Application of preoperative vaginal packing, intraoperative uterine circular suture, and ligation of descending branch of uterine artery in cesarean section in patients with severe placental implantation
Zhang Yanxin, Ren Fenfen, Li Chuanrui, Lin Pingzhen, Wang Yonghui, Huo Nana, Song Yanliang, Jin Xiaowei, Wang Li
Department of High-Risk Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang Critical Maternal Treatment Center, Zaozhuang 277100, China
Abstract：Objective To explore the application value of preoperative vaginal tamponade combined intraoperative annular suture of uterus and ligation of descending branch of uterine artery during cesarean section in patients with severe placental implantation. Methods The prospective randomized controlled study was conducted. A total of 120 patients in the Zaozhuang Maternal and Child Health Hospital from January 2019 to August 2021 were included. The clinical data of these patients, with severe placental implantation as suggested by B-ultrasound in high-risk obstetrics, were obtained. The age of the patients ranged from 27-41 years, and all patients underwent cesarean section. They were randomly divided into observation group and control group, with 60 cases each. The observation group was treated with preoperative vaginal packing, intraoperative uterine circular suture, and ligation of the descending branch of uterine artery. The control group was treated with abdominal aortic balloon occlusion. The observation indices were as follows. (1) We compared the baseline data of the two groups, such as age, gestational weeks, times of pregnancy and delivery, preoperative hemoglobin level, artificial assisted pregnancy, previous operating hospital, times of cesarean section, ultrasound scoring system score, and so on. (2) We also compared the perioperative observation indices of the two groups, such as effective rate, operation time, intraoperative bleeding, bleeding 24 h after operation, admission time in intensive care unit, hemoglobin level 72 h after operation, postoperative hospital stay, medical expenses, hysterectomy, neonatal asphyxia, and postoperative complications. Results All patients completed the operation successfully without death. (1) No significant difference in baseline data existed between the two groups (all P values > 0.05). (2) During the operation, we confirmed that 57 cases of the patients in the observation group had placental implantation, among which 54 cases (94.74%) were effective after treatment; and 58 cases in the control group had placental implantation, among which 54 cases (93.10%) were effective. The difference was not statistically significant (χ2=0.00,P=0.981). The operation time, bleeding 24 h after operation, time in intensive care unit, postoperative hospital stay, and medical expenses in the observation group were (64±23) min, (185±31) mL, (1.2±0.5) d, (5.1±0.7) d, and (16±3) thousand yuan, whereas those in the control group were (82±35) min, (334±96) mL, (1.7±0.6) d, (5.6±0.8) d, and (28±4) thousand million Yuan. The differences were significant (t=3.26,11.24,4.86,3.57,18.22; all P values < 0.01). No significant difference existed in intraoperative bleeding, hysterectomy rate, postoperative hemoglobin level, neonatal asphyxia rate, and postoperative complications between the two groups (all P values > 0.05). Conclusion Preoperative vaginal tamponade, intraoperative circular suture, and ligation of descending branch of uterine artery are safe, effective, economical, and feasible to use during cesarean section in patients with severe placental implantation.
张延新, 任芬芬, 李传瑞, 林平珍, 王勇慧, 霍娜娜, 宋言亮, 金小巍, 王丽. 术前阴道填塞联合术中子宫环形缝合及子宫动脉下行支结扎在重型胎盘植入患者剖宫产术中的应用[J]. 中华解剖与临床杂志, 2022, 27(6): 405-410.
Zhang Yanxin, Ren Fenfen, Li Chuanrui, Lin Pingzhen, Wang Yonghui, Huo Nana, Song Yanliang, Jin Xiaowei, Wang Li. Application of preoperative vaginal packing, intraoperative uterine circular suture, and ligation of descending branch of uterine artery in cesarean section in patients with severe placental implantation. Chinese Journal of Anatomy and Clinics, 2022, 27(6): 405-410.
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2022, Vol. 27 
