Classification of hemostatic methods and their efficacy in placenta increta.

Abstract

Introduction: Placenta increta is a serious complication of pregnancy that needs a variety of intraoperative hemostatic methods to stop bleeding. However, the efficacy of different hemostatic methods is still not known. This study aimed to evaluate the efficacy of different hemostatic methods in placenta increta.

Material and methods: A total of 187 placenta increta patients that underwent treatment at Xiangya Hospital Central South University from March 1, 2017 to January 31, 2021 were included in this retrospective study. Perioperative data of patients with placenta increta were retrospectively analyzed. The patients were distributed into two groups according to the hemostasis methods, namely permanent group (n = 29), permanent plus temporary group (n = 158). Permanent hemostasis included the subgroups of uterine hemostasis (e.g., uterine tamponade, B-Lynch suture, and uterine local suture) and vascular hemostasis (e.g., uterine artery ligation and internal iliac artery ligation). The clinical information and maternal-fetal outcomes of the groups and subgroups were analyzed.

Results: A significant difference in blood loss was detected between the permanent hemostasis group and the permanent plus temporary hemostasis group. Compared with the uterine hemostatic, the vascular, and combined hemostatic methods had a significant reduction in postpartum blood loss (p < 0.05). No differences were found within these subgroups in the permanent plus temporary group. Pregnancy outcomes did not differ significantly among the subgroups.

Conclusions: Vascular hemostasis and combined hemostasis may be better than uterine hemostasis alone for placenta increta without temporary hemostasis. Prospective and large-scale studies are needed to investigate long-term outcomes and confirm the efficacy of these hemostatic techniques.