Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, No. 160, Pujian Road, Pudong New District, Shanghai, 200127, China.
Department of Obstetrics & Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China.
Eur Radiol. 2020 Aug;30(8):4524-4533. doi: 10.1007/s00330-020-06813-w. Epub 2020 Mar 28.
The aim of this study is to evaluate the efficacy of prophylactic internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion in the control of postpartum hemorrhage in women with placenta accreta spectrum (PAS).
This is a prospective and non-randomized controlled study. The participants were assigned into three groups: without balloon catheterization (non-BC) group, balloon catheterization (BC) group, and Pituitrin combined with balloon catheterization (PBC) group. The primary outcomes were estimated blood loss (EBL) and the units of transfused packed red blood cells (PRBC). The secondary outcome was the incidence of hysterectomy.
A total of 100 participants were recruited between August 2013 and November 2018 and assigned into the respective groups as follows: 27 in the non-BC group, 22 in the BC group, and 51 in the PBC group. No statistical differences were found in demographic characteristics among the three groups. There was a trend of lower EBL, PRBC, and hysterectomy rate in the BC group than those in the non-BC group, while all values showed no significant differences (all p > 0.05). Patients in the PBC group had significantly lower EBL, PRBC, and hysterectomy rate compared with those in the non-BC group (all p < 0.05). Linear regression analysis revealed that the PBC (vs. others) was negatively correlated with EBL and the non-BC (vs. others) independently predicted more EBL.
Balloon occlusion combined with Pituitrin infusion is an effective treatment method which significantly reduced EBL, PRBC, and hysterectomy rate in patients with PAS.
• Internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion can significantly decrease EBL, PRBC, and hysterectomy rate during cesarean section in patients with PAS. • Cesarean section without balloon occlusion and placenta accreta depth are two independent risk factors for EBL in patients with PAS.
本研究旨在评估预防性子宫动脉内球囊闭塞联合垂体后叶素动脉内输注在胎盘植入谱系疾病（PAS）患者产后出血控制中的疗效。
这是一项前瞻性、非随机对照研究。将参与者分为三组：无球囊导管组（非 BC 组）、球囊导管组（BC 组）和垂体后叶素联合球囊导管组（PBC 组）。主要结局为估计失血量（EBL）和输血量（PRBC）。次要结局为子宫切除术的发生率。
2013 年 8 月至 2018 年 11 月期间共招募了 100 名参与者，并分别分配到相应的组中：非 BC 组 27 例、BC 组 22 例和 PBC 组 51 例。三组患者的人口统计学特征无统计学差异。BC 组的 EBL、PRBC 和子宫切除术率均有降低趋势，但均无统计学差异（均 P>0.05）。PBC 组的 EBL、PRBC 和子宫切除术率均明显低于非 BC 组（均 P<0.05）。线性回归分析显示，PBC（与其他组相比）与 EBL 呈负相关，非 BC（与其他组相比）独立预测 EBL 更多。
球囊闭塞联合垂体后叶素输注是一种有效的治疗方法，可显著降低 PAS 患者的 EBL、PRBC 和子宫切除术率。
• 子宫动脉内球囊闭塞联合垂体后叶素动脉内输注可显著降低 PAS 患者剖宫产术中 EBL、PRBC 和子宫切除术率。• 无球囊闭塞和胎盘植入深度是 PAS 患者 EBL 的两个独立危险因素。
