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Chen D, Xu J, Tian Y, Ling Q, Peng B. Clinical evaluation of the effect for prophylactic balloon occlusion in pregnancies complicated with placenta accreta spectrum disorder: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 167:109-127. [PMID: 38899567 DOI: 10.1002/ijgo.15704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/02/2024] [Accepted: 04/14/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Placenta accreta spectrum (PAS) disorder is a critical and severe obstetric condition associated with high risk of intraoperative massive hemorrhage and cesarean hysterectomy. Severe obstetric hemorrhage is currently one of the leading causes of maternal death worldwide. Prophylactic balloon occlusions, including prophylactic balloon occlusion of the abdominal aorta (PBOAA) and prophylactic balloon occlusion of the internal iliac arteries (PBOIIA), are the most common means of controlling hemorrhage in patients with PAS disorder, but their effectiveness is still debated. OBJECTIVE A systematic review and meta-analysis were conducted to evaluate the clinical effectiveness of prophylactic balloon occlusion during cesarean section (CS) in improving maternal outcomes for PAS patients. SEARCH STRATEGY MEDLINE, EMBASE, OVID, PubMed and the Cochrane Library were systematically searched from the inception dates to June 2022, using the keywords "placenta accreta spectrum disorder/morbidly adherent placenta (placenta previa, placenta accreta, placenta increta, placenta percreta), balloon occlusion, internal iliac arteries, abdominal aorta, hemorrhage, hysterectomy, estimated blood loss (EBL), packed red blood cells (PRBCs)" to identify the systematic reviews or meta-analyses. SELECTION CRITERIA All articles regarding PAS disorders and including the application of balloon occlusion were included in the screening. DATA COLLECTION AND ANALYSIS Two independent researchers performed the data extraction and assessed study quality. EBL volume and PRBC transfusion volume was regarded as the primary endpoints. Random and fixed effects models were used for the meta-analysis (RRs and 95% CIs), and the Newcastle-Ottawa Scale was used for quality assessments. MAIN RESULTS Of 429 studies identified, a total of 35 trials involving the application of balloon occlusion for patients with PAS disorder during CS were included. A total of 19 studies involving 935 patients who underwent PBOIIA were included in the PBOIIA group, and 851 patients were included in control 1 group. Ten studies including 428 patients with PAS who underwent PBOAA were allocated to the PBOAA group, and 324 patients without PBOAA were included in control 2 group. Simultaneously, we compared the effect on PBOAA and PBOIIA including seven studies, which referred to 267 cases in the PBOAA group and 313 cases in the PBOIIA group. The results showed that the PBOIIA group had a reduced EBL volume (MD: 342.06 mL, 95% CI: -509.90 to -174.23 mL, I2 = 77%, P < 0.0001) and PRBC volume (MD: -1.57 U, 95% CI: -2.49 to -0.66 U, I2 = 91%, P = 0.0008) than that in control 1 group. With regard to the EBL volume (MD: -926.42 mL, 95% CI: -1437.07 to -415.77 mL, I2 = 96%, P = 0.0004) and PRBC transfusion volume (MD: -2.42 U, 95% CI: -4.25 to -0.59 U, I2 = 99%, P = 0.009) we found significant differences between the PBOAA group and control 2 group. Prophylactic balloon occlusion (PBOAA and PBOIIA) had a significant effect on reducing intraoperative blood loss and blood transfusion volume in patients with PAS. Moreover, PBOAA was more effective than PBOIIA in reducing intraoperative blood loss (MD: -406.63 mL, 95% CI: -754.12 to -59.13 mL, I2 = 92%, P = 0.020), but no significant difference in controlling PRBCs (MD: -3.48 U, 95% CI: -8.90 to 1.95 U, I2 = 99%, P = 0.210) between the PBOIIA group and the PBOAA group. Hierarchical analysis was conducted by differentiating gestational weeks and maternal age to reduce the high heterogeneity of meta-analysis. Hierarchical analysis results demonstrated the heterogeneities of the study were reduced to some extent, and gestational weeks and maternal age might be the cause of increased heterogeneity. CONCLUSION Prophylactic balloon occlusion is a safe and effective method to control hemorrhage and reduce PRBC transfusion volume for patients with PAS, and PBOAA could reduce more intraoperative blood loss than PBOIIA. However, we found no statistical difference in lessening packed red blood cell transfusion volume for PAS patients. Hence, preoperative prophylactic balloon occlusion is the recommended application for PAS patients in obstetric CSs. Furthermore, PBOAA is preferred for controlling intraoperative bleeding in patients with corresponding medical conditions.
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Affiliation(s)
- Daijuan Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Jinfeng Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Tian
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Qiao Ling
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Bing Peng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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Bonsen LR, Sleijpen K, Hendriks J, Urlings TAJ, Dekkers OM, le Cessie S, van de Velde M, Gurung P, van den Akker T, van der Bom JG, Henriquez DDCA. Prophylactic Radiologic Interventions for Postpartum Hemorrhage Control in Women With Placenta Accreta Spectrum Disorder: A Systematic Review and Meta-analysis. Obstet Gynecol 2024; 144:315-327. [PMID: 38954828 PMCID: PMC11321610 DOI: 10.1097/aog.0000000000005662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/01/2024] [Accepted: 05/23/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE To quantify the association between prophylactic radiologic interventions and perioperative blood loss during cesarean delivery in women with placenta accreta spectrum disorder through a systematic review and network meta-analysis. DATA SOURCES On January 3, 2023, a literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science. We also checked ClinicalTrials.gov retrospectively. Prophylactic radiologic interventions to reduce bleeding during cesarean delivery involved preoperative placement of balloon catheters, distal (internal or common iliac arteries) or proximal (abdominal aorta), or sheaths (uterine arteries). The primary outcome was volume of blood loss; secondary outcomes were the number of red blood cell units transfused and adverse events. Studies including women who received an emergency cesarean delivery were excluded. METHODS OF STUDY SELECTION Two authors independently screened citations for relevance, extracted data, and assessed the risk of bias of individual studies with the Cochrane Risk of Bias in Non-randomized Studies of Interventions tool. TABULTATION, INTEGRATION, AND RESULTS From a total of 1,332 screened studies, 50 were included in the final analysis, comprising 5,962 women. These studies consisted of two randomized controlled trials and 48 observational studies. Thirty studies compared distal balloon occlusion with a control group, with a mean difference in blood loss of -406 mL (95% CI, -645 to -167). Fourteen studies compared proximal balloon occlusion with a control group, with a mean difference of -1,041 mL (95% CI, -1,371 to -710). Sensitivity analysis excluding studies with serious or critical risk of bias provided similar results. Five studies compared uterine artery embolization with a control group, all with serious or critical risk of bias; the mean difference was -936 mL (95% CI, -1,522 to -350). Reported information on adverse events was limited. CONCLUSION Although the predominance of observational studies in the included literature warrants caution in interpreting the findings of this meta-analysis, our findings suggest that prophylactic placement of balloon catheters or sheaths before planned cesarean delivery in women with placenta accreta spectrum disorder may, in some cases, substantially reduce perioperative blood loss. Further study is required to quantify the efficacy according to various severities of placenta accreta spectrum disorder and the associated safety of these radiologic interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022320922.
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Affiliation(s)
- Lisanne R Bonsen
- Departments of Obstetrics and Gynaecology, Clinical Epidemiology, Clinical Endocrinology, and Biomedical Data Sciences, Leiden University Medical Center, and Leiden University Libraries, Leiden University, Leiden, the Department of Radiology, Catharina Hospital, Eindhoven, the Department of Radiology, Haaglanden Medical Center, The Hague, and Athena Institute, VU University, Amsterdam, the Netherlands; and the Department of Cardiovascular Sciences, Section Anesthesiology, KU Leuven and UZ Leuven, Leuven, Belgium
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Lee SH, Lee YH. Hybrid operating rooms and the risk of postoperative hypothermia in pregnant women with placenta previa: A retrospective cohort study. PLoS One 2024; 19:e0305951. [PMID: 38917215 PMCID: PMC11198747 DOI: 10.1371/journal.pone.0305951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/09/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Births at advanced maternal ages (≥ 35 years) are increasing. This has been associated with a higher incidence of placenta previa, which increases bleeding risk. Hybrid operating rooms, designed to accommodate interventions and cesarean sections, are becoming more prominent because of their dual capabilities and benefits. However, they have been associated with increased postoperative hypothermia in pediatric settings; moreover, this has not been studied in pregnant women with placenta previa. METHODS This retrospective cohort study included pregnant women diagnosed with placenta previa who underwent elective cesarean section under general anesthesia between May 2019 and 2023. The patients were categorized according to the operating room type. The primary outcome was to determine whether the hybrid operating room is a risk factor for immediate postoperative hypothermia, defined as a tympanic membrane temperature below 36.0°C. The secondary outcomes were the effects of immediate postoperative hypothermia on the durations of postanesthetic care unit and postoperative hospital stays and incidence of complications. RESULTS Immediate postoperative hypothermia (tympanic membrane temperature < 36.0°C) was more prevalent in the hybrid than in the standard operating room group (20% vs. 36.6%, p = 0.033), with a relative risk of 2.86 (95% confidence interval 1.24-6.64, p < 0.001). Patients undergoing surgery in the hybrid operating room who experienced immediate postoperative hypothermia stayed longer in the postanesthetic care unit (26 min vs. 40 min, p < 0.001) and in the hospital after surgery (4 days; range 3-5 vs. 4 days; range 4-11, p = 0.021). However, the complication rates of both groups were not significantly different (11.3% vs 7.3%, p = 0.743). CONCLUSION Hybrid operating rooms may increase the risk of postoperative hypothermia. Postoperative hypothermia is associated with prolonged postanesthetic care unit and hospital stays. Preventing hypothermia in patients in hybrid operating rooms is of utmost importance.
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Affiliation(s)
- Sou Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - You Hyun Lee
- Department of Ophthalmology, Daegu Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
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Lukies M, Han Wei LT, Chandramohan S. Collateral Round Ligament Arterial Supply of Placenta Accreta Spectrum and Considerations for Prophylactic Balloon Occlusion Catheter Placement. J Vasc Interv Radiol 2024; 35:895-899. [PMID: 38492660 DOI: 10.1016/j.jvir.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
Internal iliac artery (IIA) balloon occlusion catheters have been commonly inserted to decrease the risk of postpartum hemorrhage in placenta accreta spectrum disorders; however, there has been mixed success in clinical studies. Placement of an infrarenal aortic balloon has shown more consistent effectiveness in recent studies. A possible reason for this is collateral arterial supply to the placenta from external iliac artery branches. Retrospective chart review was conducted of angiography images during prophylactic IIA balloon occlusion catheter insertion over a 7-year period. Sixty-two individual cases were identified. Digital subtraction angiography (DSA) was performed in 32 (52%) cases, and 20 (62%) showed collateral blood supply from branches of the external iliac arteries, namely the round ligament artery. In conclusion, a high proportion of placenta accreta spectrum cases have arterial blood supply from branches of the external iliac artery, which may explain the discrepancy in effectiveness seen between IIA and infrarenal aortic sites of balloon occlusion catheter placement.
