Effect of placement of an arterial sheath before cesarean section on uterine blood flow in the interventional treatment of pernicious placenta praevia

ZHANG Tao; YANG Yue; ZHAI Duxiu

doi:10.3969/j.issn.1002-7386.2025.05.019

Abstract：Objective To analyze the efficacy of preoperative placement of an arterial sheath before cesarean section in the interventional management of pernicious placenta praevia and its effect on uterine blood flow.Methods Clinical data of 78 patients with pernicious placenta praevia,who received cesarean section+interventional treatment in our hospital from June 2020 to September 2023 were retrospectively analyzed.They were divided into the control group(non-placement of an arterial sheath before cesarean section,n=39)and the observation group(placement of an arterial sheath before cesarean section,n=39).The time of the interventional treatment,dose of embolization agent,postpartum hemorrhage,the effect of embolization and the incidence of adverse pregnancy conditions of the two groups were compared.Coagulation and uterine hemodynamics of the two groups in the prenatal and postnatal periods were compared as well.Results The intervention time in the observation group was significantly shorter than that of the control group(P＜0.05).The dose of embolic agent used in the observation group was significantly less than that of the control group(P＜0.05).The amount of bleeding at 2,12 and 24 hours after delivery was significantly lower in the observation group than of the control group(P＜0.05).The success rate of embolization treatment was significantly higher in the observation group than that of the control group(P＜0.05).The incidence of adverse pregnancy conditions was significantly lower in the observation group than that of the control group(P＜0.05).Prenatally,the thrombin time,prothrombin time,fibrinogen and activated thrombin time of the two groups were similar(P＞0.05),which,at postnatal,were significantly higher in the observation group than the control group(P＜0.05).Prenatally,the resistance index and peak systolic flow rate/diastolic flow rate ratio of the left and right uterus of the two groups were similar(P＞0.05).At 24 hours postpartum,the resistance index and peak systolic flow rate/diastolic flow rate ratio of the left and right uterus of the observation group were significantly higher than those of the control group(P＜0.05).At 2 weeks postpartum,the resistance index and peak systolic flow rate/diastolic flow rate ratio of the left and right uterus of the observation group were significantly lower than those of the control group(P＜0.05).Conclusion Preoperative placement of an arterial sheath during cesarean section in the interventional treatment of pernicious placenta praevia improves the efficiency of the intervention and the success rate of embolization,further strengthening the effect of controlling postpartum hemorrhage,and the recovery of postpartum coagulation.Moreover,it reduces the dose of embolization agents used and mitigates the impact of the intervention on postpartum uterine blood flow in the mother.