maternal mean MCA-CBFV in both healthy subjects (controls) and preeclamptic subjects (cases). The two groups were similar in age, gestational age, and parity. Healthy subjects were categorized into three groups: Group I, 6–14 weeks, n = 10; Group 11, 24–40 weeks, n = 27; Group HI, postpartum n = 15, 12–36 h. Serial TCD examinations of the middle cerebral artery were completed in 21 preeclamptic subjects at four different points in time: Time I is an initial measurement before delivery; Time 2 is also before delivery but after magnesium had been administered; Time 3 is postpartum while on magnesium (12–24 h), Time 4 is postpartum off magnesium, (24–48 h).

Preeclamptic subjects had significantly increased mean MCA-CBFV when compared to healthy subjects: antepartum (mean 78.2 vs. 55.1 cm/sec, P < 0.0005); postpartum (mean 101.3 vs. 69.8 cm/sec, P < 0.0001). Severe preeclamptics had significantly higher mean MCA-CBFV than mild preeclamptics at each point in time: Time 1: P < 0.016; Time 2: P < 0.040; Time 3: P < 0.002; and Time 4: P < 0.028. These data support the theory that cerebral vasospasm of the smaller diameter vessels is a major component of preeclampsia.     

Uterine artery Doppler and subendometrial blood flow in patients with unexplained recurrent miscarriage

Objective

To evaluate uterine artery blood flow and subendometrial blood flow in women with unexplained recurrent miscarriage (RM) compared to normal fertile women.

Design

Case control study.

Settings

Departments of Obstetrics and Gynaecology, Cairo university and, Beni Souif University, Cairo, Egypt.

Patients and methods

Women were divided into two groups: those with history of unexplained recurrent miscarriage (study group, no. = 40), and those with no history of miscarriage and at least one child born at term (control group, no. = 40), transvaginal 3D power Doppler ultrasonography was performed to all patients in the second phase of non-pregnant unstimulated cycle to detect uterine artery pulsatility index (UAPI) and subendometrial area to detect subendometrial blood flow presented by the indices vascularisation index (VI), flow index (FI), and vascular flow index (VFI). The indices between the two groups were compared.

Results

UAPI was significantly higher in the study group (p = 0.000), on the other hand VI (p = 0.000), FI (p = 0.000), VFI (p = 0.000) were significantly lower in the study group. A significant positive correlation was found between UAPI and recurrent miscarriage in the study group (r = 0.8, p = 0.00), whereas a significant negative correlation was found between VI (r = −0.56, p = 0.00), and FI (r = −0.79, p = 0.00) and recurrent miscarriage in the study group, but no significant correlation was found between endometrial thickness and endometrial volume between the two groups. However the application of binary logistic regression analysis model found that adding variables has not significantly increased the ability to predict the occurrence of miscarriage.

Conclusion

The presence of good uterine and endometrial blood flow is an important prerequisite for successful implantation and continuation of pregnancy as shown by higher uterine artery blood flow resistance and lower endometrial blood flow in recurrent miscarriage cases and those patients with unexplained RPL may have abnormalities in the uterine and endometrial blood flow. Despite these findings we could not find any cut off values that could predict the occurrence of miscarriage which may be attributed to small sample size and short period of follow up so larger prospective studies are needed aiming to confirm such results and reaching values that can accurately predict the occurrence of miscarriage.     

Uterine Artery Notching on Color Doppler Ultrasound and Roll over Test in Prediction of Pregnancy Induced Hypertension

Objective

To study the role of uterine artery notch on color Doppler ultrasound and roll over test in prediction of PIH.

Methods

100 women with high risk pregnancies were studied for presence or absence of uterine artery diastolic notch by Doppler ultrasound at 16–28 weeks. Same women were then subjected to roll over test at 28–32 weeks.

Results

The primary outcome was that uterine diastolic notching alone and combined together with roll over test shows a high specificity (98.53%) for predicting PIH than roll over test (76.47%) alone. PPV of uterine artery diastolic notching (83.33%) was higher than roll over test alone (54.29%) and both tests combined together (80%).

Conclusion

After analyzing all the results, it has been concluded that uterine artery Doppler notching is better predictor for PIH than roll over test or even combined Doppler + Roll over test together.     

胎儿畸形的脐动脉彩色多普勒血流频谱分析

目的探讨脐动脉彩色多普勒血流频谱分析在胎儿畸形中的临床意义.方法1997年10月至1999年11月于本院行彩色多普勒超声检查胎儿发育异常59例,全部病例在出生或引产后得到证实.同期收集正常孕妇154例作为对照组,研究其脐动脉血流收缩期峰速与舒张期末期最低速度之比值(S/D值).结果胎儿畸形组的S/D值明显高于正常组(P＜0.01);各类畸形中,多发畸形、消化系统畸形和中枢神经系统畸形组脐动脉血流S/D值异常者明显多于正常对照组(P＜0.005);而泌尿系统畸形和胸、腹水组与正常对照组比较,无显著差异(P＞0.01).结论胎儿畸形,尤其是多发畸影、消化系统畸形和中枢神经系统畸形可引起S/D值增高.     