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Affiliation(s)
- Matthew Lukies
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore; Department of Radiology, Alfred Health, Melbourne, Victoria, Australia; Department of Radiology, Monash Health, Melbourne, Victoria, Australia.
| | - Luke Toh Han Wei
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore; Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Sivanathan Chandramohan
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore; Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
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Berman ZT, Boone CE, Melber DJ, Ballas J, Parikh R, Ramos G, Kelly T, McHale M, Picel AC, Roberts AC. Intraoperative Multivessel Embolization Reduces Blood Loss and Transfusion Requirements Compared to Internal Iliac Artery Balloon Placement during Cesarean Hysterectomy for Placenta Accreta Spectrum. J Vasc Interv Radiol 2023; 34:1915-1921. [PMID: 37527770 DOI: 10.1016/j.jvir.2023.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/16/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of prophylactic multivessel selective embolization (MVSE) compared to those of internal iliac artery occlusion balloon (IIABO) placement in patients undergoing cesarean hysterectomy for placenta accreta spectrum (PAS). MATERIALS AND METHODS An institutional review board-approved retrospective series was conducted with consecutive patients with PAS at a single institution between 2010 and 2021. MVSE was performed in a hybrid operating room after cesarean section prior to hysterectomy. IIABO was performed with balloons placed into the bilateral internal iliac arteries, which were inflated during hysterectomy. Median blood loss, transfusion requirements, percentage of cases requiring transfusion, and adverse events were recorded. RESULTS A total of 20 patients treated with embolization and 34 patients with balloon placement were included. Placenta percreta and previa were seen in 60% and 90% of patients, respectively. Median blood loss in the MVSE group was 713 mL (interquartile range [IQR], 475-1,000 mL) compared to 2,000 mL (IQR, 1,500-2,425 mL) in the IIABO group (P < .0001). The median total number of units of packed red blood cell transfusions (0 vs 2.5) and percentage of cases requiring a transfusion (20% vs 65%) were less in the MVSE group (P < .01). A median of 4 vessels (IQR, 3-9) were embolized during MVSE. No major adverse events or nontarget embolization consequences were observed. CONCLUSIONS Prophylactic MVSE is a safe procedure that reduces operative blood loss and transfusion requirements compared to those of IIABO in patients undergoing cesarean hysterectomy for presumed higher-degree PAS.
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Affiliation(s)
- Zachary T Berman
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, San Diego, California.
| | - Christine E Boone
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, San Diego, California
| | - Dora J Melber
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Jerasimos Ballas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Rupal Parikh
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, San Diego, California
| | - Gladys Ramos
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Thomas Kelly
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Michael McHale
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Andrew C Picel
- Department of Radiology, Division of Interventional Radiology, Stanford University, Stanford, California
| | - Anne C Roberts
- Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, San Diego, California
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Einerson BD, Sandlin AT, Afshar Y, Sharawi N, Fox KA, Newton JM, Shainker SA, Pezeshkmehr A, Carusi DA, Moroz L. General Management Considerations for Placenta Accreta Spectrum. Am J Perinatol 2023; 40:1026-1032. [PMID: 37336221 DOI: 10.1055/s-0043-1761915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The ideal management of a patient with placenta accreta spectrum (PAS) includes close antepartum management culminating in a planned and coordinated delivery by an experienced multidisciplinary PAS team. Coordinated team management has been shown to optimize outcomes for mother and infant. This section provides a consensus overview from the Pan-American Society for the Placenta Accreta Spectrum regarding general management of PAS.
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Affiliation(s)
| | - Adam T Sandlin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arizona
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Nadir Sharawi
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arizona
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Department of Obstetric and Gynecology, Baylor College of Medicine (Texas Children's Hospital Pavilion for Women), Houston, Texas
| | - J M Newton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center Nashville, Tennessee
| | - Scott A Shainker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amir Pezeshkmehr
- Department of Radiology Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Daniela A Carusi
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Baldwin HJ, Randall DA, Maher R, West SP, Torvaldsen S, Morris JM, Patterson JA. Interventional radiology in obstetric patients: A population-based record linkage study of use and outcomes. Acta Obstet Gynecol Scand 2023; 102:370-377. [PMID: 36700375 PMCID: PMC9951351 DOI: 10.1111/aogs.14508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/07/2022] [Accepted: 12/21/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Interventional radiology (IR) is a technique for controlling hemorrhage and preserving fertility for women with serious obstetric conditions such as placenta accreta spectrum (PAS) or postpartum hemorrhage. This study examined maternal, pregnancy and hospital characteristics and outcomes for women receiving IR in pregnancy and postpartum. MATERIAL AND METHODS A population-based record linkage study was conducted, including all women who gave birth in hospital in New South Wales or the major tertiary hospital in the neighboring Australian Capital Territory, Australia, between 2003 and 2019. Data were obtained from birth and hospital records. Characteristics and outcomes of women who underwent IR in pregnancy or postpartum are described. Outcomes following IR were compared in a high-risk cohort of women: those with PAS who had a planned cesarean with hysterectomy. Women were grouped by those who did and those who did did not have IR and were matched using propensity score and other factors. RESULTS We identified IR in 236 pregnancies of 1 584 708 (15.0 per 100 000), including 208 in the delivery and 26 in a postpartum admission. Two-thirds of women receiving IR in the birth admission received a transfusion of red cells or blood products, 28% underwent hysterectomy and 12.5% were readmitted within 6 weeks. Other complications included: severe maternal morbidity (29.8%), genitourinary tract trauma/repair (17.3%) and deep vein thrombosis/pulmonary embolism (4.3%). Outcomes for women with PAS who underwent planned cesarean with hysterectomy were similar for those who did and did not receive IR, with a small reduction in transfusion requirement for those who received IR. CONCLUSIONS Interventional radiology is infrequently used in pregnant women. In our study it was performed at a limited number of hospitals, largely tertiary centers, with the level of adverse outcomes reflecting use in a high-risk population. For women with PAS undergoing planned cesarean with hysterectomy, most outcomes were similar for those receiving IR and those not receiving IR, but IR may reduce bleeding.
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Affiliation(s)
- Heather J. Baldwin
- The University of Sydney Northern Clinical SchoolWomen and Babies ResearchSt LeonardsNew South WalesAustralia,Northern Sydney Local Health DistrictKolling InstituteSt LeonardsNew South WalesAustralia
| | - Deborah A. Randall
- The University of Sydney Northern Clinical SchoolWomen and Babies ResearchSt LeonardsNew South WalesAustralia,Northern Sydney Local Health DistrictKolling InstituteSt LeonardsNew South WalesAustralia
| | - Richard Maher
- Department of RadiologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Simon P. West
- Department of Obstetrics and GynaecologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia,The University of SydneySydney Medical School‐ NorthernSt LeonardsNew South WalesAustralia
| | - Siranda Torvaldsen
- The University of Sydney Northern Clinical SchoolWomen and Babies ResearchSt LeonardsNew South WalesAustralia,Northern Sydney Local Health DistrictKolling InstituteSt LeonardsNew South WalesAustralia,School of Population HealthUNSWSydneyNew South WalesAustralia
| | - Jonathan M. Morris
- The University of Sydney Northern Clinical SchoolWomen and Babies ResearchSt LeonardsNew South WalesAustralia,Northern Sydney Local Health DistrictKolling InstituteSt LeonardsNew South WalesAustralia,Department of Obstetrics and GynaecologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Jillian A. Patterson
- The University of Sydney Northern Clinical SchoolWomen and Babies ResearchSt LeonardsNew South WalesAustralia,Northern Sydney Local Health DistrictKolling InstituteSt LeonardsNew South WalesAustralia
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Emergency Obstetric Hysterectomy after Conservative Management of Placenta Accreta. Case Rep Obstet Gynecol 2023; 2023:2420333. [PMID: 36891220 PMCID: PMC9988370 DOI: 10.1155/2023/2420333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/08/2022] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
Background Obstetric hemorrhage is a frequent and life-threatening complication of either vaginal or cesarean delivery. It can be due to many causes, one of which is placenta accreta, the abnormal invasion of the placenta into the myometrial wall of uterus. Ultrasonography is the first line diagnostic method that can lead to the diagnosis of placenta accreta although, the depth of penetration is estimated by magnetic resonance imaging. Placenta accreta is a life-threatening situation requiring an experienced health care team for its management. Hysterectomy is usually performed although, conservative management might be preferred in carefully selected cases. Case Presentation. A 32-year-old woman (G2, P0) who had an inconsistently monitored pregnancy appeared at a regional hospital with contractions at 39th week of gestation. In her first pregnancy, she was subjected to cesarean section due to delay in second stage of labor and unfortunately her child died due to sudden cardiac death. During C-section, placenta accreta was identified. Given her previous history and her desire to maintain fertility, conservative management was initially planned to preserve her uterus. However, due to persisting vaginal bleeding immediately after delivery an emergency hysterectomy was performed. Conclusion Conservative management of placenta accreta can be considered in some special cases with the aim to spare fertility. However, if bleeding cannot be controlled during the immediate postpartum period, emergency hysterectomy is unavoidable. A specialized multidisciplinary medical team is required to optimize management.
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Zhang LL, Wang WH, Hou YL. Analysis of the Risk Factors for Massive Hemorrhage in Pernicious Placenta Previa and Evaluation of the Efficacy of Internal Iliac Artery Balloon Occlusion. Int J Womens Health 2022; 14:1769-1776. [PMID: 36575728 PMCID: PMC9790154 DOI: 10.2147/ijwh.s379965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the risk factors of intraoperative massive hemorrhage in patients with pernicious placenta previa (PPP) and analyze the value of bilateral internal iliac artery balloon occlusion in Cesarean section for these patients. Methods The clinical data of 134 patients with PPP admitted to the Second Hospital of Shanxi Medical University from January 2012 to January 2019 were analyzed. A logistic regression analysis was used to analyze the risk factors for intraoperative massive hemorrhage in PPP. The study subjects were divided into the intervention group (38 cases) and the routine group (96 cases) according to whether bilateral internal iliac artery balloon occlusion was conducted during the operation. The differences in some clinical indicators were compared between the two groups. Results The risk factors for intraoperative massive hemorrhage in PPP were age ≥35 years, gestational age ≥34 weeks, complete placenta previa, and the presence of placenta accreta. The differences in the operation time, postoperative transfer to the intensive care unit, postoperative length of the hospital stay, and neonatal weight and score were not statistically significant between the intervention group and the routine group (P > 0.05 for all). While the intraoperative blood loss and the transfusion volume in the intervention group were lower than in the routine group, the hospitalization cost was higher in the former than in the latter, and the differences were statistically significant (P < 0.05 for all). Moreover, there was no case of hysterectomy in the intervention group, while there were two cases of hysterectomies in the routine group. Conclusion The risk factors for intraoperative massive hemorrhage in PPP were age ≥35 years, gestational age ≥34 weeks, complete placenta previa, and the presence of placenta accreta. Internal iliac artery balloon occlusion during PPP could reduce intraoperative blood loss and the hysterectomy rate.
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Affiliation(s)
- Li-Li Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, 030000, People’s Republic of China
| | - Wen-Hao Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, 030000, People’s Republic of China
| | - Yong-Li Hou
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan, 030000, People’s Republic of China,Correspondence: Yong-Li Hou, Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030000, People’s Republic of China, Tel +86 03513382151, Email
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10
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A Review and Comparison of the Efficacy of Prophylactic Interventional Radiological Arterial Occlusions in Placenta Accreta Spectrum Patients: A Meta-analysis. Acad Radiol 2022:S1076-6332(22)00575-X. [DOI: 10.1016/j.acra.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
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Aryananda RA, Aditiawarman A, Gumilar KE, Wardhana MP, Akbar MIA, Cininta N, Ernawati E, Wicaksono B, Joewono HT, Dachlan EG, Bachtiar CA, Kurniawati D, Virdayanti DP, Ariani G, Dekker GA, Sulistyono A. Uterine conservative-resective surgery for selected placenta accreta spectrum cases: Surgical-vascular control methods. Acta Obstet Gynecol Scand 2022; 101:639-648. [PMID: 35301710 DOI: 10.1111/aogs.14348] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The incidence of placenta accreta spectrum (PAS) has increased, but the optimal management and the optimal way to achieve vascular control are still controversial. This study aims to compare maternal outcomes between different methods of vascular control in surgical PAS management. MATERIAL AND METHODS A retrospective cohort study on consecutive cases diagnosed with PAS between 2013 and 2020 in single tertiary hospital. The final diagnosis of PAS was made following preoperative ultrasound and confirmation during surgery. Management of PAS using cesarean hysterectomy with internal iliac artery ligation (IIAL) was compared with two types of vascular control in uterine conservative-resective surgery (IIAL vs identification-ligation of the upper vesical, upper vaginal, and uterine arteries). RESULTS Over an 8-year period, 234 pregnant women were diagnosed with PAS meeting the inclusion criteria. Uterine conservative-resective surgery (200 cases) was associated with lower mean blood loss compared with cesarean hysterectomy with IIAL (34 cases) in all PAS cases (1379 ± 769 mL vs 3168 ± 1916 mL; p < 0.001). In sub-analysis of the two uterine conservative-resective surgery subgroups, the group with identification-ligation of the upper vesical, upper vaginal, and uterine arteries had a significantly lower blood loss compared with uterine conservative-resective surgery with IIAL (1307 ± 743 mL vs 1701 ± 813 mL; p = 0.005). Women in the hysterectomy with IIAL group had more massive transfusion (35.3% vs 2.5%; p < 0.001; odds ratio [OR] 21.3, 95% confidence interval [CI] 6.9-66), major blood loss (>1500 mL) (70.6% vs 34%, p < 0.001; OR 4.7; 95% CI 2.1-10.3), catastrophic blood loss (>2500 mL) (64.7% vs 12.5%;p < 0.001; OR 12.8, 95% CI 5.7-29.1), other complications (32% vs 12.4%; p = 0.007; OR 3.4, 95% CI 1.5-7.7), and intensive care unit admission (32.4% vs 1.5%; p < 0.001; OR 31.4, 95% CI 8.2-120.7) compared with the uterine conservative-resective surgery groups. The identification-ligation of the upper vesical, upper vaginal and uterine arteries had a significant lower risk for major blood loss (30.5% vs 50%; p = 0.041; OR 0.44, 95% CI = 0.2-0.9) compared with IIAL for vascular control of uterine conservative-resective surgery. CONCLUSIONS Cesarean hysterectomy is not the default treatment for PAS, PAS with invasion above the vesical trigone are suitable for uterine conservative-resective surgery with upper vesical, upper vaginal and uterine artery vascular control.
