A cost-effective operation specifically for pernicious placenta previa:Uterine tone-preserving bladder dissociation(UTBD)
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Abstract Objective:Pernicious placenta previa (PPP) is a special type of placenta previa, which emphasizes that the placenta attaches to the scar of the uterus [1], and has a high risk of placenta adhesion, implantation and fatal bleeding.PPP requires cesarean section to terminate pregnancy, often endangers the life of the parturient due to excessive bleeding during operation. Therefore, how to take effective measures to reduce bleeding during operation is the key to reduce the rate of hysterectomy and mortality.In order to solve this problem, we propose to apply a new surgical method--uterine tone-preserving bladder dissociation(UTBD) in cesarean section to provide better hemostatic effect. Methods:The retrospective study was conducted on malignant placenta previa treated in Chongqing University Fuling Hospital from January 2016 to September 2022.During cesarean section, the patients who used uterine tone-preserving bladder dissociation were defined as the study group, and the patients who did not use the method were defined as the control group.The intraoperative blood loss, blood transfusion, operation time, hysterectomy, ICU occupancy rate and newborn birth of the two groups were counted. Results: Total of 117 patients were screened out in this study, 54 of whom underwent cystectomy with uterine tension preservation during cesarean section, and 63 patients in the control group. During cesarean section, the use of bladder dissociation with preservation of uterine tension can significantly reduce intraoperative bleeding [700 (200~3800) vs 500 (300~2000)ml, p=0.001]; Blood transfusion volume significantly decreased [800 (100~3800) vs 600 (200~1200)ml, p=0.048], hysterectomy rate decreased (11.11% vs 0, p=0.033), and ICU occupancy rate decreased (14.29% vs 0, p=0.011). However, there was no statistical difference in the incidence of placental implantation (77.78% vs 85.19%, p=0.307), the probability of transfer to pediatrics (44.44% vs 39.62%, p=0.6) and the operation time[85 (43~290) vs 77.50 (40~160)min, p=0.082]. Conclusions:In the caesarean section of PPP patients, the use of uterine tone-preserving bladder distribution is simple to operate, can reduce intraoperative bleeding, maximize the retention of uterus, reduce the occupancy rate of ICU, improve the Apgar score of newborns, and does not increase the operation time. It is an effective and safe method targeting PPP.
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A cost-effective operation specifically for pernicious placenta previa:Uterine tone-preserving bladder dissociation(UTBD) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A cost-effective operation specifically for pernicious placenta previa:Uterine tone-preserving bladder dissociation(UTBD) Feng Yang, Meng Xiong, Daju Zhou, Xiaohua Liu, Shiqiong Li, Qingrong Wu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2730328/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective :Pernicious placenta previa (PPP) is a special type of placenta previa, which emphasizes that the placenta attaches to the scar of the uterus [1] , and has a high risk of placenta adhesion, implantation and fatal bleeding.PPP requires cesarean section to terminate pregnancy, often endangers the life of the parturient due to excessive bleeding during operation. Therefore, how to take effective measures to reduce bleeding during operation is the key to reduce the rate of hysterectomy and mortality.In order to solve this problem, we propose to apply a new surgical method--uterine tone-preserving bladder dissociation(UTBD) in cesarean section to provide better hemostatic effect. Methods: The retrospective study was conducted on malignant placenta previa treated in Chongqing University Fuling Hospital from January 2016 to September 2022.During cesarean section, the patients who used uterine tone-preserving bladder dissociation were defined as the study group, and the patients who did not use the method were defined as the control group.The intraoperative blood loss, blood transfusion, operation time, hysterectomy, ICU occupancy rate and newborn birth of the two groups were counted. Results: Total of 117 patients were screened out in this study, 54 of whom underwent cystectomy with uterine tension preservation during cesarean section, and 63 patients in the control group. During cesarean section, the use of bladder dissociation with preservation of uterine tension can significantly reduce intraoperative bleeding [700 (200~3800) vs 500 (300~2000)ml, p=0.001]; Blood transfusion volume significantly decreased [800 (100~3800) vs 600 (200~1200)ml, p=0.048], hysterectomy rate decreased (11.11% vs 0, p=0.033), and ICU occupancy rate decreased (14.29% vs 0, p=0.011). However, there was no statistical difference in the incidence of placental implantation (77.78% vs 85.19%, p=0.307), the probability of transfer to pediatrics (44.44% vs 39.62%, p=0.6) and the operation time[85 (43~290) vs 77.50 (40~160)min, p=0.082]. Conclusions: In the caesarean section of PPP patients, the use of uterine tone-preserving bladder distribution is simple to operate, can reduce intraoperative bleeding, maximize the retention of uterus, reduce the occupancy rate of ICU, improve the Apgar score of newborns, and does not increase the operation time. It is an effective and safe method targeting PPP. Pernicious placenta previa (PPP) Uterine tone-preserving bladder dissociation(UTBD) Cesarean section Bleeding Figures Figure 1 What does this study adds to the clinical work We have found a surgical method-Uterine tone-preserving bladder dissociation,it has a positive effect on reducing bleeding during cesarean section for the pernicious placenta previa and can reserve the uterus to the maximum extent.The uterine tone-preserving bladder dissociation is an effective, practical, and safe method,and it is simple in operation, so it can be popularized in PPP patients. Highlights 1. Pernicious placenta previa requires cesarean section to terminate pregnancy, with high intraoperative bleeding 2.Uterine tone-reserving blader disassociation (UTBD) can effectively reduce bleeding during PPP cesarean section and can reserve the uterus to the maximum extent. 3.Uterine tone-reserving blader disassociation (UTBD) is an effective, practical, and safe method, and it does not increase the operation time. Introduction PPP was first proposed by Chattopadhyay in 1993,It refers to those who have placenta previa in their pregnancy after cesarean section, with or without placenta implantation [2] .Now more scholars define PPP as having a history of cesarean section, the current pregnancy is placenta previa, and the placenta covers the original uterine incision [3] .The specific pathogenesis of PPP patients is still unclear, and most people think it is related to the dysplasia or loss of decidua basalis [4] , and the risk of placenta implantation is as high as about 50%.For various reasons, such as China, now each family can deliver three children, leading to an increase in the cesarean section rate, leading to a significant increase in the incidence of PPP [5] .PPP cannot deliver via vagina, and cesarean section is needed to end the delivery. However, bleeding during operation is a very serious problem we need to face. In China, nearly half of perinatal maternal deaths are caused by postpartum bleeding [6] .Therefore, how to take effective measures to reduce bleeding during cesarean section has always been a research focus in the field of obstetrics.During cesarean section, the suture should be performed quickly to stop bleeding, which requires the operator to fully release the adhesion and push down the bladder, so as to obtain enough operation space.However, when PPP patients have excessive vaginal bleeding and acute fetal distress, they need to deliver the fetus in a short time, which often leads to insufficient exposure of the space between the lower segment of the uterus and adjacent organs and surrounding tissues before the delivery of the fetus. After the delivery of the fetal placenta, due to the disappearance of the fetal uterine tension, it is difficult to separate the bladder from the anterior wall of the uterus, affecting the operation, and increasing the risk of intraoperative bleeding and bladder injury.In the past, many researchers have