Abstract：Objective To investigate the incidence of prenatal, intraoperative and postoperative bleeding and severe complications in patients with scar uterus complicated with central placenta previa. Methods A total of 135 patients with single-fetal scar uterus and central placenta previa who met the inclusion criteria during the period from March 2017 to February 2018 were enrolled. According to the adhesion of placenta and uterus during operation, they were divided into the placenta adhesion group (n=30), placenta implantation group (n=51) and normal group ( neither adhesion nor implantation, n=54). The perioperative bleeding, complications and treatment measures of the three groups were analyzed and recorded. Results There was no significant difference in antepartum bleeding rate between the three groups (χ2=0.22,P=0.90). The bleeding rate, perioperative bleeding rate and hysterectomy rate in the three groups were statistically different (F/χ2=72.05, 42.45, 54.64,P<0.01). The amount of intra-operation bleeding and perioperative bleeding in the placenta implantation group were significantly higher than those in the placental adhesion group and the normal group (t=6.22, 10.53, 4.50, 8.66,P<0.01). The amount of intra-operation bleeding and perioperative bleeding in the placenta adhesion group were higher than those in the normal group (t=4.81, 3.46, P<0.01). The rate of hysterectomy in the placenta-implanted group was significantly higher than that in the placenta-adhesive group and the normal group. There was no significant difference in the rate of hysterectomy between the placenta-adhesive group and the normal group (P<0.05). There were 32 cases of hysterectomy in placenta implantation group, which was significantly higher than 2 cases in placenta adhesion group and 2 cases in the normal group (χ2=22.14, 39.10,P<0.01). The other patients used suture, uterine contraction, abdominal aortic balloon block and other symptomatic treatment to stop bleeding and preserve the uterus. In the placenta-implanted group, 1 case of pregnant women had an intraoperative blood loss of 6000 mL with cardiac arrest. After active rescue and symptomatic treatment, the mother and baby in this case were saved and discharged. In the placenta-implantation group, 15 patients underwent abdominal aortic balloon block whose lower abdominal aorta was blocked by balloon filling during operation. Of the 15 patients, 8 underwent hysterectomy and 7 underwent conservative treatment. The mean amount of bleeding was 1142.86 mL while the mean amount of bleeding in patients without abdominal aortic balloon block was 2100 mL. The volume of bleeding in patients with abdominal aortic balloon obstruction decreased significantly (Z=3.58,P=0.03). Conclusion Patients with scar uterus complicated with central placenta previa have the characteristics of high placenta implantation rate and large amount of bleeding. The abdominal aorta balloon obstruction can effectively reduce the intra-operation and perioperative bleeding.
邹红霞, 白淑芳, 张娟娟, 王瑞. 瘢痕子宫合并中央性前置胎盘围术期出血临床分析[J]. 医学临床研究, 2019, 36(2): 273-276.
ZOU Hong-xia, BAI Shu-fang, ZHANG Juan-juan, et al. Clinical Analysis of Perioperative Bleeding in Patients with Scar Uterus Complicated with Central Placenta Previa. JOURNAL OF CLINICAL RESEARCH, 2019, 36(2): 273-276.
2019, Vol. 36 