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Affiliation(s)
- Rozi Aditya Aryananda
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Aditiawarman Aditiawarman
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Khanisyah Erza Gumilar
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Manggala Pasca Wardhana
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - M Ilham Aldika Akbar
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Nareswari Cininta
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Ernawati Ernawati
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Budi Wicaksono
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Hermanto Tri Joewono
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Erry Gumilar Dachlan
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Citra Aulia Bachtiar
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Devita Kurniawati
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Dian Puspita Virdayanti
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Grace Ariani
- Anatomical Pathology Department, Dr. Soetomo General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Gustaaf Albert Dekker
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia.,Women & Children's Division, Department of Obstetrics and Gynecology, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
| | - Agus Sulistyono
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
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Bae JG, Kim YH, Kim JY, Lee MS. The Feasibility and Safety of Temporary Transcatheter Balloon Occlusion of Bilateral Internal Iliac Arteries during Cesarean Section in a Hybrid Operating Room for Placenta Previa with a High Risk of Massive Hemorrhage. J Clin Med 2022; 11:jcm11082160. [PMID: 35456251 PMCID: PMC9031967 DOI: 10.3390/jcm11082160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate the feasibility and safety of temporary transcatheter balloon occlusion of bilateral internal iliac arteries (TBOIIA) during cesarean section in a hybrid operating room (OR) for placenta previa (PP) with a high risk of massive hemorrhage. This retrospective study analyzed the medical records of 62 patients experiencing PP with a high risk of massive hemorrhage (mean age, 36.2 years; age range 28-45 years) who delivered a baby via planned cesarean section with TBOIIA in a hybrid OR between May 2019 and July 2021. Operation time, estimated blood loss (EBL), amount of intra- and postoperative blood transfusion, perioperative hemoglobin level, hospital stay after operation, balloon time, fluoroscopy time, radiation dose, rate of uterine artery embolization (UAE) and hysterectomy, and complication-related TBOIIA were assessed. The mean operation time was 122 min, and EBL was 1290 mL. Nine out of sixty-two patients (14.5%) received a blood transfusion. The mean hemoglobin levels before surgery, immediately after surgery and within 1 week after surgery were 11.3 g/dL, 10.4 g/dL and 9.2 g/dL, respectively. In terms of radiation dose, the mean dose area product (DAP) and cumulative air kerma were 0.017 Gy/cm2 and 0.023 Gy, respectively. Ten out of sixty-two patients (16.1%) underwent UAE postoperatively in the hybrid OR. One out of sixty-two patients had been diagnosed with placenta percreta with bladder invasion based on preoperative ultrasound, and thus underwent cesarean hysterectomy following TBOIIA and UAE. While intra-arterial balloon catheter placement for managing PP with a high risk of hemorrhage remains controversial, a planned cesarean section with TBOIIA in a hybrid OR is effective in eliminating the potential risk of intra-arterial balloon catheter displacement, thus reducing intraoperative blood loss, ensuring safe placental removal and conserving the uterus.
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Affiliation(s)
- Jin-Gon Bae
- Department of Obstetrics and Gynecology, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, Daegu 42601, Korea;
| | - Young Hwan Kim
- Department of Radiology, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, Daegu 42601, Korea; (Y.H.K.); (J.Y.K.)
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, Daegu 42601, Korea; (Y.H.K.); (J.Y.K.)
| | - Mu Sook Lee
- Department of Radiology, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, Daegu 42601, Korea; (Y.H.K.); (J.Y.K.)
- Correspondence: ; Tel.: +82-53-258-7862
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13
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Cervical tourniquet during cesarean section to reduce bleeding in morbidly adherent placenta: a pilot study. Future Sci OA 2022; 8:FSO789. [PMID: 35369280 PMCID: PMC8965796 DOI: 10.2144/fsoa-2021-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate a modified surgical technique aiming to reduce bleeding and preserve fertility in morbidly adherent placenta by cervical tourniquet in cesarean sections. Methods: The cesarean section operations and the cervical ligation approach were performed by a single expert consultant obstetrician. The general demographics and clinical characteristics for all participants were collected and studied. Results: Eleven participants were involved. The uterus was preserved in nine patients, whereas two patients had hysterectomy. The mean blood loss was 1688.8 ml for patients whose uterus was preserved. The mean length of stay was 5.5 days. Conclusion: Cervical ligation is a simple method that can be applied by junior and experienced obstetricians to preserve the uterus. Placenta accreta is the abnormal adhesion of placenta into the uterine wall. It carries a significant risk for hysterectomy, intrapartum and postpartum hemorrhage, and maternal morbidity and mortality. As the preservation of fertility and femininity is desired by many women, numerous methods were adapted to avoid hysterectomy in patients with placenta accreta. In this study, we describe and evaluate a novel technique to preserve the uterus by ligating the cervix with a Foley catheter.
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14
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Lu R, Chu R, Wang Q, Xu Y, Zhao Y, Tao G, Li Q, Ma Y. Role of Abdominal Aortic Balloon Placement in Planned Conservative Management of Placenta Previa With Placenta Increta or Percreta. Front Med (Lausanne) 2022; 8:767748. [PMID: 34970561 PMCID: PMC8712569 DOI: 10.3389/fmed.2021.767748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: We investigated the role of balloon placement in the abdominal aorta (BPAA) in planned conservative management of placenta previa with placenta increta or percreta and the effects of BPAA on perinatal adverse maternal events. Methods: This retrospective case-control study included women with placenta previa (increta or percreta), who underwent pregnancy termination at the Qilu Hospital of Shandong University between January 2016 and June 2019. Patients were categorized into the BPAA and non-BPAA groups based on the BPAA placement before delivery. The Chi-square and non-parametric rank-sum tests were used for the intergroup comparison of patient characteristics. The propensity score matching algorithm was used to minimize the intergroup differences in clinical characteristics. Logistic regression analysis was used to identify the factors associated with a high risk of adverse pregnancy outcomes. The area under the receiver operating characteristic curve [area under the curve (AUC)] was used to evaluate the classification of the selected high-risk factors. Results: The study included 260 patients, and 104 patients were identified after propensity score matching. In the post-matched cohort, intraoperative blood loss was significantly lower in the BPAA than in the non-BPAA group (median 1,000 vs. 2,250 ml, P < 0.001). Intraoperative B-Lynch suture was performed in fewer patients in the BPAA (15.4 vs. 34.6%, P = 0.024) than in the non-BPAA group. The packed red blood cell (PRBC) transfusion rate was lower in the BPAA group (median 4 vs. 8 units, P < 0.001). Overall, 46 (45.1%) patients developed adverse maternal events; however, the rate of adverse maternal events was lower in the BPAA group (19.6 vs. 80.4%, P < 0.001). No ligation of the ascending branch of the uterine artery (P = 0.034), no BPAA (P < 0.001), intraplacental vascular lacunae (P = 0.046), and cervical hypervascularity (P = 0.001) were associated with a high risk of adverse perinatal maternal events. The AUC of the high-risk factors was 0.89 in the post-matched and 0.76 in the pre-matched cohorts. Conclusion: Planned conservative management using BPAA significantly minimized the intraoperative blood loss, the need for a B-Lynch suture, and PRBC transfusion in patients with severe placenta accreta spectrum and placenta previa.
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Affiliation(s)
- Ruihui Lu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiannan Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yintao Xu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ying Zhao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guowei Tao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Qi Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuyan Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
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15
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Thang NM, Anh NTH, Thanh PH, Linh PT, Cuong TD. Emergent versus planned delivery in patients with placenta accreta spectrum disorders: A retrospective study. Medicine (Baltimore) 2021; 100:e28353. [PMID: 34941147 PMCID: PMC8702197 DOI: 10.1097/md.0000000000028353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The aim of this study is to compare the clinical outcomes and to identify risk factors for emergent cesarean delivery and planned cesarean delivery in patients with placenta accreta spectrum (PAS) disorders in Vietnam.The medical records of patients admitted to our hospital with a diagnosis of PAS disorders >5 years were retrospectively reviewed.A total of 255 patients with PAS disorders were identified, including 95 cases in the emergent delivery group and 160 cases in the planned delivery group. The percentage of complete/partial placenta previa in the planned delivery group was significantly higher than that in the emergent delivery group (59.22% vs 32.16%, P = .027). Fewer patients in the planned group had vaginal bleeding compared with those in the emergent group (29 vs 36 cases, P < .001). The percentage of blood transfusion was similar between the 2 groups; however, the transfused units of pack red blood cells were greater in the emergent delivery group (5.3 ± 0.33 vs 4.5 ± 0.25 U, P = .036). When considering the neonatal outcomes, the data demonstrated that the planned delivery group had a significantly higher birth weight and a lower rate of preterm delivery than the emergent group (P < .001). The mean gestational age at delivery for the emergent group was 35.1 ± 0.27 weeks compared with 38.0 ± 0.10 weeks for the planned group (P < .001). The increased risk factors for emergent delivery were vaginal bleeding (odds ratio 2.86, 95% confidence interval 1.59-5.26) and preterm delivery (odds ratio 5.26, 95% confidence interval 2.13-14.29).Planned delivery is strongly associated with a lower need for blood transfusion and better neonatal outcomes compared with emergent delivery. Antenatal vaginal bleeding and preterm labor are risk factors for emergent delivery among patients with PAS disorders. Based on the results of this study, we recommend that the management strategies for patients with PAS disorders should be individualized to determine the optimal timing of delivery and to decrease the rate of emergent cesarean delivery.