devoted themselves to finding ways to reduce bleeding during cesarean section. Up to now, various surgical methods have been proposed to control bleeding related to placenta previa, including hysterectomy [7-9] .However, women and their families often have a strong expectation of preserving the uterus and fertility. For PPP, reducing intraoperative bleeding is still a great challenge, which requires other methods that can reduce bleeding during PPP cesarean section to replace hysterectomy.Through reference and exploration of various hemostatic methods, we finally put forward the uterine tone-preserving bladder dissociation. This study aims to evaluate the effectiveness of the uterine tone-preserving bladder dissociation in reducing bleeding during cesarean section, reducing blood transfusion, reducing hospital stay and preventing hysterectomy for PPP pregnant women. At the same time, we analyzed the short-term complications and prognosis of mothers and infants. Patients And Methods Patients From January 2016 to September 2022, patients from Chongqing University Fuling Hospital who met the following criteria were included in this study: 1. Single pregnancy with late pregnancy; 2. Preoperative ultrasound and/or magnetic resonance examination showed that it was PPP; 3. The cesarean section conforms to the PPP diagnostic criteria of the 9th edition of Obstetrics and Gynecology.The patients who used uterine tone-preserving bladder dissociation during the operation were defined as the study group, and the patients who did not use uterine tone-preserving bladder dissociation during the operation were defined as the control group. The operation technology was approved by the Ethics Committee of Chongqing University Fuling Hospital, and all patients provided written informed consent before the operation. Data Collection The following clinical characteristics of patients and neonates were routinely collected, including age, pregnancy times, cesarean section times, weeks of pregnancy, operation time (minutes), blood transfusion (ml), intraoperative blood loss (mL), whether remove the uterus, whether transfer to ICU, neonatal birth weight, 1/5/10 minute Apgar score of neonates. The data of normal distribution are expressed in mean ± standard deviation, while the categorical variables are expressed in figures and/or percentages. SPSS 26.0 was used for statistical analysis. The significance level was p<0.05。 Procedure The two groups of pregnant women were initially diagnosed as PPP by color ultrasound or magnetic resonance imaging. Before operation, experienced anesthesiologists, interventional radiologists, hematologists, ICU doctors, obstetricians and neonatal pediatricians had multidisciplinary discussions.Except for the patients who need immediate operation due to vaginal bleeding and fetal distress, the elective cesarean section should be carried out in the 34th to 37th weeks. On the day of operation, the placental position and fetal orientation should be confirmed again by color ultrasound. Those who are found to be non PPP during the operation will be rejected. The previous procedure is the same as that of ordinary cesarean section, but before the fetus is delivered, it is only necessary to slightly separate the adhesion and expose the incision position of the lower segment of the uterus.After the fetus is delivered, the placenta will not be delivered temporarily, the uterus will be held out of the abdominal cavity, and a tourniquet will be quickly used to bind the inner opening of the lower cervical segment of the uterus from the outside of the round ligament. The binding range includes all the blood vessels around the uterus, and can also include part of the bladder.Then the placental tissue is temporarily retained in situ to maintain the tension of the lower segment of the uterus, and then the bladder peritoneal reflux is opened to fully free the bladder and the surrounding tissue of the lower segment of the uterus.Pull the umbilical cord to deliver the part of placenta that has not been adhered and implanted, then release the tourniquet, use the oval forceps to quickly clamp the residual placental tissue, if there is still placental tissue that cannot be removed, trim it, and tighten the tourniquet again after the placenta is completely delivered.After these steps are completed, the wound bleeding will be processed in a followed way: suture the top incisions on both sides of the uterus, ligate the ascending branches of the bilateral uterine arteries, suture the wound of uterine cavity bleeding, and suture the uterine incision in the cervical pull type plus the folding type of the lower segment of the uterus.Then loosen the tourniquet and check the uterine bleeding. If the bleeding can not be controlled after appeal, consider removing the uterus.Finally, investigate the condition of the pelvic cavity, check the integrity of the bladder, retain the pelvic drainage tube, and send the patient back to the ward for further observation after the vaginal bleeding is reduced and the uterine contraction is good. Statisticalanalysis SPSS 19.0 software was used for data processing. Measurement data conforming to normal distribution were represented by x±s, one-way ANOVA was used, measurement data of non normal distribution were represented by median (minimum~maximum), Kruskal Wallis rank sum test was used, and counting data were represented by percentage χ 2. Test, P＜0.05 means there is statistical difference, P＜0.01 means there is significant statistical difference. Results Baseline data of two groups In this study, 117 patients were screened out, of which 54 patients in the study group were treated with uterine tone-preserving bladder dissociation during cesarean section, and 63 patients in the control group were treated with traditional surgery. The comparison of baseline data between the two groups were shown in Table 1. The average age of patients in the control group and the study group was 32.41 (SD: ± 4.87) and 32.72 (SD: ± 4.41) years, respectively, with no statistical difference (P=0.721); The time of termination of pregnancy in the two groups was similar [37 (30.86~40.29) vs 37.07 (30.14~39.29) weeks, p=0.685]; The number of pregnancies in the two groups was 5 (2-8) and 4 (2-9), respectively, with no statistical difference (P=0.36); The number of previous deliveries in the two groups was 1 (1-5) and 1 (1-3), respectively, with no statistical difference (P=0.113); The number of previous cesarean sections in the two groups was 1 (1-3) and 1 (1-2) respectively, and the results were also not statistically different (P=0.257). The influence of uterine tone-preserving bladder dissociation on the mother The use of uterine tone-preservice blader disassociation during cesarean section can significantly reduce the intraoperative bleeding volume [700 (200~3800) ml vs 500 (300~2000), p=0.001], and correspondingly, the blood transfusion volume of patients is also significantly reduced [800 (100~3800) vs 600 (200~1200), p=0.048], see Table 2. After the use of uterine tone-reserving blader disassociation, the hysterectomy rate of mothers decreased (11.11% vs 0, p=0.033), and the ICU occupancy rate also decreased (14.29% vs 0, p=0.011). However, the incidence of placental implantation (77.78% vs 85.19%, p=0.307), the probability of transferring to paediatrics (44.44% vs 39.62%, p=0.6) and the operation time (85 (43~290) vs 77.50 (40~160), p=0.082) have no statistical difference, see Table 3. It shows that the uterine tone--preserving blader disassociation can maximize the retention of the uterus of PPP patients, thus preserving their fertility, without increasing the related complications and operation time. Effect of uterine tone-preserving bladder dissociation on newborns There was no statistical difference between the two groups in the probability of transferring to pediatrics (44.44% vs 39.62%, p=0.6). The effects of using uterine tone-preservice blader disassociation during cesarean section on newborns were shown in Table 4. There was no statistical difference in the 1-minute Apgar score of newborn [10 (5-10) vs 10 (4-10)], 5-minute Apgar score of newborn [10 (7-10) vs 10 (6-10)], 10-minute Apgar score of newborn [10 (9-10) vs 10 (9-10)] and neonatal birth weight [2820 (1630-4490) vs 2925 (1600-3800)]. Discussion PPP is one of the most serious complications of cesarean section, which may cause severe postpartum hemorrhage, and sometimes requires emergency hysterectomy, which