Introduction and utility of resuscitative endovascular balloon occlusion of the aorta for cases with a potential high risk of postpartum hemorrhage: A single tertiary care center experience of two cases

Abstract

Postpartum hemorrhage is an important obstetric complication and the leading cause of maternal mortality worldwide. Occasionally, we encounter unexpected massive postpartum hemorrhage diagnosed for the first time after delivery. Therefore, it is essential to pay attention to patients with a high risk of postpartum hemorrhage. The authors report two cases of patients at high risk of postpartum hemorrhage that were successfully managed by resuscitative endovascular balloon occlusion of the aorta before cesarean section. Case 1 : A 32 -yearold woman with a history of cesarean section and who conceived using assisted reproductive technology was diagnosed with partial placenta previa at 25 weeks of gestation. Because of tocolysis failure, emergent cesarean section with resuscitative endovascular balloon occlusion of the aorta was performed at 36 weeks of gestation. Natural placental resorption was observed. She was discharged at 5 days after delivery without significant hemorrhage. Case 2 : A 41 -yearold woman with suspected placenta accreta spectrum due to a cesarean scar pregnancy was referred to our hospital at 33 weeks of gestation. A planned cesarean section with resuscitative endovascular balloon occlusion of the aorta was conducted at 37 weeks of gestation. There was no visual evidence of abnormal placental invasion of the myometrium, and natural placental resorption was observed. She was discharged at 5 days after delivery without significant hemorrhage.

Late-onset hypertensive disorders of pregnancy and red blood cell distribution width during late pregnancy among Japanese primipara: A nested case-control study

“…For example, the ratio of BMI > 25 kg/m 2 before pregnancy in the control group was 26.3%, which was higher than that in the birth cohort study (BMI > 25 kg/m 2 before pregnancy: 12.7%) conducted during the same period in Fukushima Prefecture [1]. Finally, because most cases in our institution were referred from other hospitals as high-risk cases [34], information that could potentially affect CBC data such as iron de ciency/supplement was unavailable.…”

Postpartum hemorrhage with associated placenta previa in a kidney transplant recipient: A case report

“…Recently, prophylactic REBOA has been utilized to reduce bleeding in PPH cases, and its effectiveness has been investigated [ 7 , 8 , 11 ]. However, awareness of the risks associated with REBOA, such as ischemia-reperfusion-related complications, including acute kidney injury, limb ischemia, spinal cord ischemia, and visceral organ dysfunction, is necessary [ 12 , 13 ].…”

Predicting postpartum hemorrhage in women undergoing planned cesarean section: A multicenter retrospective cohort study in Japan

“…REBOA has been shown to reduce overall blood loss and transfusions, improving maternal outcomes in patients with expected placenta accreta spectrum disorders [ 39 – 43 ]. Our institution recently introduced REBOA for high-risk PPH cases [ 44 ]. We consider that the use of REBOA may help prevent PPH when bleeding risk factors identified in our analysis coincide with placenta previa, a known bleeding factor.…”