Department of Anesthesiology, Peking University People's Hospital, Beijing, 100044, China.
BMC Anesthesiol. 2021 Apr 29;21(1):134. doi: 10.1186/s12871-021-01354-1.
Pernicious placenta previa (PPP) can increase the risk of perioperative complications. During caesarean section in patients with adherent placenta, intraoperative blood loss, hysterectomy rate and transfusion could be reduced by interventional methods. Our study aimed to investigate the influence of maternal hemodynamics control and neonatal outcomes of prophylactic temporary abdominal aortic balloon (PTAAB) occlusion for patients with pernicious placenta previa.
This was a retrospective study using data from the Peking University People's Hospital from January 2014 through January 2020. Clinical records of pregnant women undergoing cesarean section were collected. Patients were divided into two groups: treatment with PTAAB placement (group A) and no balloon placement (group B). Group A was further broken down into two groups: prophylactic placement (Group C) and balloon occlusion (group D).
Clinical records of 33 cases from 5205 pregnant women underwent cesarean section were collected. The number of groups A, B, C, and D were 17, 16, 5 and 12.We found that a significant difference in the post-operative uterine artery embolism rates between group A and group B (0% vs.31.3%, p = 0.018). There was a significant difference in the Apgar scores at first minute between group A and group B (8.94 ± 1.43 vs 9.81 ± 0.75,p = 0.037),and the same significant difference between two groups in the pre-operative central placenta previa (29.4% vs. 0%,p = 0.044), complete placenta previa (58.8% vs 18.8%, p = 0.032),placenta implantation (76.5% vs 31.3%, p = 0.015). We could also observe the significant difference in the amount of blood cell (2.80 ± 2.68vs.10.66 ± 11.97, p = 0.038) and blood plasma transfusion (280.00 ± 268.32 vs. 1033.33 ± 1098.20, p = 0.044) between group C and group D. The significant differences in the preoperative vaginal bleeding conditions (0% vs 75%, p = 0.009), the intraoperative application rates of vasopressors (0% vs. 58.3%, p = 0.044) and the postoperative ICU (intensive care unit) admission rates (0% vs. 58.3%, p = 0.044) were also kept.
PTAAB occlusion could be useful in reducing the rate of post-operative uterine artery embolism and the amount of transfusion, and be useful in coping with patients with preoperative vaginal bleeding conditions, so as to reduce the rate of intraoperative applications of vasopressors and the postoperative ICU (intensive care unit) admission. In PPP patients with placenta implantation, central placenta previa and complete placenta previa, we advocate the utilization of prophylactic temporary abdominal aortic balloon placement.
凶险性前置胎盘（PPP）会增加围手术期并发症的风险。在粘连性胎盘患者剖宫产术中，介入方法可降低术中出血量、子宫切除率和输血率。我们的研究旨在探讨预防性使用临时腹主动脉球囊（PTAAB）阻断术对凶险性前置胎盘患者母婴结局的影响。
这是一项回顾性研究，使用了北京大学人民医院 2014 年 1 月至 2020 年 1 月的数据。收集了行剖宫产术孕妇的临床记录。患者分为两组：使用 PTAAB 放置术（A 组）和不使用球囊放置术（B 组）。A 组进一步分为预防性放置组（C 组）和球囊阻断组（D 组）。
共收集了 5205 例剖宫产孕妇的 33 例临床记录。A、B、C 和 D 组的数量分别为 17、16、5 和 12。我们发现 A 组和 B 组术后子宫动脉栓塞率有显著差异（0% vs.31.3%，p=0.018）。A 组和 B 组新生儿第 1 分钟 Apgar 评分有显著差异（8.94±1.43 vs 9.81±0.75，p=0.037），两组在术前中央型前置胎盘（29.4% vs. 0%，p=0.044）、完全性前置胎盘（58.8% vs. 18.8%，p=0.032）、胎盘植入（76.5% vs. 31.3%，p=0.015）方面也有显著差异。我们还观察到 C 组和 D 组的血细胞（2.80±2.68 vs.10.66±11.97，p=0.038）和血浆输血（280.00±268.32 vs. 1033.33±1098.20，p=0.044）量有显著差异。术前阴道出血情况（0% vs.75%，p=0.009）、术中血管加压素应用率（0% vs.58.3%，p=0.044）和术后 ICU 入住率（0% vs.58.3%，p=0.044）也存在显著差异。
PTAAB 阻断术可降低术后子宫动脉栓塞率和输血量，有助于处理术前阴道出血患者，降低术中血管加压素应用率和术后 ICU 入住率。在胎盘植入、中央型前置胎盘和完全性前置胎盘的 PPP 患者中，我们主张预防性使用临时腹主动脉球囊放置术。