is a life-threatening situation [10] .Research shows that the risk of PPP for women with one cesarean section is about 20%, but the incidence of PPP for women with two cesarean sections increases to 1/6 [11] .The placenta of PPP patients may have adhesion and implantation, or even some placental tissue may be implanted into the cervical canal, which will damage the lower segment of the uterus, affect the uterine contraction and physiological contraction of the cervix. After placenta separation during operation, blood vessels on the placental attachment surface are prone to rupture and blood sinuses open in large numbers, leading to intractable postpartum hemorrhage [12] .In order to reduce the bleeding during the PPP cesarean section, there are two commonly used clinical treatments in the past, one of which is hysterectomy, which can effectively prevent and treat the bleeding during the operation. However, the decreased blood supply of ovarian tissue after the operation may affect the endocrine function of the ovary, accelerate the decline of ovarian function, and even lead to premature ovarian failure [13] . After hysterectomy, patients may also have psychological disorders and sexual life disorders [14] .Another commonly used method is to retain the placenta in situ. This method can be used for those whose incisions do not hurt the placenta and the placenta does not show signs of separation after fetal delivery. However, this treatment scheme takes a long time and has a high risk of infection, and 6% - 17% of patients still need to undergo hysterectomy again [15] .Therefore, the key to the success of PPP treatment is how to avoid intractable postpartum hemorrhage [16] .At present, there are many improved surgical methods,such as Parallel Loop Binding Compression Suture [17] ，The Triple P procedure [12] ，intrauterine tamponade balloons brought out through the abdominal wal l [18] ，Prophylactic temporary abdominal aortic balloon occlusion [19] ，prophylactic internal iliac artery balloon occlusion [20] ，Anti-Arcuate Compression Suturing [21] ，Transverse parallel compression suture [10] ，Uterine artery ligation [22] etc,but the incidence of intractable postpartum hemorrhage is still high.During pregnancy, uterine ligament relaxation, cervical ripening and softening, and uterine isthmus extension provide conditions for binding tourniquet. The binding range of tourniquet includes the whole uterine peripheral blood vessels and part of the bladder floor, which can reduce intraoperative bleeding and effectively ensure clear surgical field.We had accumulated many clinical cases to explore the surgical method, and found that uterine tone-preserving bladder dissociation can effectively reduce intraoperative bleeding and maximize the preservation of uterus.In our study, there was no statistical difference between the study group and the control group in the operation time. The amount of intraoperative bleeding and the rate of hysterectomy in the study group were smaller than those in the control group, and the difference was statistically significant. This shows that theuterine tone-preserving bladder dissociation can significantly reduce intraoperative bleeding and the rate of hysterectomy, and will not increase the operation time.The amount of blood transfusion in the study group and the probability of pregnant women transferring to ICU are both smaller than those in the control group, and the difference is statistically significant, which confirms our previous conjecture (previously, when we made statistics when the number of cases was small, the difference in the amount of blood transfusion was not statistically significant, considering that the sample size was too small), indicating that this method can reduce the amount of blood products, reduce the proportion of critically ill patients, and save medical resources.There was no significant difference in Apgar score, birth weight and puerperal infection rate between the two groups, indicating the safety of the operation in terms of mothers and infants. In this study, a "disposable plastic film bag" was stuck on the patient's hip during the operation to facilitate the observation of vaginal bleeding during the operation, because this part is often the most easily ignored, so that the blood loss can be accurately evaluated, as to facilitate the timely supplement of blood volume and the selection of appropriate surgical methods.The longitudinal incision of the lower abdomen is selected for the operation, slightly separating the adhesion can expose the lower segment of the uterus. If the adhesion of the bottom of the bladder moves upward and affects the delivery of the fetus, open the bladder peritoneum to expose the lower segment of the uterus. Cut the uterus at a relatively thin position of the placenta at the lower segment of the anterior wall of the uterus to deliver the fetus, which can significantly shorten the time from the beginning of the operation to the delivery of the fetus.Especially for patients with more vaginal bleeding or acute fetal distress before operation, this method can reduce the amount of bleeding before fetal delivery, improve the Apgar score of newborns after birth, increase the survival rate of newborns, and reduce long-term complications of newborns.After the fetus is delivered, the placenta will not be delivered temporarily. Use oval forceps to clamp the uterine incision and placenta together, and then hold the uterus out of the abdominal cavity. Quickly bind the lower segment of the uterus from the outside of the round ligament with a tourniquet, which can effectively reduce intraoperative bleeding and ensure clear surgical field.After the delivery of the fetus, due to the contraction of the uterus, a large amount of blood in and around the uterus returns, and the surface of the bladder peritoneum and the lower segment of the uterus are filled with blood vessels that are significantly smaller than before. At this time, the placenta is retained in situ to keep the tension in the lower segment of the uterus, which is conducive to finding the space between the bladder and the anterior wall of the uterus during the separation of adhesion, reducing the damage to the bladder and blood vessels, shortening the operation time, and reducing intraoperative bleeding.Compared with abdominal aorta or internal iliac artery occlusion, this method is simple and less risky, which is more conducive to promotion. It is especially suitable for emergency surgery patients who need to deliver the fetus as soon as possible and stop bleeding and have no time for interventional treatment before surgery. Conclusions The uterine tone-preserving bladder dissociation is simple in operation, can reduce intraoperative bleeding of PPP, and can reserve the uterus to the maximum extent. It is an effective, practical, and safe method, and is good for Apgar newborn. More importantly, it does not increase the operation time, and can be popularized in PPP patients. Declarations Funding sources: This study was supported by the project of Fuling District Science and Technology Bureau (FLKJ, 2020ABC2037) Conflict of Interests: The authors declare that there are no competing interests. CONFLICT OF INTEREST The authors have no conflflicts of interest. AUTHOR CONTRIBUTIONS Feng Yang collected case information and relevant data.Meng Xiong: verify information and make statistical analysis. Daju Zhou: Communication and treatment of patients.Xiaohua Liu : Operation and patient management. Shiqiong Li: Guide patient management. Qingrong Wu: Fund management, surgical operation, project promotion. Fengjiang Qin: fund application, patient management, information collection, manuscript writing and submission. References Li, N., et al., Feasibility of Infrarenal Abdominal Aorta Balloon Occlusion in Pernicious Placenta Previa Coexisting with Placenta Accrete. Biomed Res Int, 2018. 2018: p. 4596189.DOI: 10.1155/2018/4596189. Chattopadhyay, S.K., H. Kharif, and M.M. Sherbeeni, Placenta praevia and accreta after previous caesarean section. Eur J Obstet Gynecol Reprod Biol, 1993. 52(3): p. 151-6.DOI: 10.1016/0028-2243(93)90064-j. Liu, J., et al., Grade Prediction of Bleeding Volume in Cesarean Section of Patients With Pernicious Placenta Previa Based on Deep Learning. Front Bioeng Biotechnol, 2020. 8: p. 343.DOI: 10.3389/fbioe.2020.00343. Silver, R.M. and K.D. Barbour, Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am, 2015. 