宫缩期脐血流与胎儿宫内窘迫的相关性分析

目的 :通过检测产程处于潜伏期的孕妇宫缩时的脐动脉血流变化 ,了解宫缩对胎儿的影响 ,探讨脐血流预测胎儿宫内窘迫的价值。方法 :采用彩色多普勒超声血流诊断技术 ,对 4 7例处于潜伏期的孕妇分别进行宫缩期及间歇期脐动脉检测。结果 :33例检测结果正常 ,14例异常 (宫缩期 S/ D>2 .7)。两组比较 ,除 MAX以外 ,宫缩期及间歇期各项指标都有差异 ,且胎儿窘迫的发生也有差异 ;组内分析 ,异常组的 MIN的降幅对比 MAX的降幅有统计学差异。结论 :超声多普勒脐血流产时检测 ,可以作为预测胎儿宫内窘迫的筛选实验。其敏感性、特异性、阳性预测值、阴性预测值分别是 :83.3%、93.5 %、83.3%和 93.5 %。     

再发子痫前期危险因素的分析

目的:探讨再发子痫前期(PE)的相关危险因素。方法:采用回顾性病例对照研究的方法,选择2010年1月至2014年12月西安交通大学第一附属医院住院的有2次单胎妊娠且前次妊娠合并PE的孕妇139例为研究对象,根据第2次妊娠是否再次发生PE分为再发PE组(84例)和对照组(55例)。采用单因素分析及二项分类Logistic回归分析各因素和再发PE之间的相互关系。结果:单因素分析显示:再发PE组与对照组中再次妊娠时的年龄、再次妊娠孕前体质量指数(BMI)、前次妊娠PE发病孕周和终止孕周、两次妊娠间隔时间、合并慢性高血压的比较,差异有统计学意义(P0.05)。二项分类Logistic回归显示:再次妊娠时的年龄(≥35岁)、再次妊娠孕前超重及肥胖(BMI≥24 kg/m~2)、两次妊娠间隔时间(≥5年)是PE再次发生的独立危险因素(P0.05)。结论:对于有再发PE独立危险因素的妇女,孕期应积极采取有效的预防及监测,避免PE的再次发生。     

妊娠早期子宫动脉的多普勒监测对子痫前期的预测价值

提前识别孕妇患子痫前期的风险,可以降低孕产妇和胎儿的发病率和死亡率。子宫动脉多普勒频谱分析在妊娠中期预测子痫前期的研究已较广泛。利用妊娠早期子宫动脉多普勒来预测子痫前期成为了近年的研究热点。子宫动脉多普勒参数作为单独的标志物,其敏感度不高。妊娠早期子宫动脉多普勒参数(如搏动指数)与母体特征及相关生化标志物(如妊娠相关血浆蛋白A、胎盘生长因子)相结合,对早发型子痫前期的检测率高于90%。但结合生化标志物增加了成本,未来研究的方向是筛选最佳组合的预测模型来早期预测子痫前期。     

Ischemia-Modified Albumin (IMA): A Novel Marker for Preeclampsia Independent of Uterine Artery Notching Identified by Doppler Ultrasound

Objective: To determine the predictive value of second trimester serum ischemia-modified albumin (IMA) levels for preeclampsia (PE), small for gestational age (SGA) and gestational diabetes mellitus (GDM). Methods: The study was conducted at a tertiary care hospital between May and August 2014. Healthy pregnant women (n?=?88) who were screened for fetal anomalies with ultrasound at 20–24 weeks of gestation were included in the study. Doppler measurements of the bilateral uterine arteries were performed in all the patients. Serum samples were obtained for an IMA assay. The maternal serum IMA levels were compared in pregnant women who had normal and abnormal uterine artery Doppler findings, including notching, and also in pregnant women who subsequently developed PE, SGA, and GDM during the follow-up period. Results: Uterine artery notching was not significantly predictive for PE, GDM or SGA (p?>?0.05). There was no significant difference between notching of the uterine arteries and serum IMA levels (p?>?0.05). Eight pregnant women (9.1%) subsequently developed PE. Serum IMA levels were significantly elevated in patients with PE compared with patients who did not subsequently develop PE (p?=?0.002). However, serum IMA levels were not significantly different in patients who subsequently developed SGA and GDM compared with women who did not (p?>?0.05). There was no correlation between serum IMA levels and maternal characteristics and laboratory findings. Conclusion: Maternal serum IMA levels at 20–24 weeks’ gestation might be a predictive biomarker for PE, independent of notching of the uterine arteries, maternal characteristics and laboratory findings.     

