Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
Arch Gynecol Obstet. 2022 Dec;306(6):1979-1987. doi: 10.1007/s00404-022-06476-6. Epub 2022 Mar 15.
To evaluate the efficacy of intrauterine inflated Cook Cervical Ripening Balloon (ICRB) in postpartum hemorrhage (PPH) management and fertility preserving for placenta accreta spectrum disorders with placenta previa (previa PAS).
At a tertiary referral center, 74 patients suffering with previa PAS were entered into this retrospective cohort study from January, 2016 to December, 2020, and were confirmed intraoperatively that abnormal invasive placenta reaches the cervical internal ostium and the upper part of the cervical canal. In control group (n = 39), the combination of infrarenal abdominal aorta balloon occlusion (IAABO) and longitudinal parallel compression suture to lower uterine segment were performed. In study group (n = 35), in addition to the aforementioned surgical techniques, ICRB was implemented at the cervical internal ostium and the outside of the cervix simultaneously.
Use of ICRB significantly reduced the rate of peripartum hysterectomy (2.9% vs 30.4%, p = 0.001), and associated with a reduction in surgical time and duration of IAABO (mean 172.7 min vs 206.6 min, p = 0.017; median 30 min vs 40 min, p < 0.001). Use of ICRB significantly reduced the estimated amount of blood loss (median 2500 ml vs 4000 ml, p < 0.001), amounts of packed red blood cells and fresh-frozen plasma transfusion (median 6 U vs 13.5 U, p < 0.001; median 450 ml vs 1200 ml, p < 0.001), postoperative hospital stay and the incidence of oligomenorrhea postoperatively (median 5 days vs 6 days, p = 0.009; 13.8% vs 61.1% p = 0.001). No significant difference was observed between both the groups regarding the use of cryo and PLT, injury of urinary system, relaparotomy, admission to the ICU, postpartum hematocele in uterine cavity, and postoperative complications (including incidence rate of DVT, incidence rate of femoral thrombosis, puerperal morbidity, intrauterine infection, surgical site infection, and deep tissue infection).
ICRB was a simple, effective procedure for PPH management and fertility preserving in some previa PAS cases in which abnormal invasive placenta reaches the cervical internal ostium and the upper part of the cervical canal, in tandem with IAABO and compression suture.
评估宫内充气库克宫颈扩张球囊（ICRB）在胎盘前置合并胎盘植入（前置 PAS）产后出血（PPH）管理和保留生育能力中的疗效。
在一家三级转诊中心，2016 年 1 月至 2020 年 12 月，对 74 例患有前置 PAS 的患者进行了回顾性队列研究，术中证实异常侵袭性胎盘到达宫颈内口和宫颈管上段。在对照组（n=39）中，采用腹主动脉下段球囊阻断术（IAABO）和纵向平行压迫缝合术。在研究组（n=35）中，除了上述手术技术外，还在宫颈内口和宫颈外同时使用 ICRB。
使用 ICRB 显著降低了围产期子宫切除术的发生率（2.9%比 30.4%，p=0.001），并与手术时间和 IAABO 持续时间的缩短相关（平均 172.7 分钟比 206.6 分钟，p=0.017；中位数 30 分钟比 40 分钟，p<0.001）。使用 ICRB 显著减少了估计出血量（中位数 2500ml 比 4000ml，p<0.001）、红细胞和新鲜冷冻血浆的输注量（中位数 6U 比 13.5U，p<0.001；中位数 450ml 比 1200ml，p<0.001）、术后住院时间和术后月经稀少的发生率（中位数 5 天比 6 天，p=0.009；13.8%比 61.1%，p=0.001）。两组间在使用 cryo 和 PLT、泌尿系统损伤、再次剖腹手术、入住 ICU、宫腔积血、术后并发症（包括深静脉血栓形成发生率、股静脉血栓形成发生率、产后发病率、宫内感染、手术部位感染和深部组织感染）方面无显著差异。
对于异常侵袭性胎盘到达宫颈内口和宫颈管上段的某些前置 PAS 病例，ICRB 联合 IAABO 和压迫缝合是一种简单、有效的 PPH 管理和生育能力保留方法。