42(2): p. 381-402.DOI: 10.1016/j.ogc.2015.01.014. Tadevosyan, M., et al., Factors contributing to rapidly increasing rates of cesarean section in Armenia: a partially mixed concurrent quantitative-qualitative equal status study. BMC Pregnancy Childbirth, 2019. 19(1): p. 2.DOI: 10.1186/s12884-018-2158-6. Du, L., et al., Probability of severe postpartum hemorrhage in repeat cesarean deliveries: a multicenter retrospective study in China. Sci Rep, 2021. 11(1): p. 8434.DOI: 10.1038/s41598-021-87830-7. Bhal, K., et al., The uterine compression suture--a valuable approach to control major haemorrhage at lower segment caesarean section. J Obstet Gynaecol, 2005. 25(1): p. 10-4.DOI: 10.1080/01443610400022553. Li, G.T., et al., Funnel compression suture: a conservative procedure to control postpartum bleeding from the lower uterine segment. 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Tables TABLE1:baseline characteristics of patients Project control group study group t/Z p Age 32.41±4.87 32.72±4.41 -0.358 0.721 Gestational week (week) 37（30.86～40.29） 37.07（30.14～39.29） -0.405 0.685 Number of pregnancies 5（2～8） 4（2～9） -0.916 0.36 Previous birth times 1（1～5） 1（1～3） -1.585 0.113 Previous cesarean section times 1（1～3） 1（1～2） -1.134 0.257 TABLE2:Indicators in operation Project control group study group t/Z p Intraoperative bleeding volume (ml) 700（200～3800） 500（300～2000） -3.468 0.001 Intraoperative infusion of suspended red blood cells (ml) 800（100～3800） 600（200～1200） -1.977 0.048 Operation time (min) 85（43～290） 77.50（40～160） -1.738 0.082 TABLE3:The influence of uterine tone-preserving bladder dissociation Group Hysterectomy Hemorrhagic shock Placental implantation Transfer to ICU Transfer to pediatrics yes no rate yes no rate yes no rate yes no rate yes no rate study 7 56 11.11 3 60 4.76 49 14 77.78 9 54 14.29 28 35 44.44 control 0 54 0 0 54 0 46 8 85.19 0 54 0 21 32 39.62 χ 2 4.559 1.077 1.045 6.466 0.274 P 0.033 0.299 0.307 0.011 0.600 TABLE4: Influence on neonates Project control group study group t/Z p Apgar score of newborn (1min) 10（5～10） 10（4～10） -0.18 0.857 Apgar score of newborn (5min) 10（7～10） 10（6～10） -0.033 0.974 Apgar score of newborn (10min) 10（9～10） 10（9～10） -1.183 0.237 Newborn weight (g) 2820（1630～4490） 2925（1600～3800） -0.309 0.757 Supplementary Files ProcedureVideo.mp4 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2730328","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":189897615,"identity":"d3bad879-e703-4a04-b72e-9daf8adaf26f","order_by":0,"name":"Feng Yang","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"Yang","suffix":""},{"id":189897616,"identity":"a831bab2-6f4d-4d8c-a284-7daba91d7a87","order_by":1,"name":"Meng Xiong","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Meng","middleName":"","lastName":"Xiong","suffix":""},{"id":189897617,"identity":"ed5e8f53-c735-4adb-8a78-c0e9e87afe06","order_by":2,"name":"Daju Zhou","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Daju","middleName":"","lastName":"Zhou","suffix":""},{"id":189897618,"identity":"91d8ec9a-f6ec-462d-ad4f-d2dabc1b157b","order_by":3,"name":"Xiaohua Liu","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaohua","middleName":"","lastName":"Liu","suffix":""},{"id":189897619,"identity":"435dde4c-123e-40af-ba55-ce970aaf0a8e","order_by":4,"name":"Shiqiong Li","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shiqiong","middleName":"","lastName":"Li","suffix":""},{"id":189897620,"identity":"8f1f5cc7-5962-4e01-b634-d62add355f81","order_by":5,"name":"Qingrong Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBAC9nYog42Z+eCDDwY2dgS18ByGMvjY2ZINZxSkJROvRY6fx0ya58MhxgaCWph5zCTe7jmc2MbMlmxsY3CAmYH98NENhLRIznkG0sJ88HGOwR0+Bp60tBv4tNgzg9xz4DbElhyDZ8wMEjxmeLXwILQAGRYGhxkbSNPCQJwWtmLLOQf+G4McZthjkJbMRsgvPOzNG2+8OZAmO7//8MEHP/7Y2PGzHz6GVwsDA4eJBA8ynw2/chBgf/yBh7CqUTAKRsEoGMkAADWNRHXj1f+AAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Qingrong","middleName":"","lastName":"Wu","suffix":""},{"id":189897621,"identity":"226f11de-76c8-4dfe-853c-4c737c88d8c1","order_by":6,"name":"Fengjiang Qin","email":"","orcid":"https://orcid.org/0009-0003-8197-552X","institution":"Chongqing university Fuling Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fengjiang","middleName":"","lastName":"Qin","suffix":""}],"badges":[],"createdAt":"2023-03-24 05:39:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2730328/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2730328/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":35734956,"identity":"de32c237-6068-4d67-95cb-2fd77ad148a8","added_by":"auto","created_at":"2023-04-13 22:34:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":935327,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical pictures (A) PPP combined with placental implantation (B)Leave the placenta in its original position and retain the uterine tension (C)Tourniquet bind the inner opening of the lower cervical segment of the uterus from the outside of the round ligament,including part of bladder (D)open the bladder peritoneal reflux to fully free the bladder and the surrounding tissue of the lower segment of the uterus\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2730328/v1/e510851a3917797f5c1f3ef6.png"},{"id":37747679,"identity":"1d4d8dac-c7a2-47ab-9bdf-7f1c17d9f6b2","added_by":"auto","created_at":"2023-05-31 09:48:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1118109,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2730328/v1/5e08fdde-d14b-466b-9a63-3d02018bdd92.pdf"},{"id":35734957,"identity":"d6c3daa0-9e3b-48eb-91ad-90c431f30781","added_by":"auto","created_at":"2023-04-13 22:34:17","extension":"mp4","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":139806863,"visible":true,"origin":"","legend":"","description":"","filename":"ProcedureVideo.mp4","url":"https://assets-eu.researchsquare.com/files/rs-2730328/v1/20811e469fee8990e9499863.mp4"}],"financialInterests":"","formattedTitle":"A cost-effective operation specifically for pernicious placenta previa:Uterine tone-preserving bladder dissociation(UTBD)","fulltext":[{"header":"What does this study adds to the clinical work","content":"\u003cp\u003eWe have found a surgical method-Uterine tone-preserving bladder dissociation,it has a positive effect on reducing bleeding during cesarean section for the pernicious placenta previa and can reserve the uterus to the maximum extent.The uterine tone-preserving bladder dissociation is an effective, practical, and safe method,and it is simple in operation, so it can be popularized in PPP patients.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Highlights","content":"\u003cp\u003e1. Pernicious placenta previa requires cesarean section to terminate pregnancy, with high intraoperative bleeding\u003c/p\u003e\n\u003cp\u003e2.Uterine tone-reserving blader disassociation (UTBD) can effectively reduce bleeding during PPP cesarean section and can reserve the uterus to the maximum extent.\u003c/p\u003e\n\u003cp\u003e3.Uterine tone-reserving blader disassociation (UTBD) is an effective, practical, and safe method, and it does not increase the operation time.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003ePPP was first proposed by Chattopadhyay in 1993,It refers to those who have placenta previa in their pregnancy after cesarean section, with or without placenta implantation\u003csup\u003e[2]\u003c/sup\u003e.Now more scholars define PPP as having a history of cesarean section, the current pregnancy is placenta previa, and the placenta covers the original uterine incision\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[3]\u003c/sup\u003e.The specific pathogenesis of PPP patients is still unclear, and most people think it is related to the dysplasia or loss of decidua basalis\u003csup\u003e[4]\u003c/sup\u003e, and the risk of placenta implantation is as high as about 50%.For various reasons, such as China, now each family can deliver three children, leading to an increase in the cesarean section rate, leading to a significant increase in the incidence of PPP\u003csup\u003e[5]\u003c/sup\u003e.PPP cannot deliver via vagina, and cesarean section is needed to end the delivery. However, bleeding during operation is a very serious problem we need to face. In China, nearly half of perinatal maternal deaths are caused by postpartum bleeding\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[6]\u003c/sup\u003e.Therefore, how to take effective measures to reduce bleeding during cesarean section has always been a research focus in the field of