Ma Yushan, Luo Xi, Jiang Xiaoqin, Liu Hui, Wu Lan
Anesthesiology Department of West China Second University Hospital, Sichuan University, Sichuan Province.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education.
Medicine (Baltimore). 2020 Aug 28;99(35):e21916. doi: 10.1097/MD.0000000000021916.
Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS.This retrospective study included all women who were diagnosed with PPP and PA and underwent PTUI CS from October 1, 2016, to October 31, 2018. Sixty-four patients were included: 34 underwent prophylactic IIA BO (IIA group), whereas 30 were treated without prophylactic IIA BO (control group). The primary outcome was a composite measure of perioperative blood management outcomes, including the estimated blood loss (EBL), donor blood transfusion, salvaged blood returned, fresh frozen plasma (FFP), pre- and postoperative serum hemoglobin and hematocrit. In addition, the baseline conditions of mother and neonates were compared.EBL was significantly higher in the IIA group compared to the control group (2883.5 mL in the IIA group vs 1868.7 mL in the control group, P = .001). Overall, the donor blood transfusion rate was 23.5% (8/34), averaging 4.2 U, in the IIA group versus 30% (9/30), averaging 3.4 U, in the control group, which were not significantly different. The FFP transfusion rate was 47%, averaging 765.6 mL, in the IIA group versus 20%, averaging 816.7 mL, in the control group. In the IIA group, 97.1% used cell savage and had salvaged blood returned, averaging 954.9 mL. In the control group, 90% had salvaged blood returned, averaging 617.9 mL. No cases of amniotic fluid embolism were observed with leukocyte depletion filters.Prophylactic IIA BO during PTUI CS in women with PPP and PA does not lead to a statistically significant reduction in EBL. Cell salvage was associated with a reduction in the rate of donor blood transfusion during PTUI CS.
凶险性前置胎盘（PPP）是产科严重产后出血和子宫切除术的主要原因，且常需输注异体血。预防性髂内动脉（IIA）球囊封堵（BO）联合血液回收技术越来越多地应用于子宫下段横切口剖宫产术（PTUI CS）中。本研究旨在探讨预防性IIA BO在PTUI CS中与未使用该技术时血液管理的差异，并评估血液回收技术在减少PTUI CS术中异体输血需求方面的安全性和有效性。这项回顾性研究纳入了2016年10月1日至2018年10月31日期间所有诊断为PPP和前置胎盘（PA）并接受PTUI CS的女性。共纳入64例患者：34例行预防性IIA BO（IIA组），30例未行预防性IIA BO（对照组）。主要结局指标为围手术期血液管理结局的综合指标，包括估计失血量（EBL）、异体输血、回收回输的血液、新鲜冰冻血浆（FFP）、术前和术后血清血红蛋白及血细胞比容。此外，还比较了母亲和新生儿的基线情况。IIA组的EBL显著高于对照组（IIA组为2883.5 mL，对照组为1868.7 mL，P = 0.001）。总体而言，IIA组的异体输血率为23.5%（8/34），平均4.2 U；对照组为30%（9/30），平均3.4 U，两组差异无统计学意义。IIA组的FFP输注率为47%，平均765.6 mL；对照组为20%，平均816.7 mL。IIA组中，97.1%使用了血液回收技术且有回收回输的血液，平均954.9 mL。对照组中，90%有回收回输的血液，平均617.9 mL。使用白细胞滤器未观察到羊水栓塞病例。PPP和PA女性在PTUI CS术中预防性IIA BO并不能使EBL在统计学上显著降低。血液回收技术与PTUI CS术中异体输血率的降低有关。
