Wu Xiafei, He Jie, Bai Yuxiang, Gan Yanqiong, Xu Hongbing, Qi Hongbo, Yu Xinyang
Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China.
Ann Med. 2025 Dec;57(1):2442065. doi: 10.1080/07853890.2024.2442065. Epub 2024 Dec 19.
This study aims to investigate the risk factors for severe postpartum hemorrhage (SPPH) in patients with placenta accreta spectrum (PAS) undergoing cesarean delivery, despite the prophylactic use of resuscitative endovascular balloon occlusion of the aorta (REBOA).
We conducted a retrospective case-control study on PAS patients who underwent cesarean delivery with prophylactic REBOA at the First Affiliated Hospital of Chongqing Medical University from January 2017 to December 2021. Prophylactic REBOA placement was determined by a prenatal ultrasound scoring system. Patients were divided into those who experienced SPPH (case group) and those who did not (control group), with SPPH defined by one or a combination of the following criteria: intraoperative blood loss ≥1500 mL, transfusion of ≥4 units of packed red blood cells, intraoperative hysterectomy, or sequential uterine artery embolization. Propensity score matching (PSM) was employed to minimize biases, and multivariate logistic regression was used to calculate adjusted odds ratios (aOR) for risk factors.
Of the 424 enrolled patients, 102 experienced SPPH (case group), while 322 did not (control group). After PSM, the case group comprised 79 patients, and the control group included 130. After adjusting for confounders, patients with placenta increta (aOR 3, 95% CI 1.49-6.03, = 0.002), percreta (aOR 21.77, 95% CI 6.57-72.09, < 0.001), lower hemoglobin levels (aOR 0.98, 95% CI 0.95-1, = 0.050), and higher D-dimer levels (aOR 1.36, 95% CI 1.12-1.65, = 0.002) had an elevated risk of SPPH. Threshold effect analysis indicated no significant nonlinear relationship between hemoglobin, D-dimer, and outcomes.
PAS patients, particularly those with placenta increta and percreta, lower hemoglobin levels, and elevated D-dimer levels, are at an increased risk of SPPH during cesarean delivery, even with REBOA intervention.
本研究旨在调查尽管预防性使用了复苏性血管内主动脉球囊阻断术（REBOA），但接受剖宫产的胎盘植入谱系障碍（PAS）患者发生严重产后出血（SPPH）的危险因素。
我们对2017年1月至2021年12月在重庆医科大学附属第一医院接受剖宫产并预防性使用REBOA的PAS患者进行了一项回顾性病例对照研究。预防性REBOA的放置由产前超声评分系统决定。患者分为发生SPPH的患者（病例组）和未发生SPPH的患者（对照组），SPPH的定义为以下一项或多项标准：术中失血≥1500mL、输注≥4单位浓缩红细胞、术中子宫切除术或序贯性子宫动脉栓塞。采用倾向评分匹配（PSM）以尽量减少偏倚，并使用多因素逻辑回归计算危险因素的调整比值比（aOR）。
在424例入组患者中，102例发生了SPPH（病例组），而322例未发生（对照组）。PSM后，病例组包括79例患者，对照组包括130例。在对混杂因素进行调整后，胎盘植入患者（aOR 3，95%CI 1.49 - 6.03，P = 0.002）、穿透性胎盘植入患者（aOR 21.77，95%CI 6.57 - 72.09，P < 0.001）、血红蛋白水平较低（aOR 0.98，95%CI 0.95 - 1，P = 0.050）以及D - 二聚体水平较高（aOR 1.36，95%CI 1.12 - 1.65，P = 0.002）的患者发生SPPH的风险升高。阈值效应分析表明血红蛋白、D - 二聚体与结局之间无显著的非线性关系。
PAS患者，尤其是胎盘植入和穿透性胎盘植入患者、血红蛋白水平较低以及D - 二聚体水平升高的患者，即使接受REBOA干预，剖宫产期间发生SPPH的风险也会增加。