obstetrics.During cesarean section, the suture should be performed quickly to stop bleeding, which requires the operator to fully release the adhesion and push down the bladder, so as to obtain enough operation space.However, when PPP patients have excessive vaginal bleeding and acute fetal distress, they need to deliver the fetus in a short time, which often leads to insufficient exposure of the space between the lower segment of the uterus and adjacent organs and surrounding tissues before the delivery of the fetus. After the delivery of the fetal placenta, due to the disappearance of the fetal uterine tension, it is difficult to separate the bladder from the anterior wall of the uterus, affecting the operation, and increasing the risk of intraoperative bleeding and bladder injury.In the past, many researchers have devoted themselves to finding ways to reduce bleeding during cesarean section. Up to now, various surgical methods have been proposed to control bleeding related to placenta previa, including hysterectomy\u003csup\u003e[7-9]\u003c/sup\u003e.However, women and their families often have a strong expectation of preserving the uterus and fertility. For PPP, reducing intraoperative bleeding is still a great challenge, which requires other methods that can reduce bleeding during PPP cesarean section to replace hysterectomy.Through reference and exploration of various hemostatic methods, we finally put forward the uterine tone-preserving bladder dissociation. This study aims to evaluate the effectiveness of the uterine tone-preserving bladder dissociation in reducing bleeding during cesarean section, reducing blood transfusion, reducing hospital stay and preventing hysterectomy for PPP pregnant women. At the same time, we analyzed the short-term complications and prognosis of mothers and infants.\u003c/p\u003e"},{"header":"Patients And Methods","content":"\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eFrom January 2016 to September 2022, patients from Chongqing University Fuling Hospital who met the following criteria were included in this study: 1. Single pregnancy with late pregnancy; 2. Preoperative ultrasound and/or magnetic resonance examination showed that it was PPP; 3. The cesarean section conforms to the PPP diagnostic criteria of the 9th edition of Obstetrics and Gynecology.The patients who used uterine tone-preserving bladder dissociation during the operation were defined as the study group, and the patients who did not use uterine tone-preserving bladder dissociation during the operation were defined as the control group. The operation technology was approved by the Ethics Committee of Chongqing University Fuling Hospital, and all patients provided written informed consent before the operation.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe following clinical characteristics of patients and neonates were routinely collected, including age, pregnancy times, cesarean section times, weeks of pregnancy, operation time (minutes), blood transfusion (ml), intraoperative blood loss (mL), whether remove the uterus, whether transfer to ICU, neonatal birth weight, 1/5/10 minute Apgar score of neonates.\u003c/p\u003e\u003cp\u003eThe data of normal distribution are expressed in mean \u0026plusmn; standard deviation, while the categorical variables are expressed in figures and/or percentages. SPSS 26.0 was used for statistical analysis. The significance level was p\u0026lt;0.05。\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe two groups of pregnant women were initially diagnosed as PPP by color ultrasound or magnetic resonance imaging. Before operation, experienced anesthesiologists, interventional radiologists, hematologists, ICU doctors, obstetricians and neonatal pediatricians had multidisciplinary discussions.Except for the patients who need immediate operation due to vaginal bleeding and fetal distress, the elective cesarean section should be carried out in the 34th to 37th weeks. On the day of operation, the placental position and fetal orientation should be confirmed again by color ultrasound. Those who are found to be non PPP during the operation will be rejected.\u003c/p\u003e\u003cp\u003eThe previous procedure is the same as that of ordinary cesarean section, but before the fetus is delivered, it is only necessary to slightly separate the adhesion and expose the incision position of the lower segment of the uterus.After the fetus is delivered, the placenta will not be delivered temporarily, the uterus will be held out of the abdominal cavity, and a tourniquet will be quickly used to bind the inner opening of the lower cervical segment of the uterus from the outside of the round ligament. The binding range includes all the blood vessels around the uterus, and can also include part of the bladder.Then the placental tissue is temporarily retained in situ to maintain the tension of the lower segment of the uterus, and then the bladder peritoneal reflux is opened to fully free the bladder and the surrounding tissue of the lower segment of the uterus.Pull the umbilical cord to deliver the part of placenta that has not been adhered and implanted, then release the tourniquet, use the oval forceps to quickly clamp the residual placental tissue, if there is still placental tissue that cannot be removed, trim it, and tighten the tourniquet again after the placenta is completely delivered.After these steps are completed, the wound bleeding will be processed in a followed way: suture the top incisions on both sides of the uterus, ligate the ascending branches of the bilateral uterine arteries, suture the wound of uterine cavity bleeding, and suture the uterine incision in the cervical pull type plus the folding type of the lower segment of the uterus.Then loosen the tourniquet and check the uterine bleeding. If the bleeding can not be controlled after appeal, consider removing the uterus.Finally, investigate the condition of the pelvic cavity, check the integrity of the bladder, retain the pelvic drainage tube, and send the patient back to the ward for further observation after the vaginal bleeding is reduced and the uterine contraction is good.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStatisticalanalysis\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eSPSS 19.0 software was used for data processing. Measurement data conforming to normal distribution were represented by x\u0026plusmn;s, one-way ANOVA was used, measurement data of non normal distribution were represented by median (minimum~maximum), Kruskal Wallis rank sum test was used, and counting data were represented by percentage \u0026chi; 2. Test, P＜0.05 means there is statistical difference, P＜0.01 means there is significant statistical difference.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline data of two groups\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 117 patients were screened out, of which 54 patients in the study group were treated with uterine tone-preserving bladder dissociation \u0026nbsp;during cesarean section, and 63 patients in the control group were treated with traditional surgery. The comparison of baseline data between the two groups were shown in Table 1.\u003c/p\u003e\n\u003cp\u003eThe average age of patients in the control group and the study group was 32.41 (SD: \u0026plusmn; 4.87) and 32.72 (SD: \u0026plusmn; 4.41) years, respectively, with no statistical difference (P=0.721); The time of termination of pregnancy in the two groups was similar [37 (30.86~40.29) vs 37.07 (30.14~39.29) weeks, p=0.685]; The number of pregnancies in the two groups was 5 (2-8) and 4 (2-9), respectively, with no statistical difference (P=0.36); The number of previous deliveries in the two groups was 1 (1-5) and 1 (1-3), respectively, with no statistical difference (P=0.113); The number of previous cesarean sections in the two groups was 1 (1-3) and 1 (1-2) respectively, and the results were also not statistically different (P=0.257).