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Correlation of An Ultrasonic Scoring System and Intraoperative Blood Loss in Placenta accreta spectrum disorders: A Retrospective Cohort Study

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Biomedical and Environmental Sciences 2021年第2期34卷 163-169页

作者： CHEN Lian SHI Hui Feng JIANG Hai SHI Xiao Ming WANG Yuan Yuan ZHANG Ai Qing CHONG Yi Wen ZHAO Yang Yu Department of Obstetrics and Gynecology Peking University Third HospitalBeijing 100191China

Objective This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss(IBL) in placenta accreta spectrum(PAS) disorders.Methods A retrospective cohort study was conducted between January 2015 and November 2019.Clinical data for patients with PAS have been obtained from medical records. Generalized additive models were used to explore the nonlinear relationships between ultrasonic scores and IBL. Logistic regressions were used to determine the differences in the risk of IBL ≥ 1,500 m L among groups with different ultrasonic scores.Results A total of 332 patients participated in the analysis. Generalized additive models showed a significant positive correlation between score and blood loss. The amount of IBL was increased due to the rise in the ultrasonic score. All cases were divided into three groups according to the scores(low score group: ≤ 6 points, n = 147;median score group: 7-9 points, n = 126;and high score group: ≥ 10 points, n = 59). Compared with the low score group, the high score group showed a higher risk of IBL≥ 1,500 m L [odds ratio, 15.09;95% confidence interval(3.85, 59.19);P ≤ 0.001] after a multivariable adjustment.Conclusions The risk of blood loss equal to or greater than 1,500 m L increases further when ultrasonic score greater than or equal to 10 points, the preparation for transfusion and referral mechanism should be considered.

关键词： Ultrasonic scoring system Intraoperative blood loss Placenta accreta spectrum disorders

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Intra-abdominal aortic balloon occlusion in the management of placenta percreta

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Chinese Medical Journal 2022年第4期135卷 441-446页

作者： Weiran Zheng Ruochong Dou Jie Yan Xinrui Yang Xianlan Zhao Dunjin Chen Yuyan Ma Weishe Zhang Yiling Ding Ling Fan Huixia Yang Department of Obstetrics and Gynecology Peking University First HospitalBeijing Key Laboratory of Maternal-Fetal Medicine of Gestational Diabetes MellitusXicheng DistrictBeijing 100034China Department of Obstetrics and Gynecology First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenan 450052China Department of Obstetrics and Gynecology Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdong 510260China Department of Obstetrics and Gynecology Qilu Hospital of Shandong UniversityJinanShandong 250012China Department of Obstetrics and Gynecology Xiangya Hospital Central South UniversityChangshaHunan 410008China Department of Obstetrics and Gynecology Second Xiangya Hospital of Central South UniversityChangshaHunan 410008China Department of Obstetrics and Gynecology Beijing Obstetrics and Gynecology HospitalBeijing 100026China

Background:Massive bleeding is the main concern for the management of placenta percreta(PP).Intra-abdominal aortic balloon occlusion(IABO)is one method for pelvic devascularization,but the efficacy of IABO is uncertain.This study aims to investigate the outcomes of IABO in PP patients.Methods:We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015.PP cases with/without the use of IABO were analyzed.Propensity score matching analysis was performed to reduce the effect of selection bias.Postpartum hemorrhage(PPH)and the rate of hysterectomy,as well as neonatal outcomes,were analyzed.Results:One hundred and thirty-two matched pairs of patients were included in the final analysis.Compared with the control group,maternal outcomes,including PPH(68.9%vs.87.9%,χ^(2)=13.984,P<0.001),hysterectomy(8.3%vs.65.2%,χ^(2)=91.672,P<0.001),and repeated surgery(1.5%vs.12.1%,χ^(2)=11.686,P=0.001)were significantly reduced in the IABO group.For neonatal outcomes,Apgar scores at 1 minute(8.67±1.79vs.8.53±1.68,t=-0.638,P=0.947)and 5 minutes(9.43±1.55vs.9.53±1.26,t=0.566,P=0.293)were not significantly different between the two groups.Conclusions:IABO can significantly reduce blood loss,hysterectomies,and repeated surgeries.This procedure has not shown harmful effects on neonatal outcomes.

关键词： Placenta accreta spectrum disorders placenta percreta Conservative management Intra-abdominal aortic balloon occlusion Propensity score matching

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