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

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.

Prediction for Postpartum Hemorrhage of Placenta Previa Patients through MRI Using Self-Adaptive Edge Detection Algorithm

“…The postpartum hemorrhage rate and hysterectomy rate of complete placenta previa were higher than partial placenta previa and marginal placenta previa, and the difference was notable ( p < 0.05), but no notable differences were noted in placenta adhesion, placenta accreta, neonatal death, and neonatal asphyxia between the three types ( p > 0.05). This was different from the research results of Su and Chen [ 18 ]. It may be due to the lower position of the complete placenta previa, and the cervix would be completely covered by the placenta tissue.…”

Clinical diagnostic value and analysis of MRI combined with ultrasound in prenatal pernicious placenta previa with placenta accreta

“…Therefore, timely diagnosis of placenta previa combined with placenta accreta is of great importance during pregnancy. At present, the diagnosis of placenta previa combined with placenta accreta occurs mainly through magnetic resonance imaging (MRI) and ultrasound (7,8); however, patient physique, placenta position, external environment and other factors can seriously impact diagnostic results. These issues can interfere with timely and effective diagnosis of placenta previa with placenta accreta and increase the risk of adverse events during pregnancy (9,10).…”