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe influence of uterine tone-preserving bladder dissociation on the mother\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe use of uterine tone-preservice blader disassociation during cesarean section can significantly reduce the intraoperative bleeding volume [700 (200~3800) ml vs 500 (300~2000), p=0.001], and correspondingly, the blood transfusion volume of patients is also significantly reduced [800 (100~3800) vs 600 (200~1200), p=0.048], see Table 2. After the use of uterine tone-reserving blader disassociation, the hysterectomy rate of mothers decreased (11.11% vs 0, p=0.033), and the ICU occupancy rate also decreased (14.29% vs 0, p=0.011). However, the incidence of placental implantation (77.78% vs 85.19%, p=0.307), the probability of transferring to paediatrics (44.44% vs 39.62%, p=0.6) and the operation time (85 (43~290) vs 77.50 (40~160), p=0.082) have no statistical difference, see Table 3. It shows that the uterine tone--preserving blader disassociation can maximize the retention of the uterus of PPP patients, thus preserving their fertility, without increasing the related complications and operation time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffect of uterine tone-preserving bladder dissociation on newborns\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no statistical difference between the two groups in the probability of transferring to pediatrics (44.44% vs 39.62%, p=0.6). The effects of using uterine tone-preservice blader disassociation during cesarean section on newborns were shown in Table 4. There was no statistical difference in the 1-minute Apgar score of newborn [10 (5-10) vs 10 (4-10)], 5-minute Apgar score of newborn [10 (7-10) vs 10 (6-10)], 10-minute Apgar score of newborn [10 (9-10) vs 10 (9-10)] and neonatal birth weight [2820 (1630-4490) vs 2925 (1600-3800)].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePPP is one of the most serious complications of cesarean section, which may cause severe postpartum hemorrhage, and sometimes requires emergency hysterectomy, which is a life-threatening situation\u003csup\u003e[10]\u003c/sup\u003e.Research shows that the risk of PPP for women with one cesarean section is about 20%, but the incidence of PPP for women with two cesarean sections increases to 1/6\u003csup\u003e[11]\u003c/sup\u003e.The placenta of PPP patients may have adhesion and implantation, or even some placental tissue may be implanted into the cervical canal, which will damage the lower segment of the uterus, affect the uterine contraction and physiological contraction of the cervix. After placenta separation during operation, blood vessels on the placental attachment surface are prone to rupture and blood sinuses open in large numbers, leading to intractable postpartum hemorrhage\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[12]\u003c/sup\u003e.In order to reduce the bleeding during the PPP cesarean section, there are two commonly used clinical treatments in the past, one of which is hysterectomy, which can effectively prevent and treat the bleeding during the operation. However, the decreased blood supply of ovarian tissue after the operation may affect the endocrine function of the ovary, accelerate the decline of ovarian function, and even lead to premature ovarian failure\u003csup\u003e[13]\u003c/sup\u003e. After hysterectomy, patients may also have psychological disorders and sexual life disorders\u003csup\u003e[14]\u003c/sup\u003e.Another commonly used method is to retain the placenta in situ. This method can be used for those whose incisions do not hurt the placenta and the placenta does not show signs of separation after fetal delivery. However, this treatment scheme takes a long time and has a high risk of infection, and 6% - 17% of patients still need to undergo hysterectomy again\u0026nbsp;\u003csup\u003e[15]\u003c/sup\u003e.Therefore, the key to the success of PPP treatment is how to avoid intractable postpartum hemorrhage\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[16]\u003c/sup\u003e.At present, there are many improved surgical methods,such as Parallel Loop Binding Compression Suture\u003csup\u003e[17]\u003c/sup\u003e，The Triple P procedure\u003csup\u003e[12]\u003c/sup\u003e，intrauterine tamponade balloons brought out through the abdominal wal\u003csup\u003el\u003c/sup\u003e\u003csup\u003e[18]\u003c/sup\u003e，Prophylactic temporary abdominal aortic balloon occlusion\u0026nbsp;\u003csup\u003e[19]\u003c/sup\u003e，prophylactic internal iliac artery balloon occlusion\u003csup\u003e[20]\u003c/sup\u003e，Anti-Arcuate Compression Suturing\u003csup\u003e[21]\u003c/sup\u003e，Transverse parallel compression suture\u003csup\u003e[10]\u003c/sup\u003e，Uterine artery ligation\u0026nbsp;\u003csup\u003e[22]\u003c/sup\u003eetc,but the incidence of intractable postpartum hemorrhage is still high.During pregnancy, uterine ligament relaxation, cervical ripening and softening, and uterine isthmus extension provide conditions for binding tourniquet. The binding range of tourniquet includes the whole uterine peripheral blood vessels and part of the bladder floor, which can reduce intraoperative bleeding and effectively ensure clear surgical field.We had accumulated many clinical cases to explore the surgical method, and found that uterine tone-preserving bladder dissociation can effectively reduce intraoperative bleeding and maximize the preservation of uterus.In our study, there was no statistical difference between the study group and the control group in the operation time. The amount of intraoperative bleeding and the rate of hysterectomy in the study group were smaller than those in the control group, and the difference was statistically significant. This shows that theuterine tone-preserving bladder dissociation can significantly reduce intraoperative bleeding and the rate of hysterectomy, and will not increase the operation time.The amount of blood transfusion in the study group and the probability of pregnant women transferring to ICU are both smaller than those in the control group, and the difference is statistically significant, which confirms our previous conjecture (previously, when we made statistics when the number of cases was small, the difference in the amount of blood transfusion was not statistically significant, considering that the sample size was too small), indicating that this method can reduce the amount of blood products, reduce the proportion of critically ill patients, and save medical resources.There was no significant difference in Apgar score, birth weight and puerperal infection rate between the two groups, indicating the safety of the operation in terms of mothers and infants.\u003c/p\u003e\n\u003cp\u003eIn this study, a \u0026quot;disposable plastic film bag\u0026quot; was stuck on the patient\u0026apos;s hip during the operation to facilitate the observation of vaginal bleeding during the operation, because this part is often the most easily ignored, so that the blood loss can be accurately evaluated, as to facilitate the timely supplement of blood volume and the selection of appropriate surgical methods.The longitudinal incision of the lower abdomen is selected for the operation, slightly separating the adhesion can expose the lower segment of the uterus. If the adhesion of the bottom of the bladder moves upward and affects the delivery of the fetus, open the bladder peritoneum to expose the lower segment of the uterus. Cut the uterus at a relatively thin position of the placenta at the lower segment of the anterior wall of the uterus to deliver the fetus, which can significantly shorten the time from the beginning of the operation to the delivery of the fetus.Especially for patients with more vaginal bleeding or acute fetal distress before operation, this method can reduce the amount of bleeding before fetal delivery, improve the Apgar score of newborns after birth, increase the survival rate of newborns, and reduce long-term complications of newborns.After the fetus is delivered, the placenta will not be delivered temporarily. Use oval forceps to clamp the uterine incision and placenta together, and then hold the uterus out of the abdominal cavity. Quickly bind the lower segment of the uterus from the outside of the round ligament with a tourniquet, which can effectively reduce intraoperative bleeding and ensure clear surgical field.After the delivery of the fetus, due to the contraction of the uterus, a large amount of blood in and around the uterus returns, and the surface of the bladder peritoneum and the lower segment of the uterus are filled with blood vessels that are significantly smaller than before. At this time, the placenta is retained in situ to keep the tension in the lower segment of the uterus, which is conducive to finding the space between the bladder and the anterior wall of the uterus during the separation of adhesion, reducing the damage to the bladder and blood vessels, shortening the operation time, and reducing intraoperative bleeding.Compared with abdominal aorta or internal iliac artery occlusion, this method is simple and less risky, which is more conducive to promotion. It is especially suitable for emergency surgery patients who need to deliver the fetus as soon as possible and stop bleeding and have no time for interventional treatment before surgery.