Cook Cervical Ripening Balloon for placenta accreta spectrum disorders with placenta previa: a novel approach to uterus preserving.

To evaluate the efficacy of intrauterine inflated Cook Cervical Ripening Balloon (ICRB) in postpartum hemorrhage (PPH) management and fertility preserving for placenta accreta spectrum disorders with placenta previa (previa PAS). At a tertiary referral center, 74 patients suffering with previa PAS were entered into this retrospective cohort study from January, 2016 to December, 2020, and were confirmed intraoperatively that abnormal invasive placenta reaches the cervical internal ostium and the upper part of the cervical canal. In control group (n = 39), the combination of infrarenal abdominal aorta balloon occlusion (IAABO) and longitudinal parallel compression suture to lower uterine segment were performed. In study group (n = 35), in addition to the aforementioned surgical techniques, ICRB was implemented at the cervical internal ostium and the outside of the cervix simultaneously. Use of ICRB significantly reduced the rate of peripartum hysterectomy (2.9% vs 30.4%, p = 0.001), and associated with a reduction in surgical time and duration of IAABO (mean 172.7 min vs 206.6 min, p = 0.017; median 30 min vs 40 min, p < 0.001). Use of ICRB significantly reduced the estimated amount of blood loss (median 2500 ml vs 4000 ml, p < 0.001), amounts of packed red blood cells and fresh-frozen plasma transfusion (median 6 U vs 13.5 U, p < 0.001; median 450 ml vs 1200 ml, p < 0.001), postoperative hospital stay and the incidence of oligomenorrhea postoperatively (median 5 days vs 6 days, p = 0.009; 13.8% vs 61.1% p = 0.001). No significant difference was observed between both the groups regarding the use of cryo and PLT, injury of urinary system, relaparotomy, admission to the ICU, postpartum hematocele in uterine cavity, and postoperative complications (including incidence rate of DVT, incidence rate of femoral thrombosis, puerperal morbidity, intrauterine infection, surgical site infection, and deep tissue infection). ICRB was a simple, effective procedure for PPH management and fertility preserving in some previa PAS cases in which abnormal invasive placenta reaches the cervical internal ostium and the upper part of the cervical canal, in tandem with IAABO and compression suture.

Gu Y ，Zhou Y ，Li L ，Li H ，Wang S ，Wang Y ，Zuo C ... -  《-》

Is prophylactic intraoperative abdominal aortic balloon occlusion beneficial in pregnancies with placenta previa and placenta accreta spectrum during cesarean section? A 5-year retrospective study.

To assess whether prophylactic intraoperative abdominal aortic balloon occlusion (IAABO) is indeed beneficial in pregnancies with placenta previa (PP) and placenta accreta spectrum (PAS) during cesarean section. A retrospective case-control study included 251 pregnancies with PP and/or PAS. All enrolled patients were divided into a PP/PAS group, a PP + PAS group, and an IAABO group. The demographic characteristics and maternal and neonatal outcomes were compared. There was no significant difference in blood loss and transfusion between the IAABO group and the PP + PAS group (P > 0.05). However, blood loss and red blood cell and fresh frozen plasma transfusion in the above two groups were significantly higher than in the PP/PAS group (P < 0.05). More pregnancies in the IAABO group had to undergo uterine artery embolization (29.2%) or hysterectomy (20.8%), and this percentage was significantly higher than that in the other two groups (P < 0.001). All neonatal characteristics did not show differences between the IAABO group and PP + PAS group (P > 0.05). IAABO led to femoral artery thrombosis in three cases and minor postoperative renal injury in one case. IAABO only acted as a less important supporting technique during cesarean section. There was no evidence suggesting that IAABO could significantly control the massive hemorrhage in pregnancies with PP and PAS during cesarean delivery.

Wang ZX ，Zhao YF ，Li L 《-》

Parallel transverse uterine incisions, a novel approach for managing heavy hemorrhage and preserving the uterus: A retrospective cohort study for patients with anterior placenta previa and accreta.

Peng X ，Chen D ，Xu J ，Liu X ，You Y ，Peng B ... -  《-》

[Intrauterine balloon tamponade combined with temporary abdominal aortic balloon occlusion in the management of women with placenta accreta spectrum:a randomized controlled trial].

Dai YM ，Wei J ，Wang ZQ ，Zhang XB ，Cheng L ，Gu N ，Hu YL ... -  《-》

[Application of uterine lower part breakwater-like suture operation in placenta previa].

Zhao Y ，Zhu JW ，Wu D ，Wang QH ，Lu SS ，Liu XX ，Zou L ... -  《-》