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Affiliation(s)
- Nguyen Manh Thang
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam
- National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam
| | - Nguyen Thi Huyen Anh
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Pham Thi Linh
- Thai Binh Obstetrics and Gynecology Hospital, Thai Binh, Vietnam
| | - Tran Danh Cuong
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam
- National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam
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16
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Li Z, Chen Y, Zeng X, Stephen S, Li Y, Li H, Dong L, He T, Zhang S, Yang P, Jiang W, Fan H. Clinical and hemodynamic insights into the use of internal iliac artery balloon occlusion as a prophylactic technique for treating postpartum hemorrhage. J Biomech 2021; 129:110827. [PMID: 34736088 DOI: 10.1016/j.jbiomech.2021.110827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/02/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Abstract
Recently, the effectiveness of internal iliac artery balloon occlusion (IIABO) for treating postpartum hemorrhage caused by pernicious placenta previa (PPP) has been questioned. We conducted a retrospective analysis and hemodynamic simulation to assess the IIABO's effectiveness. The retrospective analysis involved 480 patients with PPP, among which 288 underwent IIABO treatment and the remaining 192 were used as controls. Blood loss and preoperative indicators were recorded, and multiple regression analysis was applied to test the effect of preoperative indicators on blood loss. Hemorrhage mechanisms were simulated using a numerical model. Results suggested that no significant difference in blood loss (1836 ± 1440 ml vs. 1784 ± 1647 ml, p = 0.22) was observed between the two groups. In addition, preoperative indicators, including age, weight, gestational age, gravidity, parity, blood type, anemia, or diabetes, were not associated with blood loss. In the simulation, after the intra-iliac artery was blocked, blood loss was caused by a reversed flow in the intrapelvic arteries, uterine veins, and uterine venules. The ratio of the time-averaged hemorrhage velocity (TAHV) in the balloon group to that in the control group was lower than that obtained in a clinical study (13.0% vs. 88.9%); in the presence of collateral circulation, blood loss occurred from collateral circulation and uterine venules after IIABO intervention, and the TAHV was 60%-90% that of the control group, which was closer to the clinical results (88.9%). These results suggest that IIABO cannot effectively treat postpartum hemorrhage because of the collateral circulation and reversed flow in the uterine venules.
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Affiliation(s)
- Zhongyou Li
- Department of Applied Mechanics, Sichuan University, Chengdu 610065, China
| | - Yu Chen
- Department of Applied Mechanics, Sichuan University, Chengdu 610065, China; Medical Big Data Center, Sichuan University, Chengdu 610041, China.
| | - Xiaoxi Zeng
- Medical Big Data Center, Sichuan University, Chengdu 610041, China
| | - Salerno Stephen
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Huafeng Li
- West China Second Hospital, Sichuan University, Chengdu 610041, China.
| | - Lihua Dong
- Department of Anatomy, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Teng He
- Department of Applied Mechanics, Sichuan University, Chengdu 610065, China
| | - Shihong Zhang
- West China Second Hospital, Sichuan University, Chengdu 610041, China
| | - Pei Yang
- West China Second Hospital, Sichuan University, Chengdu 610041, China
| | - Wentao Jiang
- Department of Applied Mechanics, Sichuan University, Chengdu 610065, China
| | - Haidong Fan
- Department of Applied Mechanics, Sichuan University, Chengdu 610065, China
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Hu Q, Li C, Luo L, Li J, Zhang X, Chen S, Yang X. Clinical analysis of second-trimester pregnancy termination after previous caesarean delivery in 51 patients with placenta previa and placenta accreta spectrum: a retrospective study. BMC Pregnancy Childbirth 2021; 21:568. [PMID: 34407784 PMCID: PMC8375210 DOI: 10.1186/s12884-021-04017-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS Pregnancy termination during the second trimester in patients with placenta previa and placenta accreta spectrum (PAS) is a complex and challenging clinical problem. Based on our literature review, there has been a relative increase in the number of such cases being treated by hysterotomy and/or local uterine lesion resection and repair. In the present study, a retrospective analysis was conducted to compare the clinical outcomes when different management strategies were used to terminate pregnancy in the patients with placenta previa and PAS. METHODS A total of 51 patients who underwent pregnancy termination in the second trimester in Beijing Obstetrics and Gynecology Hospital between June 2013 and December 2018 were retrospectively analyzed in this study. All patients having previous caesarean delivery (CD) were diagnosed with placenta previa status and PAS. RESULTS ① Among the 51 patients, 16 cases received mifepristone and misoprostol medical termination, 15 cases received mifepristone and Rivanol medical termination, but 1 of them was transferred to hysterotomy due to failed labor induction, another 20 cases were performed planned hysterotomy. There was no placenta percreta cases and uterine artery embolization (UAE) was all performed before surgery.② There were 31 cases who underwent medical termination and 30 cases were vaginal delivery. Dilation and evacuation (D&E) were used in 20 cases of medical abortion failure and in all 30 cases of difficult manual removal of placental tissue. ③ A statistically significant difference was found among the three different strategies in terms of gestational weeks, the type of placenta previa status, main operative success rate and β-HCG regression time (P < 0.05). ④ There were 4(7.8%) cases who were taken up for hysterectomy because of life-threatening bleeding or severe bacteremia during or after delivery and hysterotomy. The uterus was preserved with the implanted placenta partly or completely left in situ in 47(92.2%) cases. Combined medical and/or surgical management were used for the residual placenta and the time of menstrual recovery was 52(range: 33 to 86) days after pregnancy termination. CONCLUSIONS Terminating a pregnancy by vaginal delivery through medical induction of labor may be feasible if clinicians have an overall understanding of gestational age, the type of placenta previa status, the type of placenta accreta, and patients concerns about preserving fertility. A collaborative team effort in tertiary medical centers with a very experience MDT and combined application of multiple methods is required to optimize patient outcomes.
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Affiliation(s)
- Qiaofei Hu
- Department of Reproduction Regulation, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Changdong Li
- Department of Reproduction Regulation, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Lanrong Luo
- Department of Reproduction Regulation, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Jian Li
- Department of Reproduction Regulation, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Xiaofeng Zhang
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Suwen Chen
- Department of Reproduction Regulation, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
| | - Xiaokui Yang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
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Liu C, Yang DD, Qu HB, Guo Y, Liu LJ. Efficacy and safety of prophylactic abdominal aortic balloon occlusion versus internal iliac arterial balloon occlusion for placenta accreta spectrum disorder: A systematic review and meta-analysis. Clin Imaging 2021; 78:250-255. [PMID: 34171597 DOI: 10.1016/j.clinimag.2021.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/23/2021] [Accepted: 06/11/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess the efficacy and safety of abdominal aortic (AA) balloon occlusion versus internal iliac arteries (IIA) balloon occlusion in patients with placenta accreta spectrum (PAS) disorders. METHODS Databases of Embase, PubMed, Web of Science and Cochrane Library were systematically searched from inception to May 2020. The relevant literature was screened and the quality was assessed. RevMan software 5.3 was used to analyze the data. RESULTS Six studies involving 239 patients in AA occlusion and 281 patients in IIA occlusion were included. The results demonstrated that the intraoperative hemorrhage volume (MD - 410.61 ml, 95% CI -779.74 to -41.47 ml, p < 0.001), balloon dilatation duration (MD -5.34 min, 95% CI -9.91 to -0.77 min, p = 0.02) and fetus radiation dose (MD-20.81 mGy, 95% CI -31.84 to -9.78 mGy, p < 0.001) were significantly less in AA occlusion compared to IIA occlusion. There was no significant difference in the rate of lower extremity thrombosis between AA occlusion and IIA occlusion (OR 0.21, 95% CI 0.02 to 2.21, p = 0.19); similarly, no significant differences were found in blood transfusion volume (MD -344.50 ml, 95% CI -735.74 to 46.74 ml, p = 0.08), the rate of hysterectomy (OR 0.99, 95% CI 0.22 to 4.44, p = 0.99) and other outcome variables. CONCLUSION The available data demonstrated AA occlusion was more effective in reducing intraoperative hemorrhage volume and fetus radiation dose compared with IIA occlusion in patients with PAS disorders. Larger studies or randomized controlled trials are needed to further assert this evidence.
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Affiliation(s)
- Chuan Liu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, China
| | - Dan-Dan Yang
- Department of Radiology, Chengdu Third People's Hospital, China
| | - Hai-Bo Qu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, China
| | - Yi Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, China
| | - Ling-Jun Liu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, China.
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Liang D, Zhao H, Liu D, Lin Y. Internal iliac artery balloon occlusion in the management of placenta accreta: A systematic review and meta-analysis. Eur J Radiol 2021; 139:109711. [PMID: 33910145 DOI: 10.1016/j.ejrad.2021.109711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To examine the effectiveness and safety of prophylactic internal iliac artery balloon occlusion for hemorrhage control in placenta accreta. METHOD EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials data-bases were searched through November 2020. Clinical trials comparing the management of placenta accreta with and without internal iliac artery balloon occlusion were included. The meta-analysis results were expressed as the risk ratio (RR) or mean difference, with 95 % CIs. RESULTS Fifteen studies including 1098 women were eligible. No statistically significant difference was found between the internal arterial balloon occlusion group and the control group with respect to estimated blood loss volume (-0.525 mL, [95 % CI, -1.112 to -0.061], p = 0.079.), red blood cells (RBCs) transfused in observational studies (-0.682 mL, [95 % CI, -1.540 to 0.176], p = 0.119.) and in randomized controlled trials (0.134 mL, [95 % CI, -0.214 to 0.482], p = 0.451.), intensive care unit admission (p = 0.197), hysterectomy in observational studies (p = 0.969) and in randomized controlled trials (p = 0.323), urinary system injury in observational studies (p = 0.182) and in randomized controlled trials (p = 0.956), Apgar score at 5 min (p = 0.641), and neonatal intensive care unit admission (p = 0.973). CONCLUSIONS The currently available data demonstrate no significant differences between the internal iliac artery balloon occlusion group and the control group in blood loss and packed RBCs transfused for women with placenta accreta. Further large randomized controlled studies are needed to confirm our findings.
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Affiliation(s)
- Deku Liang
- Department of Obstetrics and Gynecology, Chengdu Women and Children's Central Hospital Affiliated to University of Electronic Science and Technology of China, Chengdu, 1617 Riyue Avenue, Qingyang District, Sichuan Province, China
| | - Hu Zhao
- Department of Obstetrics and Gynecology, Chengdu Women and Children's Central Hospital Affiliated to University of Electronic Science and Technology of China, Chengdu, 1617 Riyue Avenue, Qingyang District, Sichuan Province, China
| | - Dandan Liu
- Department of Obstetrics and Gynecology, Chengdu Women and Children's Central Hospital Affiliated to University of Electronic Science and Technology of China, Chengdu, 1617 Riyue Avenue, Qingyang District, Sichuan Province, China
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu Women and Children's Central Hospital Affiliated to University of Electronic Science and Technology of China, Chengdu, 1617 Riyue Avenue, Qingyang District, Sichuan Province, China.
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20
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Placenta accreta spectrum-a catastrophic situation in obstetrics. Obstet Gynecol Sci 2021; 64:239-247. [PMID: 33757280 PMCID: PMC8138076 DOI: 10.5468/ogs.20345] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/16/2021] [Indexed: 01/24/2023] Open
Abstract
Placenta accreta is a significant obstetric complication in which the placenta is completely or focally adherent to the myometrium. The worldwide incidence of placenta accreta spectrum (PAS) is increasing day by day, mostly due to the increasing trends in cesarean section rates. The accurate and timely diagnosis of placenta accreta is important to improve the feto-maternal outcome. Although standard ultrasound is a reliable and primary tool for the diagnosis of placenta accreta, the absence of ultrasound findings does not preclude the diagnosis of placenta accreta. Therefore, clinical evaluation of risk factors is equally essential for the prediction of abnormal placental invasion. Pregnant women with a high impression or established diagnosis of placenta accreta should be managed by a multidisciplinary team in a specialist center. Traditionally, PAS has been managed by an emergency obstetric hysterectomy. Previously, few studies suggested a satisfactory success rate of conservative management in well-chosen cases, whereas few studies recommended delayed hysterectomy to reduce the amount of bleeding. The continuously increasing trends of PAS and the challenges for its routine management are the main motives behind this literature review.
