Placenta Accreta Spectrum Treatment With Intraoperative Multivessel Embolization: the PASTIME protocol

Melber, Dora J.; Berman, Zachary; Jacobs, Marni; Picel, Andrew C.; Conturie, Charlotte L.; Zhang-Rutledge, Kathy; Binder, Pratibha; Eskander, Ramez N.; Roberts, Anne C.; McHale, Michael; Ramos, Gladys A.; Ballas, Jerasimos; Kelly, Thomas F.

doi:10.1016/j.ajog.2021.07.001

Cited by 17 publications

(14 citation statements)

References 36 publications

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“…There are several approaches available to decrease surgical blood loss during cesarean hysterectomy, including multivessel surgical ligation, temporary aortic clamping, multivessel embolization, and balloon occlusion of the aorta or iliac arteries. 3 Several groups have reported superior outcomes with resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to hemorrhage control during cesarean hysterectomy for PAS. [4][5][6][7][8][9][10][11][12] A meta-analysis of 731 PAS patients who underwent cesarean deliveries in which a REBOA catheter was used to occlude the infrarenal aorta, termed zone 3, found that these women experienced significantly less blood loss, received fewer transfusions, and achieved a higher rate of uterine preservation compared with other hemorrhage control strategies.…”

Section: Questionsmentioning

confidence: 99%

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confidence: 99%

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Aortic balloon occlusion in distal zone 3 reduces blood loss from obstetric hemorrhage in placenta accreta spectrum

Kluck

Russo

Appel

et al. 2023

J Trauma Acute Care Surg

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In support of improving patient care, this activity has been planned and implemented by CineMed and the American Association for the Surgery of Trauma. CineMed is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. AMA PRA Category 1 Credits™CineMed designates this enduing material for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Section: Questionsmentioning

confidence: 99%

mentioning

confidence: 99%

Aortic balloon occlusion in distal zone 3 reduces blood loss from obstetric hemorrhage in placenta accreta spectrum

Kluck

Russo

Appel

et al. 2023

J Trauma Acute Care Surg

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“…According to the SMFM guidelines, the role of iliac artery occlusion (internal and common arteries) is still controversial as it has been reported to decrease blood loss in some studies but showed no difference in others [2]. It also has been postulated that PAS is associated with neovascularisation and abnormal blood supply therefore occluding pelvic vessels may exacerbate bleeding from the collateral circulation, thus limiting the benefit of this procedure [17][18][19][20][21][22][23][24][25][26]. International Federation of Obstetrics and Gynecology (FIGO) does not recommend its routine use due to a lack of strong supporting evidence of their benefit [1].…”

Section: Discussionmentioning

confidence: 99%

Placenta Accreta Spectrum (PAS) Disorders: Lessons Learned from the Introduction of Different Management Strategies in an Australian Tertiary Hospital. Retrospective Study (2004 to 2020)

Caldas¹,

Parr²,

Adno³

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Background: Placenta accreta spectrum (PAS) disorder refers to pathologic adherence of the placenta and presents multiple perinatal challenges, accounting for between 30-50% of emergency peripartum hysterectomies. Accurate prenatal diagnosis allows multidisciplinary management and delivery at centres with experience and has been shown to improve perinatal outcomes. This study aims to analyse the results of implementing different strategies across the years on the diagnosis and management of PAS in a tertiary Australian hospital (Liverpool Hospital) including: the use of magnetic resonance imaging (MRI) and the benefits of the use of iliac artery balloons and ureteric stents. Secondary objectives include analysis of the risk factors and outcomes. Methods: Retrospective case series of 34 pregnancies complicated by PAS disorders, diagnosed between 2004 and 2020, and delivered at Liverpool Hospital. Descriptive and analytic study (with a significance level of p ≤ 0.05), approved by the Research Ethics and Governance Information System. Results: The incidence of PAS was 0.6 per 1000 deliveries. The typical risk factors (previous uterine surgeries and placenta praevia) were present in 79% of the cases. MRI was used in 39% of the cases (when ultrasound was inconclusive or placenta posterior) and was only inconclusive in 1 case. In total, 32% required emergency delivery due to haemorrhage or preterm labor. The overall complications rate was 32%. Ureteric stents were used in 44% of the cases and there were no ureteric injuries. The use of iliac balloons reduced the total blood loss (2.5 L compared to 2.8 L), however this difference was not statistically significant (p = 0.21). Conclusions: The prenatal diagnosis of PAS is essential to allow optimal perinatal management of these cases. The use of MRI appears helpful when ultrasound is inconclusive. In our study, the use of iliac balloons reduced blood loss, although this was not statistically significant, and ureteric stents appeared useful to avoid ureteric injury in the most complex cases, although the sample is very small. We hope that our study will help us improving our clinical practice.

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“…average blood loss while drastically reducing the potential for nontarget ischemia that can result from aortic or internal iliac balloon occlusion. 86,108 Similar to most balloon occlusion data, prophylactic embolization data are retrospective, but the reported reduction in blood loss and transfusion rates sparks interest for a prospective study.…”

Section: Prophylactic Multivessel Embolizationmentioning

confidence: 98%