Abnormal uterine artery Doppler velocimetry predicts adverse outcomes in patients with abnormal analytes

ObjectivesOur aim was to determine if uterine artery (UtA) Doppler studies would risk-stratify women with abnormal serum analytes on prenatal genetic screening into those at baseline and increased risk for preeclampsia and small-for-gestational age (SGA).Study designThis retrospective cohort study examined outcomes of patients with ⩾one abnormal analyte (PAPP-A < 0.3, hCG > 3.0, AFP > 2.5, inhibin > 2.0, or unconjugated estriol < 0.3MoM). At approximately 24 weeks, we assessed UtA pulsatility index (PI).Main outcome measuresPreeclampsia, preterm preeclampsia, SGA (birthweight (BW) <10%) and intrauterine growth restriction (IUGR) (BW < 3%).ResultsWe identified 132 patients with ⩾one abnormal analyte, UtA Doppler screening, and delivery outcomes. Twenty-four (18%) had an elevated UtA PI (PI > 1.6); preeclampsia occurred in 16 (12%) and 26 (20%) delivered a SGA neonate. Abnormal UtA Doppler PI increased the likelihood of a composite outcome of preeclampsia or SGA from 27% to 71% (LR 6.48 (2.93, 14.30)); a negative UtA Doppler PI reduced the likelihood to 18% (LR 0.57 (0.42, 0.78)). Abnormal UtA Doppler PI increased the likelihood of a more severe composite outcome of preterm preeclampsia or IUGR from 11% to 39% (LR 5.49 (3.03, 9.97)); a negative UtA Doppler study reduced the likelihood to 4% (LR 0.35 (0.16, 0.80)).ConclusionsIn patients with abnormal serum analytes, abnormal UtA Doppler PI is significantly associated with preeclampsia or SGA and improves the prediction of these adverse outcomes by 9–15-fold. Providers can incorporate UtA Doppler PI into an abbreviated surveillance regimen; they can be reassured that a normal study markedly decreases the risk of a severe early adverse outcome.     

Uterine artery Doppler and urinary hyperglycosylated HCG as predictors of threatened abortion outcome

ObjectiveTo study the role of uterine artery Doppler and urinary hyperglycosylated hCG (hCG-H) in predicting threatened abortion outcome.MethodsA prospective observational study was conducted on 93 cases with threatened abortion (study group) and 50 cases with normal pregnancy (control group) at 6–12 weeks of gestation. Uterine artery Doppler examination was performed and urinary hCG-H was measured in all cases. Cases were followed up till delivery and the number of aborted cases was recorded.ResultsUrinary hCG-H concentration was significantly higher in the control group and in cases who continued than in cases who miscarried 5.3 ± 3.9 vs. 2.1 ± 3.0 mIU/ml equivalents (P = 0.002) for the first and 5.1 ± 4.5 vs. 2.1 ± 3.0 mIU/mlEq (P = 0.003) for the second respectively. The ratio of hyperglycosylated hCG to total hCG was >51% in the 116 term outcome cases while it was below 49% in the 29 cases who miscarried. Unilaterally increased uterine artery pulsatility index and Δ uterine artery pulsatility index values were significantly higher in women who miscarried than in those with continuing pregnancies or the control groups (P < .0001). ROC for uterine artery Doppler revealed an area under the curve AUC of 0.77, while for urinary HCG-H the AUC was 0.82 and for uterine artery Doppler and urinary HCG-H combined the AUC reached 0.93.ConclusionThe unilaterally increased uterine arteries pulsatility index and the decreased urinary hCG-H production in the first trimester could predict miscarriage in threatened abortion.     

Maternal Serum Human Placental Growth Hormone (hPGH) at 11 to 13 Weeks of Gestation in Preeclampsia

Objective. Human placental growth hormone (hPGH) is produced by human placenta and plays a central role in the maternal metabolic adjustments to pregnancy. The objective of this study was to investigate the maternal serum concentration of hPGH at 11–13 weeks of gestation in pregnancies that subsequently developed preeclampsia (PE), and to examine the possible association with uterine artery pulsatility index (PI) and maternal serum pregnancy-associated plasma protein-A (PAPP-A). Methods. The maternal serum concentration of hPGH at 11–13 weeks was measured in a case–control study from 60 cases that developed PE and 120 unaffected controls. The measured hPGH concentration was converted into a multiple of the expected median (MoM) in unaffected pregnancies. Regression analysis was used to determine the significance of association between hPGH MoM with uterine artery PI MoM and PAPP-A MoM. Results. In the pregnancies that subsequently developed PE the median serum hPGH concentration was not significantly different from that in the unaffected group (0.92 versus 1.00 MoM), whereas uterine artery PI was increased (1.31 versus 1.01 MoM) and serum PAPP-A was decreased (0.76 versus 1.01 MoM). In the group that developed PE there was no significant association between serum hPGH MoM and gestational age at delivery, uterine artery PI MoM, or serum PAPP-A MoM. Conclusion. The finding that in the PE group serum hPGH level during the first trimester is normal suggests that it is unlikely that this hormone plays a role in the pathogenesis of PE.     

止血带联合子宫动脉结扎在凶险性前置胎盘伴重度胎盘植入术中的应用

目的:探讨止血带联合子宫动脉结扎术在凶险性前置胎盘伴重度胎盘植入术中的临床应用价值.方法:选择2016年1月至2018年12月于甘肃省妇幼保健院行术前胎盘超声评分诊断为凶险性前置胎盘伴重度胎盘植入并在术中确诊的74例孕妇作为研究对象,根据不同血管阻断方式分为子宫动脉栓塞组(28例)与止血带联合子宫动脉结扎(子宫动脉结扎...