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21
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Nankali A, Salari N, Kazeminia M, Mohammadi M, Rasoulinya S, Hosseinian-Far M. The effect prophylactic internal iliac artery balloon occlusion in patients with placenta previa or placental accreta spectrum: a systematic review and meta-analysis. Reprod Biol Endocrinol 2021; 19:40. [PMID: 33663536 PMCID: PMC7931359 DOI: 10.1186/s12958-021-00722-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide. Another cause of bleeding in pregnant women is Placenta accreta spectrum. Therefore, the aim of the present systematic review and meta-analysis is to determine the effect of prophylactic balloon occlusion of the internal iliac arteries in patients with placenta previa or placental accreta spectrum (PAS). METHODS In this systematic review and meta-analysis, to identify and select relevant studies, the SID, MagIran, ScienceDirect, Embase, Scopus, PubMed, Web of Science, and Google Scholar databases were searched, using the keywords of internal iliac artery balloon, placenta, previa, balloon, accreta, increta and percreta, without a lower time limit and until 2020. The heterogeneity of the studies was examined using the I2 index, and subsequently a random effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2). RESULTS In the review of 29 articles with a total sample size of 1140 in the control group, and 1225 in the balloon occlusion group, the mean difference between the two groups was calculated in terms of Intraoperative blood loss index (mL) and it was derived as 3.21 ± 0.38; moreover, in 15 studies with a sample size of 887 in the control group, and 760 in the balloon occlusion group, the mean difference between the two groups in terms of gestation index (weeks) was found as 2.84 ± 0.49; and also with regards to hysterectomy balloon occlusion after prophylactic closure of the iliac artery, hysterectomy (%) balloon occlusion was calculated as 8.9 %, and this, in the hysterectomy control group (%) was obtained as 31.2 %; these differences were statistically significant and showed a positive effect of the intervention (P < 0.05). CONCLUSION The results of this study show that the use of prophylactic internal iliac artery balloon occlusion in patients with placenta previa or Placenta accreta spectrum has benefits such as reduced intraoperative blood loss, reduced hysterectomy and increased gestation (weeks), which can be considered by midwives and obstetricians.
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Affiliation(s)
- Anisodowleh Nankali
- grid.412112.50000 0001 2012 5829Department of Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- grid.412112.50000 0001 2012 5829Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- grid.412112.50000 0001 2012 5829Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- grid.412112.50000 0001 2012 5829Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samira Rasoulinya
- grid.412112.50000 0001 2012 5829Department of Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Melika Hosseinian-Far
- grid.411301.60000 0001 0666 1211Department of Food Science & Technology, Faculty of Agriculture, Ferdowsi University of Mashhad (FUM), Mashhad, Iran
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Giurazza F, Angileri SA, Corvino F, Granata G, Grillo P, Savoldi AP, Albano G, Bracchi L, Carrafiello G, Niola R. Postpartum Hemorrhages: Prevention. Semin Ultrasound CT MR 2021; 42:85-94. [PMID: 33541592 DOI: 10.1053/j.sult.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The strict correlation between abnormal invasive placentation and postpartum hemorrhage suggests that a widespread antenatal diagnosis of placental anomalies would improve the management of these challenging patients; acting preventive solutions at the moment of delivery reduces blood loss and avoid hysterectomies. The role of endovascular procedures in this field has been encouraged by multiple studies reporting prophylactic uterine arteries embolization and iliac/aortic balloon catheters positioning. This paper aims to review the main imaging diagnostic findings of placental implant anomalies and summarize the principal preventive endovascular strategies proposed in literature.
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Affiliation(s)
- Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy.
| | | | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Giuseppe Granata
- Postgraduate School in Radiodiagnostic, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | - Pasquale Grillo
- Postgraduate School in Radiodiagnostic, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | - Anna Paola Savoldi
- Postgraduate School in Radiodiagnostic, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | | | - Laura Bracchi
- Diagnostic and Therapeutic Imaging Department, Cerba Healthcare Italia, Milan, Italy
| | | | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
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23
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Hawthorn BR, Ratnam LA. Role of interventional radiology in placenta accreta spectrum (PAS) disorders. Best Pract Res Clin Obstet Gynaecol 2021; 72:25-37. [PMID: 33640296 DOI: 10.1016/j.bpobgyn.2021.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
Placenta accreta spectrum (PAS) disorders are rare but potentially life-threatening obstetric conditions, which can result in severe post-partum haemorrhage (PPH). Traditional management necessitates peripartum hysterectomy, but this carries high rates of morbidity and mortality. More recently, interventional radiology techniques have been developed in order to reduce morbidity and preserve fertility. This article summarises and compares the various reported interventional radiology techniques. Arterial embolisation performed to treat PPH is the therapeutic option which is supported by the highest degree of evidence. The role of preventative procedures, such as temporary balloon occlusion of the internal iliac arteries or distal aorta, continues to be debated due to conflicting outcome data and concerns regarding associated morbidity. The choice of which, if any, interventional radiological technique is utilised is determined by local expertise, available resources and the planned obstetric approach. The most complex patients are likely to benefit from multidisciplinary management in high-volume centres.
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Affiliation(s)
- Benjamin R Hawthorn
- St George's Hospital University Hospitals NHS Foundation Trust, London, SW17 0QT, United Kingdom.
| | - Lakshmi A Ratnam
- St George's Hospital University Hospitals NHS Foundation Trust, London, SW17 0QT, United Kingdom.
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24
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Abd Elazeem HAS, Saad MM, Ahmed IA, Sayed EG, AlMahdy AM, Atef F, Elassall GM, Ashraf Salah M, Ali AK, Ragab EY, Shazly SA. High-intensity focused ultrasound in management of placenta accreta spectrum: A systematic review. Int J Gynaecol Obstet 2020; 151:325-332. [PMID: 32976627 DOI: 10.1002/ijgo.13391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/07/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is a non-invasive procedure that has been studied in the management of placenta accreta spectrum (PAS). OBJECTIVE To appraise HIFU in the management of PAS and highlight the restrictions on converting uterus-preserving studies into evidence-based practice. SEARCH STRATEGY A search on Scopus, Cochrane, PubMed and Web of Science was conducted from date of inception to January 2020. SELECTION CRITERIA Studies on using HIFU in the management of PAS were eligible. Review articles, conference papers, and case reports were excluded. DATA COLLECTION A standardized sheet was used to abstract data from eligible studies. CON-PAS registry was used to include studies on other conservative modalities. RESULTS Four studies were eligible (399 patients). Average residual placental volume was 61.74 cm3 (6.01-339 cm3 ). Treatment was successful in all patients. Normal menstruation recovered after 48.8 days (15-150 days). No major complications were encountered. Sixty-one studies were retrieved from the CON-PAS registry; uterine artery embolization (23 studies), balloon placement (15 studies), compression sutures (10 studies), placenta in situ (7 studies), and uterine resection (6 studies) were successful in 83.7%, 92.9%, 87.9%, 85.2%, and 79.3% of cases, respectively. CONCLUSIONS HIFU may fit certain clinical situations in the management of PAS. A global research strategy is recommended to incorporate conservative approaches within a comprehensive management protocol.
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Affiliation(s)
| | - Mahmoud M Saad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Islam A Ahmed
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa G Sayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - AlBatool M AlMahdy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Fatma Atef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Gena M Elassall
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Ashraf Salah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed K Ali
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa Y Ragab
- Department of Anesthesia, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sherif A Shazly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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25
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Mironov NR, Kram JJF, Heslin K, Michelson ELD. Retrospective review of cesarean hysterectomy outcomes utilizing uterine intravascular interventions in a large, community-based healthcare setting. Eur J Obstet Gynecol Reprod Biol 2020; 255:237-241. [PMID: 33160153 DOI: 10.1016/j.ejogrb.2020.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore outcomes of women with planned cesarean hysterectomies, with or without use of internal iliac intravascular occlusive balloon catheter or uterine artery embolization (UAE). STUDY DESIGN We retrospectively reviewed adult women who underwent a planned cesarean hysterectomy, 2004-2019. All planned cases were included, regardless of indication. Planned surgeries were divided into three groups: balloon placement, UAE, or no intervention. Patients with balloon placement were further subdivided into: balloons placed but not deployed or balloons placed and deployed intraoperatively. Hemorrhage was defined as estimated blood loss (EBL) ≥1,500 mL. An adverse outcome was defined as one or more of the following: intensive care unit admission, thromboembolism, ureteral stent placement, amputation, or reoperation. Basic descriptive and inferential statistics were used to explore differences among groups and adverse outcomes. RESULTS A total of 34 patients underwent planned cesarean hysterectomy. Ten patients (29.4%) had balloons placed, nine (26.5%) had UAE, and 15 (44.1%) had no intervention. Risk of hemorrhage was clinically higher among those with balloon placement (80% vs. 33% UAE vs. 60% no intervention; P = 0.14), with mean EBL (3,605.0 mL vs. 1,488.9 mL vs. 2,289.3 mL; P = 0.05) and mean transfusion requirements (9.3 units vs. 2.8 vs. 4.4; P = 0.01) being significantly higher. Adverse outcomes were also significantly higher among those with balloon placement (80.0% vs. 66.7% UAE vs. 20.0% no intervention; P ≤ 0.01). Of the ten patients with balloons placed, four were deployed. Among those with balloons placed and deployed, mean EBL (5,250.0 mL vs. 2,508.3 mL balloons placed but not deployed vs. 2,289.3 mL no intervention; P=0.04) and mean transfusion requirements (11 units vs. 7.5 units balloons placed but not deployed vs. 4.4 units no intervention; P = 0.05) were significantly higher. Adverse outcomes were also significantly higher among those who had balloons placed and deployed (100.0% vs. 66.7% balloons placed but not deployed vs. 20.0% no intervention; P ≤ 0.01). CONCLUSIONS Balloon placement, regardless of deployment, may not be beneficial to women undergoing a planned cesarean hysterectomy. Although UAE was also associated with adverse outcomes, it may be a better option for reducing intraoperative blood loss among patients with a planned cesarean hysterectomy.
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Affiliation(s)
- Natalie R Mironov
- Des Moines University College of Osteopathic Medicine, United States, Des Moines, IA, United States; Aurora UW Medical Group, Center for Urban Population Health, Advocate Aurora Health, Aurora Sinai Medical Center, United States, Milwaukee, WI, United States
| | - Jessica J F Kram
- Aurora UW Medical Group, Center for Urban Population Health, Advocate Aurora Health, Aurora Sinai Medical Center, United States, Milwaukee, WI, United States
| | - Kayla Heslin
- Aurora UW Medical Group, Center for Urban Population Health, Advocate Aurora Health, Aurora Sinai Medical Center, United States, Milwaukee, WI, United States; Advocate Aurora Research Institute, Advocate Aurora Health, United States, Milwaukee, WI, United States
| | - Elizabeth L Dickson Michelson
- Department of Oncology, Advocate Aurora Health, Aurora West Allis Medical Center, United States, West Allis, WI, United States.
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26
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Preoperative Prophylactic Balloon-Assisted Occlusion of the Internal Iliac Arteries in the Management of Placenta Increta/Percreta. ACTA ACUST UNITED AC 2020; 56:medicina56080368. [PMID: 32717928 PMCID: PMC7466236 DOI: 10.3390/medicina56080368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/22/2020] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Preoperative prophylactic balloon-assisted occlusion (PBAO) of the internal iliac arteries minimizes blood loss and facilitates surgery performance, through reductions in the rate of uterine perfusion, which allow for better control in hysterectomy performance, with decreased rates of bleeding and surgical complications. We aimed to investigate the maternal and fetal outcomes associated with PBAO use in women with placenta increta or percreta. Material and Methods: The records of 42 consecutive patients with a diagnosis of placenta increta or percreta were retrospectively reviewed. Of 42 patients, 17 patients (40.5%) with placenta increta or percreta underwent cesarean delivery after prophylactic balloon catheter placement in the bilateral internal iliac artery (balloon group). The blood loss volume, transfusion volume, postoperative hemoglobin changes, rates of hysterectomy and hospitalization, and infant Apgar score in this group were compared to those of 25 similar women who underwent cesarean delivery without balloon placement (surgical group). Results: The mean intraoperative blood loss volume in the balloon group (2319 ± 1191 mL, range 1000–4500 mL) was significantly lower than that in the surgical group (4435 ± 1376 mL, range 1500–10,500 mL) (p = 0.037). The mean blood unit volume transfused in the balloon group (2060 ± 1154 mL, range 1200–8000 mL) was significantly lower than that in the surgical group (3840 ± 1464 mL, range 1800–15,200 mL) (p = 0.043). There was no significant difference in the postoperative hemoglobin change, hysterectomy rates, length of hospitalization, or infant Apgar score between the groups. Conclusion: PBAO of the internal iliac artery prior to cesarean delivery in patients with placenta increta or percreta is a safe and minimally invasive technique that reduces the rate of intraoperative blood loss and transfusion requirements.