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe uterine tone-preserving bladder dissociation is simple in operation, can reduce intraoperative bleeding of PPP, and can reserve the uterus to the maximum extent. It is an effective, practical, and safe method, and is good for Apgar newborn. More importantly, it does not increase the operation time, and can be popularized in PPP patients.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding sources: \u003c/strong\u003eThis study was supported by the project of Fuling District Science and Technology Bureau (FLKJ, 2020ABC2037)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests:\u003c/strong\u003e The authors declare that there are no competing interests.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFeng Yang collected case information and relevant data.Meng Xiong: verify information and make statistical analysis. Daju Zhou: Communication and treatment of patients.Xiaohua \u0026nbsp;Liu : Operation and patient management. Shiqiong Li: Guide patient management. Qingrong Wu: Fund management, surgical operation, project promotion. Fengjiang Qin: fund application, patient management, information collection, manuscript writing and submission.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cem\u003e Li, N., et al., Feasibility of Infrarenal Abdominal Aorta Balloon Occlusion in Pernicious Placenta Previa Coexisting with Placenta Accrete. Biomed Res Int, 2018. 2018: p. 4596189.DOI: 10.1155/2018/4596189.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Chattopadhyay, S.K., H. Kharif, and M.M. Sherbeeni, Placenta praevia and accreta after previous caesarean section. Eur J Obstet Gynecol Reprod Biol, 1993. 52(3): p. 151-6.DOI: 10.1016/0028-2243(93)90064-j.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Liu, J., et al., Grade Prediction of Bleeding Volume in Cesarean Section of Patients With Pernicious Placenta Previa Based on Deep Learning. Front Bioeng Biotechnol, 2020. 8: p. 343.DOI: 10.3389/fbioe.2020.00343.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Silver, R.M. and K.D. Barbour, Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am, 2015. 42(2): p. 381-402.DOI: 10.1016/j.ogc.2015.01.014.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Tadevosyan, M., et al., Factors contributing to rapidly increasing rates of cesarean section in Armenia: a partially mixed concurrent quantitative-qualitative equal status study. BMC Pregnancy Childbirth, 2019. 19(1): p. 2.DOI: 10.1186/s12884-018-2158-6.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Du, L., et al., Probability of severe postpartum hemorrhage in repeat cesarean deliveries: a multicenter retrospective study in China. Sci Rep, 2021. 11(1): p. 8434.DOI: 10.1038/s41598-021-87830-7.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Bhal, K., et al., The uterine compression suture--a valuable approach to control major haemorrhage at lower segment caesarean section. J Obstet Gynaecol, 2005. 25(1): p. 10-4.DOI: 10.1080/01443610400022553.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Li, G.T., et al., Funnel compression suture: a conservative procedure to control postpartum bleeding from the lower uterine segment. Bjog, 2016. 123(8): p. 1380-5.DOI: 10.1111/1471-0528.13685.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Fan, Y., et al., A prospective observational study evaluating the efficacy of prophylactic internal iliac artery balloon catheterization in the management of placenta previa-accreta: A STROBE compliant article. Medicine (Baltimore), 2017. 96(45): p. e8276.DOI: 10.1097/md.0000000000008276.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Zhao, B., et al., Transverse parallel compression suture: a new suturing method for successful treating pernicious placenta previa during cesarean section. Arch Gynecol Obstet, 2020. 301(2): p. 465-472.DOI: 10.1007/s00404-020-05435-3.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Usta, I.M., et al., Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol, 2005. 193(3 Pt 2): p. 1045-9.DOI: 10.1016/j.ajog.2005.06.037.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Pi\u0026ntilde;as-Carrillo, A. and E. Chandraharan, Conservative surgical approach: The Triple P procedure. Best Pract Res Clin Obstet Gynaecol, 2021. 72: p. 67-74.DOI: 10.1016/j.bpobgyn.2020.07.009.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Jauniaux, E., et al., Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. Bjog, 2019. 126(1): p. e1-e48.DOI: 10.1111/1471-0528.15306.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Jauniaux, E., et al., Epidemiology of placenta previa accreta: a systematic review and meta-analysis. BMJ Open, 2019. 9(11): p. e031193.DOI: 10.1136/bmjopen-2019-031193.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Chandraharan, E., et al., The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int J Gynaecol Obstet, 2012. 117(2): p. 191-4.DOI: 10.1016/j.ijgo.2011.12.005.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Bi, S., et al., Effect of types of placenta previa on maternal and neonatal outcomes: a 10-year retrospective cohort study. Arch Gynecol Obstet, 2021. 304(1): p. 65-72.DOI: 10.1007/s00404-020-05912-9.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Fu, M., et al., Parallel Loop Binding Compression Suture, a Modified Procedure for Pernicious Placenta Previa Complicated With Placenta Increta. Front Surg, 2021. 8: p. 786497.DOI: 10.3389/fsurg.2021.786497.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Kondoh, E., et al., Successful management of intraoperative hemorrhage from placenta previa accreta: intrauterine tamponade balloons brought out through the abdominal wall. J Matern Fetal Neonatal Med, 2014. 27(3): p. 309-11.DOI: 10.3109/14767058.2013.809418.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Huo, F., H. Liang, and Y. Feng, Prophylactic temporary abdominal aortic balloon occlusion for patients with pernicious placenta previa: a retrospective study. BMC Anesthesiol, 2021. 21(1): p. 134.DOI: 10.1186/s12871-021-01354-1.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Liu, J. and X. Han, Comment on \"The effectiveness of prophylactic internal iliac artery balloon occlusion in the treatment of patients with pernicious placenta previa coexisting with placenta accreta\". J Matern Fetal Neonatal Med, 2021. 34(10): p. 1685.DOI: 10.1080/14767058.2019.1641484.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Li, Y., et al., Use of Anti-Arcuate Compression Suturing in Pernicious Placenta Previa with Accrete Spectrum Disorders: A Surgical Technique. Med Sci Monit, 2020. 26: p. e922958.DOI: 10.12659/msm.922958.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cem\u003e Lin, J., F. Lin, and Y. Zhang, Uterine artery ligation before placental delivery during caesarean in patients with placenta previa accreta. Medicine (Baltimore), 2019. 98(36): p. e16780.DOI: 10.1097/md.0000000000016780.\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Tables","content":"\u003cp\u003eTABLE1:baseline characteristics of patients\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003econtrol group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003estudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et/Z\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32.41\u0026plusmn;4.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32.72\u0026plusmn;4.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.721\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGestational week (week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37（30.86～40.29）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37.07（30.14～39.29）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber of pregnancies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5（2～8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4（2～9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrevious birth times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1（1～5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1（1～3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.585\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrevious cesarean section times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1（1～3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1（1～2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTABLE2:Indicators in operation\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003econtrol group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003estudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et/Z\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntraoperative bleeding volume (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e700（200～3800）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e500（300～2000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-3.