Intermittent aortic balloon occlusion combined with cesarean section for the treatment of patients with placenta previa complicated by placenta accreta: A retrospective study

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide but the incidence and its risk factors in China is limited. The objective of this study is to investigate the incidence and the risk factors of PPH in Chinese women.Methods: A multi-center retrospective study of pregnant women at ≥28 weeks of gestation was conducted. Logistic regression was used to identify potential risk factors of PPH and receiver operating characteristic curve was used to evaluate the predictive performance of the identified risk factors. Subgroup analysis focusing on the number of fetus and the mode of delivery was conducted.Results: A total of 99,253 pregnant women were enrolled and 804 (0.81%) experienced PPH. The subgroup analysis revealed that the incidence of PPH was 0.75, 2.65, 1.40, and 0.31% in singletons, twin pregnancies, cesarean sections, and vaginal deliveries, respectively. Placenta previa and placenta accreta were the predominant risk factors of PPH in the overall population and all subgroups. A twin pregnancy was a risk factor for PPH regardless of the mode of delivery. Obesity, and multiparity were risk factors for PPH in both singletons and cesarean section cases, but the latter predicted a reduced probability of PPH in vaginal deliveries. Macrosomia was associated with increased risk of PPH in singletons or vaginal deliveries. In women who delivered vaginally, preeclampsia was associated with a higher risk of PPH. The areas under the curve for the overall cohort, singletons, twin pregnancies, cesarean section cases, and vaginal deliveries were 0.832 (95% confidence interval [CI] 0.813–0.851), 0.824 (95% CI 0.803–0.845), 0.686 (95% CI 0.617–0.755), 0.854 (95% CI 0.834–0.874), and 0.690 (95% CI 0.646–0.735), respectively.Conclusions: The risk factors of PPH varied slightly based on the number of fetuses and the mode of delivery, while placenta previa and placenta accreta were the two major risk factors. A combination of the identified risk factors yielded a satisfactory predictive performance in determining PPH in the overall cohort, singletons pregnancies, and women who delivered by cesarean section, whereas the performance was moderate in twin pregnancies and in women delivering vaginally.

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Feasibility of Infrarenal Abdominal Aorta Balloon Occlusion in Pernicious Placenta Previa Coexisting with Placenta Accrete

BioMed Research International ◽

10.1155/2018/4596189 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Na Li ◽

Tian Yang ◽

Caixia Liu ◽

Chong Qiao

Keyword(s):

Cesarean Section ◽

Abdominal Aorta ◽

Placenta Accreta ◽

Placenta Previa ◽

Balloon Occlusion ◽

Pathological Diagnosis ◽

Premature Delivery ◽

Significant Difference ◽

Placenta Accrete ◽

Infrarenal Abdominal Aorta

Objective. To evaluate the efficacy and safety of prophylactic balloon occlusion of the infrarenal abdominal aorta in pernicious placenta previa coexisting with placenta accrete. Methods. This retrospective study was performed in patients with placenta accreta complicated with pernicious placenta previa between January 2014 and December 2016 in Shengjing Hospital; 56 patients with a pathological diagnosis were included. The degree of placental invasion was evaluated by preoperative color Doppler ultrasonography and/or magnetic resonance imaging, and all patients in this study should undergo balloon occlusion preoperatively, which was a determination made by specific doctors. The control group consisted of 32 patients who underwent cesarean section alone, and the study group included 24 patients who underwent cesarean section with preoperative balloon occlusion. Prevention of hysterectomy was the primary outcome evaluated. The secondary outcomes include operative duration, estimated blood loss, blood transfusion, prothrombin time postoperatively, decrease in the hemoglobin level postoperatively, intensive care unit admission, pathological diagnosis, and total hospital stay (days), and these data were compared between the two groups. Additionally, the neonatal outcomes, premature delivery, Apgar scores at 1 minute and 5 minutes, neonatal birth weight, hospitalization, and mortality were compared. Results. There was a significant difference in the rate of hysterectomy between the two groups (p<0.05). However, no differences were observed between the groups in any other outcomes. Conclusion. The prophylactic use of infrarenal abdominal aortic balloon occlusion is an effective and safe option for treating pernicious placenta previa coexisting with placenta accreta.

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Discussion on the Timing of Balloon Occlusion of the Abdominal Aorta during a Caesarean Section in Patients with Pernicious Placenta Previa Complicated with Placenta Accreta

BioMed Research International ◽

10.1155/2017/8604849 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Baoju Zhu ◽

Kaili Yang ◽

Lina Cai

Keyword(s):

Caesarean Section ◽

Blood Loss ◽

Abdominal Aorta ◽

Placenta Accreta ◽

Placenta Previa ◽

Balloon Occlusion ◽

Intraoperative Blood Loss ◽

Transverse Incision ◽

Aortic Balloon Occlusion ◽

Group B

Objective. This paper is aimed at investigating the role and value of the timing of balloon occlusion of the abdominal aorta during caesarean section in patients with pernicious placenta previa complicated with placenta accreta. Methods. 79 cases admitted to the Second Affiliated Hospital of Zhengzhou University from September 2015 to December 2016 were treated with ultrasound mediated abdominal aortic balloon occlusion. Among them, 42 cases, whose balloon occlusion time was selected before the delivery and transverse incision was taken, were group A. The other 37 cases were group B, whose timing of balloon occlusion was selected after the delivery and the uterine incision made trying to avoid the placenta or double incisions. The intraoperative blood loss, utilization of blood, and other indicators were compared between the two groups. Results. The intraoperative blood loss in groups A and B was 413.8 ± 105.9 ml and 810.3 ± 180.3 ml, and the utilization of blood products in groups A and B was 30.23% and 89.2%. The total hysterectomy rate was 2.53% (2/79), with no hysterectomies in groups A and 2 cases in group B. Conclusion. The balloon occlusion of the abdominal aorta before the delivery combined with a transverse incision is more effective.

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