1.
Internal Iliac Artery Balloon Occlusion for Placenta Previa and Suspected Placenta Accreta: A Randomized Controlled Trial
Chen M, Liu X, You Y, Wang X, Li T, Luo H, Qu H, Xu L
Obstet Gynecol. 2020
Abstract
OBJECTIVE To investigate the effect of intraoperative balloon occlusion of the internal iliac arteries in women with placenta previa and antenatally diagnosed placenta accreta. METHODS In this single-center, randomized controlled trial, women with placenta previa and antenatally suspected placenta accreta were randomly assigned to either the balloon occlusion group or to the control group. The perioperative management approach was similar for both groups, other than preoperative balloon catheter placement and intraoperative occlusion of bilateral internal iliac arteries. The primary outcome was the number of packed red blood cell (RBC) units transfused. With a two-sided alpha of 0.05 and a power of 0.8, a sample size of 48 women per group was calculated to detect a mean reduction of 2 units packed RBCs transfused with an expected SD of 3.5. RESULTS From August 2017 to July 2018, we randomized 50 eligible women to the balloon group and 50 to the control group. Demographic, obstetric, and placental imaging characteristics were similar between groups. The number of packed RBC units transfused was not significantly different between groups (5.3+/-5.3 in the occlusion group vs 4.7+/-5.4 in the control group, P=.54). Hospitalization costs and incidence of postoperative fever were significantly higher in the balloon group. No significant differences were found in other outcomes. CONCLUSION Intraoperative balloon occlusion of the internal iliac arteries did not reduce the number of packed RBC units transfused in women with placenta previa and antenatally suspected placenta accreta. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IOR-17012244.
2.
Risk factors for massive hemorrhage during the treatment of cesarean scar pregnancy: a systematic review and meta-analysis
Zhang Y, Zhang Z, Liu X, Zhang L, Hong F, Lu M
Archives of gynecology and obstetrics. 2020
Abstract
PURPOSE Cesarean scar pregnancy (CSP) is one of the serious complications associated with cesarean delivery (CD). This meta-analysis aims to identify risk factors associated with massive hemorrhage during the CSP treatment. METHODS Eight electronic databases were searched for case-control studies published before December 31th, 2018, which compared the possible factors causing massive bleeding during the CSP treatment. Quantitative synthesis was performed by RevMan 5.3. Sensitivity analysis and publication bias were performed by Stata 12.0. RESULTS Total 20 case - control studies including 3101 CSP patients with previous CD met the inclusion criteria. Bleeding group had 573 patients and the control group had 2528 patients. The risk factors for massive bleeding during CSP treatment included multiple gravidities (MD = 0.15, 95% CI 0.03-0.28, P = 0.73), big maximum diameter of gestation sac (MD = 18.49 mm, 95%CI 15.34-21.65, P < 0.01), high gestational days (MD = 8.98 days, 95% CI 4.12-13.84, P < 0.01), high β-HCG level (MD = 21.39 IU/ml, 95% CI 7.36-35.41, P = 0.03; MD = 3.02 U/ml, 95% CI 0.21-5.84, P < 0.01) and rich blood flow around the lesion (OR = 6.73, 95% CI 3.93-11.51, P = 0.59). While, thick myometrium (MD = - 4.94 mm, 95% CI - 6.12 to - 3.75, P < 0.01) may be protective factor. CONCLUSIONS Multiple gravidities, big gestation sac, large gestational days, high serum β-HCG level, abundant blood supply to pregnancy sac and thin myometrium maybe the risk factors for massive bleeding during the CSP treatment.
3.
Uterine artery embolization versus hysterectomy in the treatment of refractory postpartum hemorrhage: a systematic review and meta-analysis
Liu Z, Wang Y, Yan J, Li J, Liu X, Zhang L, Cheng L
The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2018;:1-13.
Abstract
INTRODUCTION We carried out a systematic review and meta-analysis to assess the safety and effectiveness of uterine artery embolization (UAE) compared with conventional hysterectomy on refractory postpartum hemorrhage (PPH). METHODS We searched PubMed, Embase, Chinese National Knowledge Infrastructure database (CNKI), Cochrane Library, and Wanfang database through October 2017 for randomized controlled trials (RCTs) and observational studies assessing the safety and effectiveness of UAE compared with hysterectomy on refractory PPH. The main outcome measures included the blood loss, operating time, hemostatic effective rate, and length of stay. RESULTS Six RCTs and nine observational studies were included in the meta-analysis, which involved 1142 women with refractory PPH. The results demonstrated that UAE was more beneficial on refractory PPH compared with hysterectomy using four scales: blood loss (WMD 893.39 mL; 95% CI: -1205.65, -581.13; p < .001); operating time (WMD -37.19 minutes; 95% CI: -44.42, -29.96; p < .001); length of stay (WMD -5.36 days; 95% CI: -5.76, -4.97; p < .001), hemostatic effective rate (OR 1.58, 95% CI: 0.80, 3.12, p = .184) . CONCLUSIONS In the present meta-analysis, the positive findings suggest UAE has beneficial effects on refractory PPH. UAE significantly reduced blood loss, shortened the operating time, and length of stay compared with hysterectomy. And there is no difference between the UAE group and hysterectomy group in hemostatic effective rate. However, those findings should be treated with caution because of heterogeneity and potential biases.