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntraoperative infusion of suspended red blood cells (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e800（100～3800）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e600（200～1200）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOperation time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85（43～290）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e77.50（40～160）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;TABLE3:The influence of uterine tone-preserving bladder dissociation\u003c/p\u003e\n\u003ctable align=\"left\" border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"110%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"8.24742268041237%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003eHysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003eHemorrhagic shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003ePlacental implantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003eTransfer to ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003eTransfer to pediatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.024096385542169%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.433734939759036%\"\u003e\n \u003cp\u003erate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.228915662650603%\"\u003e\n \u003cp\u003erate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.433734939759036%\"\u003e\n \u003cp\u003erate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.433734939759036%\"\u003e\n \u003cp\u003erate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.819277108433735%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.433734939759036%\"\u003e\n \u003cp\u003erate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.791208791208792%\"\u003e\n \u003cp\u003estudy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e11.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e77.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e14.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.395604395604396%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e44.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.791208791208792%\"\u003e\n \u003cp\u003econtrol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.593406593406593%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e85.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.4945054945054945%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.395604395604396%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e39.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.24742268041237%\"\u003e\n \u003cp\u003e\u0026chi; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e4.559\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e1.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e1.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e6.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.24742268041237%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e0.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTABLE4: Influence on neonates\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003econtrol group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003estudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et/Z\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eApgar score of newborn (1min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10（5～10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10（4～10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eApgar score of newborn (5min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10（7～10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10（6～10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eApgar score of newborn (10min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10（9～10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10（9～10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNewborn weight (g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2820（1630～4490）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2925（1600～3800）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.757\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pernicious placenta previa (PPP), Uterine tone-preserving bladder dissociation(UTBD) , Cesarean section,Bleeding ","lastPublishedDoi":"10.21203/rs.3.rs-2730328/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2730328/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e:Pernicious placenta previa (PPP) is a special type of placenta previa, which emphasizes that the placenta attaches to the scar of the uterus \u003csup\u003e[1]\u003c/sup\u003e, and has a high risk of placenta adhesion, implantation and fatal bleeding.PPP requires cesarean section to terminate pregnancy, often endangers the life of the parturient due to excessive bleeding during operation. Therefore, how to take effective measures to reduce bleeding during operation is the key to reduce the rate of hysterectomy and mortality.In order to solve this problem, we propose to apply a new surgical method--uterine tone-preserving bladder dissociation(UTBD) in cesarean section to provide better hemostatic effect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThe retrospective study was conducted on malignant placenta previa treated in Chongqing University Fuling Hospital from January 2016 to September 2022.During cesarean section, the patients who used uterine tone-preserving bladder dissociation were defined as the study group, and the patients who did not use the method were defined as the control group.The intraoperative blood loss, blood transfusion, operation time, hysterectomy, ICU occupancy rate and newborn birth of the two groups were counted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eTotal of 117 patients were screened out in this study, 54 of whom underwent cystectomy with uterine tension preservation during cesarean section, and 63 patients in the control group. During cesarean section, the use of bladder dissociation with preservation of uterine tension can significantly reduce intraoperative bleeding [700 (200~3800) vs 500 (300~2000)ml, p=0.001]; Blood transfusion volume significantly decreased [800 (100~3800) vs 600 (200~1200)ml, p=0.048], hysterectomy rate decreased (11.11% vs 0, p=0.033), and ICU occupancy rate decreased (14.29% vs 0, p=0.011). However, there was no statistical difference in the incidence of placental implantation (77.78% vs 85.19%, p=0.307), the probability of transfer to pediatrics (44.44% vs 39.62%, p=0.6) and the operation time[85 (43~290) vs 77.50 (40~160)min, p=0.082].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003eIn the caesarean section of PPP patients, the use of uterine tone-preserving bladder distribution is simple to operate, can reduce intraoperative bleeding, maximize the retention of uterus, reduce the occupancy rate of ICU, improve the Apgar score of newborns, and does not increase the operation time. It is an effective and safe method targeting PPP.\u003c/p\u003e","manuscriptTitle":"A cost-effective operation specifically for pernicious placenta previa:Uterine tone-preserving bladder dissociation(UTBD)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-13 22:34:10","doi":"10.21203/rs.3.rs-2730328/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"49007114-eea9-40fc-9196-8efb1759adf2","owner":[],"postedDate":"April 13th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-05-31T09:48:44+00:00","versionOfRecord":[],"versionCreatedAt":"2023-04-13 22:34:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2730328","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2730328","identity":"rs-2730328","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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