Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester: Two cases report.
Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester: Two cases report.
复制标题
中孕期前置胎盘患者终止妊娠时，使用宫颈催熟球囊刺入胎盘，压迫胎盘，快速减少出血
DOI：
10.1097/md.0000000000022499
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发表时间：
2020-09-25
期刊：
影响因子：
1.6
通讯作者：
Chen D
中科院分区：
文献类型：
--
作者：
Su C;Chen D
摘要引言：前置胎盘的临床治疗是复杂的，患者必须终止妊娠，由于胎儿畸形，死亡，或在中期妊娠不可避免的流产。在终止妊娠期间很难控制出血过多;这些患者面临切除子宫、感染和其他并发症的风险。患者问题：2例患者在妊娠中期发生前置胎盘。这两个病例都必须终止妊娠。例1胎儿宫内死亡。例2患者出现危及生命的阴道出血。两例患者在阴道分娩时均发生出血，宫颈未成熟。诊断：例1患者入院后经磁共振检查证实为前置胎盘。例2经超声检查证实为前置胎盘。两名患者都不得不终止妊娠。干预措施：我们设计了一种使用宫颈成熟球囊的新手术，以降低前置胎盘患者终止妊娠的风险。通过胎盘插入一个促宫颈成熟球囊，置于胎儿和胎盘之间，施加外力使促宫颈成熟球囊压在覆盖宫颈口的胎盘上，促宫颈成熟球囊扩张宫颈，迅速减少出血，并在前置胎盘患者终止妊娠时诱导阴道分娩。应用此法对2例前置胎盘必须终止妊娠的患者进行了临床观察。结果：使用这种新方法，两名患者都成功终止了妊娠，阴道分娩出血最少。从球囊放置到输送结束的总时间约为3小时。该手术仅使用宫颈成熟球囊，无需子宫动脉栓塞。胎儿经阴道娩出，子宫完全保留。无产后感染。结论：这种使用宫颈成熟球囊的新方法可能是一种快速有效的方法，以减少前置胎盘患者终止妊娠的风险。它在紧急情况下特别有用，人员和设备要求最低。我们的研究显示了宫颈成熟球囊这一新用途的巨大潜力，值得进一步研究。
Abstract Introduction: The clinical treatment is complicated for patients with placenta previa who must terminate pregnancy due to fetal malformation, death, or inevitable abortion in the second trimester. It is difficult to manage excessive bleeding during pregnancy termination; and those patients face risks of removing the uterus, infection and other complications. Patient concerns: Two patients had placenta previa in the second trimester. Both cases had to terminate pregnancy. Case 1 patient had intrauterine fetal death. Case 2 patient had life-threatening vaginal bleeding. Both patients had bleeding and their cervix was not mature during vaginal delivery. Diagnosis: After hospitalization, placenta previa was confirmed by magnetic resonance imaging for case 1 patient. Placenta previa was confirmed by ultrasound examination for case 2 patient. Both patients had to terminate pregnancy. Interventions: We designed a new procedure using a cervical ripening balloon to reduce the risks during pregnancy termination for patients with placenta previa. A cervical ripening balloon was inserted through the placenta and placed between the fetus and placenta; external force was applied to keep the cervical ripening balloon pressing against the placenta that covers the cervical os. The cervical ripening balloon dilated the cervix, quickly reduced bleeding, and induced vaginal delivery during pregnancy termination for patients with placenta previa. This method was applied to 2 patients with placenta previa who must terminate pregnancy. Outcomes: Using the new method, both patients had a successful pregnancy termination and vaginal delivery with minimal bleeding. Total time from the balloon placement to the end of the delivery was about 3 hours. The procedure only used a cervical ripening balloon without uterine artery embolization needed. The fetus was delivered through the vagina; and the uterus was fully retained. There was no postpartum infection. Conclusion: This new method using a cervical ripening balloon could be a quick and effective way to reduce the risks during pregnancy termination for patients with placenta previa. It is especially helpful in emergency situations with minimal requirements of personnel and equipment. Our study showed great potential of this new utilization of a cervical ripening balloon, and is worthy of further research.