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27
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Yu SCH, Cheng YKY, Tse WT, Sahota DS, Chung MY, Wong SSM, Chan OK, Leung TY. Perioperative prophylactic internal iliac artery balloon occlusion in the prevention of postpartum hemorrhage in placenta previa: a randomized controlled trial. Am J Obstet Gynecol 2020; 223:117.e1-117.e13. [PMID: 31978436 DOI: 10.1016/j.ajog.2020.01.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Placenta previa remains one of the major causes of massive postpartum hemorrhage and maternal mortality worldwide. OBJECTIVE To determine whether internal iliac artery balloon occlusion during cesarean delivery for placenta previa could reduce postpartum hemorrhage and other maternal complications. STUDY DESIGN This was a prospective randomized controlled trial conducted at a tertiary university obstetric unit in Hong Kong. Pregnant women who were diagnosed to have placenta previa at 34 weeks (defined as lower placenta edge within 2 cm from the internal os) and required cesarean delivery were invited to participate. Eligible pregnant women were randomized into internal iliac artery balloon occlusion (Occlusion) group or standard management (Control) group. Those randomized to the Occlusion group had internal iliac artery balloon catheter placement performed before cesarean delivery and then balloon inflation after delivery of the baby. The primary outcome was the reduction of postpartum hemorrhage in those with internal iliac artery balloon occlusion. Secondary outcome measures included hemoglobin drop after delivery; amount of blood product transfusion; incidence of hysterectomy; maternal complications including renal failure, ischemic liver, disseminated intravascular coagulation, and adult respiratory distress syndrome; length of stay in hospital; admission to intensive care unit; and maternal death. RESULTS Between May 2016 and September 2018, 40 women were randomized (20 in each group). Demographic and obstetric characteristics were similar between the 2 groups. In the Occlusion group, 3 women did not receive the scheduled procedure, as it was preceded by antepartum hemorrhage that required emergency cesarean delivery, and 1 woman had repeated scan at 36 weeks showing the placental edge was slightly more than 2 cm from the internal os. Intention-to-treat analysis found no significant differences between the Occlusion and the Control groups regarding to the median intraoperative blood loss (1451 [1024-2388] mL vs 1454 [888-2300] mL; P = .945), the median length of surgery (49 [30-62] min vs 37 [30-51] min; P = .204), or the need for blood transfusion during operation (57.9% vs 50.0%; P = .621). None of the patients had rebleeding after operation, complication related to internal iliac artery procedure, or any other maternal complications. Reanalyzing the data using on-treatment approach showed the same results. CONCLUSION The use of prophylactic internal iliac artery balloon occlusion in placenta previa patients undergoing cesarean delivery did not reduce postpartum hemorrhage or have any effect on maternal or neonatal morbidity.
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28
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Papillon-Smith J, Hobson S, Allen L, Kingdom J, Windrim R, Murji A. Prophylactic internal iliac artery ligation versus balloon occlusion for placenta accreta spectrum disorders: A retrospective cohort study. Int J Gynaecol Obstet 2020; 151:91-96. [PMID: 32506473 DOI: 10.1002/ijgo.13256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/08/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare surgical outcomes between women undergoing prophylactic internal iliac artery ligation or preoperative placement of balloon-occlusive devices at cesarean hysterectomy for placenta accreta spectrum (PAS) disorders. METHODS A retrospective cohort study was conducted at a tertiary-care referral center for PAS disorders in Ontario, Canada. Eligible electronic records were reviewed of women undergoing cesarean hysterectomy for PAS disorders between November 2012 and June 2018. Outcomes for the ligation and balloon groups were compared primarily on procedure-related complications and secondarily on total procedure time, bleeding and transfusion metrics, and intraoperative and postoperative complications. RESULTS Of the 79 cases of cesarean hysterectomy, 47 underwent balloon placement and 32 underwent ligation. Baseline characteristics between the groups were similar except for more emergency procedures in the ligation group (37.5% vs 12.8%, P=0.014). The balloon-related complication rate was 5/47 (10.6%), with no reported complications in the ligation group (P=0.077). Procedural time was longer in the balloon group (353 ± 14 vs 227 ± 13 minutes, P<0.001). Estimated blood loss was similar (1874 ± 245 mL vs 1713 ± 181 mL, P=0.590). CONCLUSION Women undergoing prophylactic placement of endovascular balloons at caesarean hysterectomy for PAS disorders had a 10.6% procedure-related complication rate and increased total procedure time, with no decrease in blood loss compared to those undergoing surgical ligation.
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Affiliation(s)
- Jessica Papillon-Smith
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Sebastian Hobson
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Lisa Allen
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - John Kingdom
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Rory Windrim
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ally Murji
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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29
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Soyer P, Barat M, Loffroy R, Barral M, Dautry R, Vidal V, Pellerin O, Cornelis F, Kohi MP, Dohan A. The role of interventional radiology in the management of abnormally invasive placenta: a systematic review of current evidences. Quant Imaging Med Surg 2020; 10:1370-1391. [PMID: 32550143 DOI: 10.21037/qims-20-548] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abnormally invasive placenta (AIP) is a potentially severe condition. To date, arterial embolization in women with postpartum hemorrhage due to AIP is the treatment option for which highest degrees of evidence are available. However, other techniques have been tested, including prophylactic catheter placement, balloon occlusion of the iliac arteries and abdominal aorta balloon occlusion. In this systematic review, we provide an overview of the currently reported interventional radiology procedures that are used for the treatment of postpartum hemorrhage due to AIP and suggest recommendations based on current evidences. Owing to a high rate of adverse events, prophylactic occlusion of internal iliac arteries should be used with caution and applied when the endpoint is hysterectomy. On the opposite, when a conservative management is considered to preserve future fertility, uterine artery embolization should be the preferred option as it is associated with a hysterectomy rate of 15.5% compared to 76.5% with prophylactic balloon occlusion of the internal iliac arteries and does not result in fetal irradiation. Limited data are available regarding the application of systematic prophylactic embolization and no comparative studies with arterial embolization are available.
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Affiliation(s)
- Philippe Soyer
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
| | - Maxime Barat
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, UFR des Sciences de Santé, Université de Bourgogne/Franche-Comté, Dijon, France
| | - Matthias Barral
- Department of Radiology, Hopital Tenon, Assistance Publique - Hopitaux de Paris, Paris, France.,Sorbonne University, Paris, France
| | - Raphael Dautry
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, LIIE, CERIMED Aix Marseille Univ, Marseille, France
| | - Olivier Pellerin
- Université de Paris, Descartes-Paris 5, Paris, France.,Department of Interventional Radiology, Hopital Européen Georges Pompidou, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Francois Cornelis
- Department of Radiology, Hopital Tenon, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
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Control of postpartum hemorrhage in women with placenta accreta spectrum using prophylactic balloon occlusion combined with Pituitrin intra-arterial infusion. Eur Radiol 2020; 30:4524-4533. [PMID: 32222796 DOI: 10.1007/s00330-020-06813-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/26/2020] [Accepted: 03/13/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the efficacy of prophylactic internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion in the control of postpartum hemorrhage in women with placenta accreta spectrum (PAS). METHODS This is a prospective and non-randomized controlled study. The participants were assigned into three groups: without balloon catheterization (non-BC) group, balloon catheterization (BC) group, and Pituitrin combined with balloon catheterization (PBC) group. The primary outcomes were estimated blood loss (EBL) and the units of transfused packed red blood cells (PRBC). The secondary outcome was the incidence of hysterectomy. RESULTS A total of 100 participants were recruited between August 2013 and November 2018 and assigned into the respective groups as follows: 27 in the non-BC group, 22 in the BC group, and 51 in the PBC group. No statistical differences were found in demographic characteristics among the three groups. There was a trend of lower EBL, PRBC, and hysterectomy rate in the BC group than those in the non-BC group, while all values showed no significant differences (all p > 0.05). Patients in the PBC group had significantly lower EBL, PRBC, and hysterectomy rate compared with those in the non-BC group (all p < 0.05). Linear regression analysis revealed that the PBC (vs. others) was negatively correlated with EBL and the non-BC (vs. others) independently predicted more EBL. CONCLUSIONS Balloon occlusion combined with Pituitrin infusion is an effective treatment method which significantly reduced EBL, PRBC, and hysterectomy rate in patients with PAS. KEY POINTS • Internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion can significantly decrease EBL, PRBC, and hysterectomy rate during cesarean section in patients with PAS. • Cesarean section without balloon occlusion and placenta accreta depth are two independent risk factors for EBL in patients with PAS.
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Weston M, Soyer P, Barral M, Dohan A, Pierre S, Rabei R, Garcia-Reyes K, Kohi MP. Role of Interventional Procedures in Obstetrics and Gynecology. Radiol Clin North Am 2020; 58:445-462. [PMID: 32044017 DOI: 10.1016/j.rcl.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Radiological guided intervention techniques are discussed in obstetric and gynecologic patients. Fallopian tube recanalization, postpartum hemorrhage control, techniques of treating uterine leiomyomas, pelvic congestion treatment, and the use of percutaneous and transvaginal ultrasonography-guided aspirations and biopsy are covered. These techniques use basic radiological interventional skills and show how they are adapted for use in the female pelvis.
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Affiliation(s)
- Michael Weston
- Department of Radiology, St James's University Hospital, Leeds LS9 7TF, UK.
| | - Philippe Soyer
- Department of Radiology, Service de Radiologie A, Hopital Cochin, APHP & Université de Paris-Descartes Paris 5, 27 rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Matthias Barral
- Department of Radiology, Service de Radiologie A, Hopital Cochin, APHP & Université de Paris-Descartes Paris 5, 27 rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Anthony Dohan
- Department of Radiology, Service de Radiologie A, Hopital Cochin, APHP & Université de Paris-Descartes Paris 5, 27 rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Sacha Pierre
- Department of Radiology, St James's University Hospital, Leeds LS9 7TF, UK
| | - Rana Rabei
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-361, San Francisco, CA 94143, USA
| | - Kirema Garcia-Reyes
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-361, San Francisco, CA 94143, USA
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-361, San Francisco, CA 94143, USA
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Chen K, Zhang G, Li F, Liu J, Xie K, Zhu E, Li W, Zhang M, Gen C, Wang A. Application of ultrasound-guided balloon occlusion in cesarean section in 130 cases of sinister placenta previa. J Interv Med 2020; 3:41-44. [PMID: 34805905 PMCID: PMC8562179 DOI: 10.1016/j.jimed.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the clinical utility of ultrasound-guided balloon occlusion in cesarean section in patients with sinister placenta previa. Methods The Interventional and Ultrasound Departments of the authors’ center assisted obstetrics to complete cesarean section in cases of sinister placenta previa. A total of 130 patients with implanted sinister placenta previa were diagnosed using obstetrical ultrasound and magnetic resonance imaging (MRI). Before cesarean section, the balloon was positioned in the bilateral radial or abdominal aorta. Immediately after delivery of the fetus, the balloon was temporarily filled to transiently seal the target vessel. According to the obstetrician’s assessment of hemostasis, the balloon was withdrawn at the appropriate time. Among the 130 patients, there was one case of abdominal aortic occlusion, with 129 cases blocked by the bilateral common iliac artery. Results All 130 cases were successfully blocked, with an average blocking time of <15 min, while intraoperative blood loss was 800–1500 ml. Conclusion Ultrasound-guided balloon blocking treatment before cesarean section can mitigate the dangers of placenta previa and significantly reduce blood loss with no exposure to X-ray radiation. Thus, the technique merits serious consideration. The incidence of major bleeding and postpartum hemorrhage in related procedures have increased, seriously threatening the lives of mothers. All 130 cases were successfully blocked, with an average blocking time <15 min, with intraoperative blood loss ranging from 800 to 1500 ml. Preoperative ultrasound-guided balloon blocking treatment before cesarean section can mitigate the dangers of placenta previa. Significantly reduce blood loss with no exposure to X-ray radiation. As such, the technique merits serious consideration.
