Huang Guiqiong, Wang Xiaodong, Yu Haiyan, Zhou Shu
Department of Obstetric and Gynecologic, West China Second University Hospital, Sichuan University, Sichuan, China.
Medicine (Baltimore). 2019 Mar;98(9):e14488. doi: 10.1097/MD.0000000000014488.
Placenta previa accreta is an obstetrical complication that severely affects the heath of the fetus and the mother due to massive hemorrhage during pregnancy. This study reported a new suture technique called "cervical internal os plasty" to control obstetrical hemorrhage in cesarean delivery for patients with placenta previa accreta and retrospectively evaluated the safety and effectiveness of the new technique.From January 2012 to May 2018, we collected 56 patients with this new suture technique, which repaired the damaged weak area with bleeding from the placental attachment site in the lower uterine segment, and restored the damaged anatomic internal os of the cervix. Meanwhile, we compared it with 60 cases with other conservative methods described by other obstetricians with the same qualifications. The perioperative outcomes (blood loss, blood transfusion, operative time, other applied medical technology, and so on) between the 2 groups were recorded in this report.There were no significant differences between 2 groups among age, gravidity, parity, gestational age, and previous dilatation and curettage techniques (P > .05). Of the patients with placenta previa accrete, 77.6% (90/116) had previous dilatation and curettage. The comparison between study group and control group on the rate of postpartum hemorrhage, blood transfusion, and mean operative time, average hospitalization days after cesarean delivery, expenses was not statistically significant (P > .05). Compared with the control group, other applied supplementary techniques (including uterine tamponade, pelvic arterial embolization, or emergency hysterectomy) for the bleeding from the the placental attachment site is fewer significantly in the study group. No operative accident and hemorrhea-related complication occurred in the 2 groups.Cervical internal os plasty is useful in patients with placenta previa accreta due to its simplicity, utility, and effectivity as well as its capacity for preserving fertility.
胎盘植入是一种产科并发症，由于孕期大出血，严重影响胎儿和母亲的健康。本研究报告了一种名为“宫颈内口成形术”的新缝合技术，用于控制胎盘植入患者剖宫产术中的产科出血，并回顾性评估了该新技术的安全性和有效性。2012年1月至2018年5月，我们收集了56例采用这种新缝合技术的患者，该技术修复了子宫下段胎盘附着部位出血的受损薄弱区域，恢复了受损的宫颈解剖学内口。同时，我们将其与60例采用其他具有相同资质的产科医生描述的保守方法的病例进行了比较。本报告记录了两组患者的围手术期结局（失血量、输血情况、手术时间、其他应用的医疗技术等）。两组患者在年龄、孕次、产次、孕周以及既往刮宫术方面无显著差异（P>0.05）。在胎盘植入患者中，77.6%（90/116）有既往刮宫史。研究组与对照组在产后出血率、输血情况、平均手术时间、剖宫产术后平均住院天数、费用方面的比较无统计学意义（P>0.05）。与对照组相比，研究组因胎盘附着部位出血而应用的其他辅助技术（包括子宫压迫缝合术、盆腔动脉栓塞术或急诊子宫切除术）明显较少。两组均未发生手术意外及与出血相关的并发症。宫颈内口成形术因其操作简单、实用、有效以及具有保留生育能力的特点，对胎盘植入患者有用。
