Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
BMC Pregnancy Childbirth. 2024 Oct 2;24(1):634. doi: 10.1186/s12884-024-06834-z.
Placenta previa accreta (PPA) is a severe obstetric condition that can cause massive postpartum hemorrhage and transfusion. Cesarean hysterectomy is necessary in some severe cases of PPA to stop the life-threatening bleeding, but cesarean hysterectomy can be associated with significant surgical blood loss and major complications. The current study is conducted to investigate the potential risk factors of excessive blood loss during cesarean hysterectomy in women with PPA.
This is a retrospective study including singleton pregnancies after 28 weeks of gestation in women with placenta previa and pathologically confirmed placenta accreta spectrum who received hysterectomy during cesarean sections. A total of 199 women from January 2012 to August 2023 were included in this study and were divided into Group 1 (estimated surgical blood loss (EBL) ≤ 3500 mL, n = 103) and Group 2 (EBL > 3500 mL, n = 96). The primary outcome was defined as an EBL over 3500 mL. Baseline characteristics and surgical outcomes were compared between the two groups. A multivariate logistic regression model was applied to find potential risk factors of the primary outcome.
Massive surgical blood loss was prevalent in our study group, with a median EBL of 3500 mL. The multivariate logistic analysis showed that emergency surgery (OR 2.18, 95% CI 1.08-4.41, p = 0.029), cervical invasion of the placenta (OR 2.70, 95% CI 1.43-5.10, p = 0.002), and intraoperative bladder injury (OR 5.18, 95% CI 2.02-13.28, p = 0.001) were all associated with the primary outcome. Bilateral internal iliac arteries balloon occlusion (OR 0.57, 95% CI 0.34-0.97) and abdominal aortic balloon occlusion (OR 0.33, 95% CI 0.19-0.56) were negatively associated with the primary outcome.
Emergency surgery, cervical invasion of the placenta, and intraoperative bladder injury were potential risk factors for additional EBL during cesarean hysterectomy in women with PPA. Future prospective studies are needed to confirm the effect of intra-arterial balloon occlusion in cesarean hysterectomy of PPA.
胎盘植入（PPA）是一种严重的产科疾病，可导致大量产后出血和输血。在一些严重的胎盘植入病例中，需要行剖宫产子宫切除术以停止危及生命的出血，但剖宫产子宫切除术可能与大量手术失血和重大并发症有关。本研究旨在探讨 PPA 患者行剖宫产子宫切除术时发生大量失血的潜在危险因素。
这是一项回顾性研究，纳入了 2012 年 1 月至 2023 年 8 月期间接受剖宫产子宫切除术的胎盘前置且经病理证实为胎盘植入谱系疾病的单胎妊娠 28 周以上的妇女。本研究共纳入 199 名妇女，分为第 1 组（估计手术失血量（EBL）≤3500ml，n=103）和第 2 组（EBL>3500ml，n=96）。主要结局定义为 EBL 超过 3500ml。比较两组的基线特征和手术结果。采用多变量逻辑回归模型寻找主要结局的潜在危险因素。
本研究组大量手术失血较为常见，中位 EBL 为 3500ml。多变量逻辑分析显示，急诊手术（OR 2.18，95%CI 1.08-4.41，p=0.029）、宫颈胎盘侵犯（OR 2.70，95%CI 1.43-5.10，p=0.002）和术中膀胱损伤（OR 5.18，95%CI 2.02-13.28，p=0.001）均与主要结局相关。双侧髂内动脉球囊闭塞（OR 0.57，95%CI 0.34-0.97）和腹主动脉球囊闭塞（OR 0.33，95%CI 0.19-0.56）与主要结局呈负相关。
急诊手术、宫颈胎盘侵犯和术中膀胱损伤是 PPA 患者行剖宫产子宫切除术时额外 EBL 的潜在危险因素。需要进一步的前瞻性研究来证实动脉内球囊闭塞在 PPA 剖宫产中的效果。