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Zhao B, Lv M, Dong T, Chen Y, Xi F, Lv W, Luo Q. Transverse parallel compression suture: a new suturing method for successful treating pernicious placenta previa during cesarean section. Arch Gynecol Obstet 2020; 301:465-472. [DOI: 10.1007/s00404-020-05435-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
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Lee AY, Ballah D, Moreno I, Dong PR, Cochran R, Picel A, Lee EW, Moriarty J, Padgett M, Nelson K, Kohi MP. Outcomes of balloon occlusion in the University of California Morbidly Adherent Placenta Registry. Am J Obstet Gynecol MFM 2019; 2:100065. [PMID: 33345981 DOI: 10.1016/j.ajogmf.2019.100065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/20/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Morbidly adherent placenta, also known as placenta accreta spectrum, is associated with severe maternal morbidity and mortality. Multiple adjunctive procedures have been proposed to improve outcomes, and at many institutions, interventional radiologists will play a role in assisting obstetricians in these cases. OBJECTIVE The objective of the study was to evaluate the outcomes of women with morbidly adherent placenta who underwent cesarean hysterectomy with aortic balloon occlusion or internal iliac artery balloon occlusion catheters, compared with cesarean hysterectomy with surgical ligation of the iliac arteries, or cesarean hysterectomy without adjunctive procedures. STUDY DESIGN A retrospective review of women with morbidly adherent placenta treated with cesarean hysterectomy was performed at 5 institutions from May 2014 to April 2018. The balloon occlusion group had either prophylactic aortic or iliac balloons placed prior to cesarean hysterectomy. Comparison groups included those who underwent internal iliac artery ligation prior to hysterectomy or a control group if they underwent cesarean hysterectomy without adjuvant procedures. Evaluated outcomes include estimated blood loss, transfusion requirements, intensive care unit admission, and adverse event rates. RESULTS There were 171 women with morbidly adherent placenta included in the study. Twenty-eight had balloon placement prior to cesarean hysterectomy, 18 had intraoperative internal iliac artery ligation, and there were 125 control women who underwent cesarean hysterectomy without any adjunctive procedures. Compared with the women who underwent cesarean hysterectomy without adjunctive procedures, women who underwent aortic or iliac artery balloon occlusion prior to hysterectomy had significantly lower estimated blood loss (30.9% decrease, P < .001), transfusion requirements (76.8% decrease, P < .001), intensive care unit admission rates (0% vs 15.2%, P < .001), and intensive care unit stay lengths (0.0 vs 3.1 days, P < .001). Compared with women who underwent surgical ligation of the internal iliac arteries prior to hysterectomy, women who underwent aortic or iliac artery balloon occlusion prior to cesarean hysterectomy had lower estimated blood loss (54.2% decrease, P < .01), transfusion requirements (90.5% decrease, P < .001), operating room times (40.0% decrease, P < .01), intensive care unit admissions rates (0% vs 77.8%, P < .001), intensive care unit stay lengths (0.0 vs 1.4 days, P < .001), and adverse events (3.6% vs 44.4%, P < .01). CONCLUSION Aortic and iliac artery balloon occlusion are associated with lower estimated blood loss, transfusion requirements, intensive care unit admission rates, and adverse event rates compared with women who underwent internal iliac artery ligation prior to cesarean hysterectomy or women who had no adjunctive interventions prior to cesarean hysterectomy for morbidly adherent placenta.
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Affiliation(s)
- Andrew Y Lee
- Department of Radiology, University of California, Davis, Sacramento, CA
| | - Deddeh Ballah
- Department of Radiology, University of California, San Francisco, San Francisco, CA
| | - Ismael Moreno
- Department of Radiology, University of California, Davis, Sacramento, CA
| | - Paul R Dong
- Department of Radiology, University of California, Davis, Sacramento, CA; Department of Radiology, Sutter Medical Group, Northern California, Sacramento, CA
| | - Rory Cochran
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Andrew Picel
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Edward W Lee
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA
| | - John Moriarty
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA
| | - Max Padgett
- Department of Radiology, University of California, Irvine, Orange, CA
| | - Kari Nelson
- Department of Radiology, University of California, Irvine, Orange, CA
| | - Maureen P Kohi
- Department of Radiology, University of California, San Francisco, San Francisco, CA.
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D'Antonio F, Iacovelli A, Liberati M, Leombroni M, Murgano D, Cali G, Khalil A, Flacco ME, Scutiero G, Iannone P, Scambia G, Manzoli L, Greco P. Role of interventional radiology in pregnancy complicated by placenta accreta spectrum disorder: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:743-751. [PMID: 30255598 DOI: 10.1002/uog.20131] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the potential benefit of interventional radiology (IR) in improving the outcome of women undergoing surgery for a placenta accreta spectrum (PAS) disorder. METHODS MEDLINE, EMBASE and CINAHL databases were searched for studies comparing outcomes of women with a prenatal diagnosis of PAS who underwent an IR procedure before surgery vs those who did not, using a robust collection of terms relating to PAS. The primary outcome was intraoperative estimated blood loss (EBL). Secondary outcomes were the number of transfused units of packed red blood cells (PRBC), fresh frozen plasma (FFP), platelets and cryoprecipitate, operation time, length of hospital stay, EBL ≥ 2.5 L, PRBC transfused ≥ 5 units, surgical complications, bladder or ureteral injury, relaparotomy, infection, disseminated intravascular coagulation, and complications related to endovascular catheter placement. Only studies reporting on the incidence of, or the mean difference in, the observed outcomes in women affected by a PAS disorder who had vs those who did not have an IR procedure before surgery were considered for inclusion. All outcomes were explored in the overall population of women with a prenatally diagnosed PAS disorder and in those undergoing hysterectomy. Quality assessment of each included study was performed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. The GRADE methodology was used to assess the quality of the body of retrieved evidence. RESULTS Fifteen studies (958 women with PAS) were included. In women who underwent IR before surgery, compared with those who did not, mean EBL (mean difference (MD), -1.02 L; 95% CI, -1.60 to -0.43 L; P < 0.001) and the risk of EBL ≥ 2.5 L (odds ratio (OR), 0.18; 95% CI, 0.04-0.78; P = 0.02) were significantly lower. There was no significant difference between the two groups in the other outcomes explored. On subgroup analysis of pregnancies complicated by PAS undergoing hysterectomy, EBL (MD, -0.68 L; 95% CI, -1.24 to -0.12 L; P = 0.02) and the number of transfused FFP units (MD, -1.66; 95% CI, -2.71 to -0.61; P = 0.02) were significantly lower in women who had an endovascular IR procedure compared with controls. Furthermore, women undergoing IR had a significantly lower risk of EBL ≥ 2.5 L (OR, 0.10; 95% CI, 0.02-0.47; P = 0.004). Overall, complications related to the placement of an endovascular catheter occurred in 5.3% (95% CI, 2.6-8.9; I2 , 65.3%) of pregnancies undergoing IR. Overall quality of evidence, as assessed by GRADE, was very low. CONCLUSIONS The current available data provide encouraging evidence that IR procedures may be associated with lower EBL and need for transfusion in pregnancies undergoing surgery for a PAS disorder. However, given the overall very low quality of the evidence, further large studies are needed in order to confirm the beneficial role of IR in improving the outcome of these women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F D'Antonio
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - A Iacovelli
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - M Liberati
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - M Leombroni
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - D Murgano
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - G Cali
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
| | - A Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - M E Flacco
- Local Health Unit of Pescara, Pescara, Italy
| | - G Scutiero
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - P Iannone
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - G Scambia
- Department of Obstetrics and Gynaecology, Catholic University of The Sacred Heart, Rome, Italy
| | - L Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - P Greco
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Mei Y, Zhao H, Zhou H, Jing H, Lin Y. Comparison of infrarenal aortic balloon occlusion with internal iliac artery balloon occlusion for patients with placenta accreta. BMC Pregnancy Childbirth 2019; 19:147. [PMID: 31046694 PMCID: PMC6498491 DOI: 10.1186/s12884-019-2303-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was designed to compare the role of infrarenal aortic artery balloon occlusion (IAABC) with internal iliac artery balloon occlusion (IIABOC). METHODS One hundred seventy-four cases with placenta accreta were retrospectively analyzed.74 cases who had IAABC were in group A, while the others who had IIABOC were in group B. RESULTS Amount of estimated blood loss (EBL), the rate of major blood loss, the rate of blood transfusion and uterine packing, length of hospitalization were not different in both groups. The rate of uterine artery embolization (UAE), balloon occlusion time, operation time and fetus radiation dose in group A were less than those in group B. CONCLUSIONS IAABC resulted in better clinical outcomes than IIABOC.
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Affiliation(s)
- Youwen Mei
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Hu Zhao
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Hui Zhou
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Huaibo Jing
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China.
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Wang M, Ballah D, Wade A, Taylor AG, Rizzuto G, Li B, Lucero J, Chen LM, Kohi MP. Uterine Artery Embolization following Cesarean Delivery but prior to Hysterectomy in the Management of Patients with Invasive Placenta. J Vasc Interv Radiol 2019; 30:687-691. [PMID: 30922797 PMCID: PMC10468213 DOI: 10.1016/j.jvir.2018.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate outcomes of patients with placenta accreta spectrum (PAS) disorders who underwent uterine artery embolization (UAE) following cesarean delivery but before hysterectomy. MATERIALS AND METHODS A retrospective review of patients with PAS treated with cesarean-hysterectomy (C-hyst) was performed. Patients in the UAE group underwent UAE after cesarean delivery but before hysterectomy; patients in the control group underwent C-hyst alone. Estimated blood loss (EBL), transfusion requirements, length of intensive care unit (ICU) stay, and adverse events were evaluated. RESULTS The study included 31 patients, 7 in the UAE group and 24 in the control group. Median EBL, transfusion requirements, and length of ICU stay in the UAE group compared with control group were 1,500 mL (range, 500-2,000 mL) vs 2,000 mL (range, 1,000-4,500 mL) (P = .04), 150 mL (range, 0-650 mL) vs 550 mL (range, 0-3,125 mL) (P = .10), and 0 d (range, 0-1 d) vs 0.5 d (range, 0-2 d) (P = .07). All patients in the UAE group had placenta increta; patients in the control group had placenta accreta (29%), increta (54%), and percreta (17%) (P = .10). Subgroup analysis of patients with placenta increta demonstrated that the UAE group had a significant decrease in median EBL (P = .004), transfusion requirements (P = .009), and length of ICU stay (P = .04). No adverse events following UAE were noted. CONCLUSIONS UAE following cesarean delivery but before hysterectomy in patients with placenta increta appears to be safe and effective in decreasing EBL, transfusion requirements, and length of ICU stay compared with C-hyst alone.
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Affiliation(s)
- Melinda Wang
- Weill Cornell Medical College, New York, New York
| | - Deddeh Ballah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Alana Wade
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Andrew G Taylor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Gabrielle Rizzuto
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | - Benjamin Li
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Jennifer Lucero
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
| | - Lee-May Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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Mitric C, Desilets J, Balayla J, Ziegler C. Surgical Management of the Placenta Accreta Spectrum: An Institutional Experience. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1551-1557. [PMID: 30948337 DOI: 10.1016/j.jogc.2019.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The incidence of placenta accreta spectrum (PAS) has risen over the past decades, primarily in response to increasing Caesarean section rates. The surgical management of PAS is associated with significant morbidity, including hemorrhage and intensive care unit (ICU) admission. This study sought to evaluate the surgical outcomes of a PAS operative approach. METHODS A single-centre retrospective chart review of all Caesarean hysterectomies for PAS by an assigned surgeon over a 16-year period was performed. Surgical outcomes were described (Canadian Task Force Classification II-2). RESULTS The described surgical approach involves a midline skin incision, high midline hysterotomy, a rapid single-layer uterine closure with no placental removal attempt, constant cephalad uterine traction, and liberal choice of subtotal hysterectomy. A total of 47 patients were included: 19 (40.4%) with placenta accreta, 14 (29.8%) with placenta increta, and 14 (29.8%) with placenta percreta. Mean estimated blood loss was 1416 ± 699 mL, and mean operative time was 112 ± 49 minutes. Overall, 16 patients (34.0%) required blood transfusion, and 4 patients (8.5%) required ICU admission. The average hospitalization was 5.2 days, with no re-admission within 30 days. The use of internal iliac balloons did not result in a difference in blood loss or operative time (P > 0.05). Patients with placenta percreta had significantly more blood loss (P = 0.02) and longer operative time (P = 0.007) compared with those with placenta accreta and increta. CONCLUSION The current surgical model for planned Caesarean hysterectomy for PAS exhibits a low complication rate. Further research is needed for developing a standardized approach to the management of PAS.
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Affiliation(s)
- Cristina Mitric
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Jade Desilets
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Jacques Balayla
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Cleve Ziegler
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC.
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Internal Iliac Artery Balloon Tamponade in Placenta Accreta: Outcomes From the Largest Tertiary Accreta Referral Centre in British Columbia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:466-472. [DOI: 10.1016/j.jogc.2018.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/13/2018] [Indexed: 11/22/2022]
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Huang G, Wang X, Yu H, Zhou S. A new surgical technique "cervical internal os plasty" in cesarean delivery for placenta previa accreta: A case-control study. Medicine (Baltimore) 2019; 98:e14488. [PMID: 30817563 PMCID: PMC6831357 DOI: 10.1097/md.0000000000014488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Placenta previa accreta is an obstetrical complication that severely affects the heath of the fetus and the mother due to massive hemorrhage during pregnancy. This study reported a new suture technique called "cervical internal os plasty" to control obstetrical hemorrhage in cesarean delivery for patients with placenta previa accreta and retrospectively evaluated the safety and effectiveness of the new technique.From January 2012 to May 2018, we collected 56 patients with this new suture technique, which repaired the damaged weak area with bleeding from the placental attachment site in the lower uterine segment, and restored the damaged anatomic internal os of the cervix. Meanwhile, we compared it with 60 cases with other conservative methods described by other obstetricians with the same qualifications. The perioperative outcomes (blood loss, blood transfusion, operative time, other applied medical technology, and so on) between the 2 groups were recorded in this report.There were no significant differences between 2 groups among age, gravidity, parity, gestational age, and previous dilatation and curettage techniques (P > .05). Of the patients with placenta previa accrete, 77.6% (90/116) had previous dilatation and curettage. The comparison between study group and control group on the rate of postpartum hemorrhage, blood transfusion, and mean operative time, average hospitalization days after cesarean delivery, expenses was not statistically significant (P > .05). Compared with the control group, other applied supplementary techniques (including uterine tamponade, pelvic arterial embolization, or emergency hysterectomy) for the bleeding from the the placental attachment site is fewer significantly in the study group. No operative accident and hemorrhea-related complication occurred in the 2 groups.Cervical internal os plasty is useful in patients with placenta previa accreta due to its simplicity, utility, and effectivity as well as its capacity for preserving fertility.
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Di Mascio D, Calì G, D'antonio F. Updates on the management of placenta accreta spectrum. ACTA ACUST UNITED AC 2019; 71:113-120. [DOI: 10.23736/s0026-4784.18.04333-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Chodraui-Filho SF, Monsignore LM, Freitas RK, Nakiri GS, de Carvalho Cavalli R, Duarte G, Abud DG. Can the combination of internal iliac temporary occlusion and uterine artery embolization reduce bleeding and the need for intraoperative blood transfusion in cases of invasive placentation? Clinics (Sao Paulo) 2019; 74:e946. [PMID: 31241664 PMCID: PMC6558998 DOI: 10.6061/clinics/2019/e946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 04/24/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Women with invasive placentation (IP) are at high risk of life-threatening hemorrhage. In the last two decades, less invasive surgical approaches combined with endovascular procedures have proven to be safe. Most case series describe the use of temporary balloon occlusion and embolization, either combined or not. Concerning hemorrhage rates, each separate interventional approach performs better than surgery alone does, yet it is not clear whether the combination of multiple interventional techniques can be beneficial and promote a lower incidence of intrapartum bleeding. We aim to evaluate whether combining temporary balloon occlusion of the internal iliac artery and uterine artery embolization promotes better hemorrhage control than do other individual interventional approaches reported in the scientific literature in the context of cesarean birth followed by hysterectomy in patients with IP. METHODS This is a retrospective analysis of patients with confirmed IP who underwent temporary balloon occlusion and embolization of the internal iliac arteries followed by puerperal hysterectomy. We compared patient results to data extracted from a recent systematic review and meta-analysis of the current literature that focused on interventional procedures in patients with IP. RESULTS A total of 35 patients underwent the procedure during the study period in our institution. The mean volume of packed red blood cells and the estimated blood loss were 487.9 mL and 1193 mL, respectively. Four patients experienced complications that were attributed to the endovascular procedure. CONCLUSION The combination of temporary balloon occlusion and uterine artery embolization does not seem to promote better hemorrhage control than each procedure performed individually does.
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Affiliation(s)
- Salomão Faroj Chodraui-Filho
- Divisao de Radiologia Intervencionista, Departamento de Imagens Medicas, Hematologia e Oncologia Clinica, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
- Corresponding author. E-mail:
| | - Lucas Moretti Monsignore
- Divisao de Radiologia Intervencionista, Departamento de Imagens Medicas, Hematologia e Oncologia Clinica, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Rafael Kiyuze Freitas
- Divisao de Radiologia Intervencionista, Departamento de Imagens Medicas, Hematologia e Oncologia Clinica, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Guilherme Seizem Nakiri
- Divisao de Radiologia Intervencionista, Departamento de Imagens Medicas, Hematologia e Oncologia Clinica, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Ricardo de Carvalho Cavalli
- Divisao de Obstetricia, Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Geraldo Duarte
- Divisao de Obstetricia, Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Daniel Giansante Abud
- Divisao de Radiologia Intervencionista, Departamento de Imagens Medicas, Hematologia e Oncologia Clinica, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
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Yasin N, Slade L, Atkinson E, Kennedy-Andrews S, Scroggs S, Grivell R. The multidisciplinary management of placenta accreta spectrum (PAS) within a single tertiary centre: A ten-year experience. Aust N Z J Obstet Gynaecol 2018; 59:550-554. [DOI: 10.1111/ajo.12932] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Nooraishah Yasin
- Department of Obstetrics and Gynaecology; Flinders Medical Centre; Southern Adelaide Local Health Network (SALHN); Adelaide Australia
- College of Medicine and Public Health; Flinders University; Adelaide Australia
| | - Laura Slade
- Department of Obstetrics and Gynaecology; Flinders Medical Centre; Southern Adelaide Local Health Network (SALHN); Adelaide Australia
| | - Elinor Atkinson
- Department of Obstetrics and Gynaecology; Flinders Medical Centre; Southern Adelaide Local Health Network (SALHN); Adelaide Australia
| | - Sue Kennedy-Andrews
- Department of Obstetrics and Gynaecology; Flinders Medical Centre; Southern Adelaide Local Health Network (SALHN); Adelaide Australia
| | - Steven Scroggs
- Department of Obstetrics and Gynaecology; Flinders Medical Centre; Southern Adelaide Local Health Network (SALHN); Adelaide Australia
| | - Rosalie Grivell
- Department of Obstetrics and Gynaecology; Flinders Medical Centre; Southern Adelaide Local Health Network (SALHN); Adelaide Australia
- College of Medicine and Public Health; Flinders University; Adelaide Australia
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Petrov DA, Karlberg B, Singh K, Hartman M, Mittal PK. Perioperative Internal Iliac Artery Balloon Occlusion, In the Setting of Placenta Accreta and Its Variants: The Role of the Interventional Radiologist. Curr Probl Diagn Radiol 2018; 47:445-451. [DOI: 10.1067/j.cpradiol.2017.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/26/2017] [Indexed: 11/22/2022]
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The Utilization of Interventional Radiologic Procedures in the Surgical Management of Placenta Accreta Syndrome. Clin Obstet Gynecol 2018; 61:795-807. [PMID: 30289770 DOI: 10.1097/grf.0000000000000401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The role of Interventional radiologic procedures for the management of suspected placenta accreta spectrum (PAS) has evolved considerably over last 3 decades. In this article, the authors describe the various techniques of vascular occlusion for the management of PAS and provide a brief review of the literature examining the pros and cons in the use of these devices.
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DeSimone RA, Leung WK, Schwartz J. Transfusion Medicine in a Multidisciplinary Approach to Morbidly Adherent Placenta: Preparing for and Preventing the Worst. Transfus Med Rev 2018; 32:244-248. [DOI: 10.1016/j.tmrv.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/21/2018] [Accepted: 05/28/2018] [Indexed: 12/17/2022]
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An alternate surgical approach to reduce hemorrhage and complications during cesarean hysterectomy for adherent placenta. Eur J Obstet Gynecol Reprod Biol 2018; 228:215-220. [DOI: 10.1016/j.ejogrb.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 06/14/2018] [Accepted: 07/02/2018] [Indexed: 01/03/2023]
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Diagnostic accuracy of magnetic resonance imaging in assessing placental adhesion disorder in patients with placenta previa: Correlation with histological findings. Eur J Radiol 2018; 106:77-84. [DOI: 10.1016/j.ejrad.2018.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/19/2022]
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Cui R, Li M, Lu J, Bai H, Zhang Z. Management strategies for patients with placenta accreta spectrum disorders who underwent pregnancy termination in the second trimester: a retrospective study. BMC Pregnancy Childbirth 2018; 18:298. [PMID: 29996794 PMCID: PMC6042202 DOI: 10.1186/s12884-018-1935-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/04/2018] [Indexed: 12/18/2022] Open
Abstract
Background The unique clinical features of pregnancy termination in the second trimester with concurrent placenta accreta spectrum (PAS) disorders place obstetricians in a complex and delicate situation. However, there are limited data on this rare and dangerous condition. The objective of this research was to investigate and evaluate the clinical management strategies of this patient group. Methods The medical records of patients who were diagnosed and treated in our hospital from December 2005 and December 2015 were retrospectively reviewed. Results A total of 29 patients were included in this analysis. A prenatal diagnosis was suspected in 8 (27.6%) patients, and the remaining 21 (72.4%) patients were diagnosed after pregnancy termination in the second trimester. In the subgroup with a prenatal diagnosis, a planned hysterotomy was performed in 7 patients who had total placenta previa and previous cesarean delivery. The remaining patient received medical termination. A subtotal hysterectomy was performed in 3 (10.3%) patients for life-threatening bleeding during hysterotomy, and the uterus was preserved with an in situ placenta in the remaining 5 patients. In the subgroup with a postnatal diagnosis, the implanted placenta remained partly or completely in situ in all 21 patients under informed consent. Ultimately, the implanted placenta remained partly or completely in situ in 26 (89.7%) patients in the two subgroups. With the application of adjuvant treatments, including uterine artery embolization and medication followed by curettage under ultrasound guidance, the implanted placenta was passed 76.6 (range: 19 to 192) days after termination. Uterus preservation was achieved in all 26 patients. The complications associated with conservative management included delayed postnatal hemorrhaging (2 cases, 7.7%), fever (6 cases, 23.1%), G1 transaminase disorder (4 cases, 15.4%), and myelosuppression (1 case, 3.8%). Seven women (26.9%) had a spontaneous pregnancy after conservative management, and no patient experienced recurrent PAS disorders. Conclusions Leaving the implanted placenta in situ is the preferred choice for patients with PAS disorders who underwent pregnancy termination in the second trimester and desired fertility preservation. Multiple adjuvant treatment modalities, either alone or in combination, may help to promote the passing or absorption of the implanted placenta under close monitoring.
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Affiliation(s)
- Ran Cui
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No.8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China
| | - Menghui Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No.8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China
| | - Junli Lu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No.8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China
| | - Huimin Bai
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No.8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China.
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No.8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China.
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Prophylactic balloon occlusion of internal iliac arteries, common iliac arteries and infrarenal abdominal aorta in pregnancies complicated by placenta accreta: a retrospective cohort study. Eur Radiol 2018; 28:4959-4967. [DOI: 10.1007/s00330-018-5527-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/21/2018] [Accepted: 05/03/2018] [Indexed: 11/25/2022]
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