Prophylactic balloon occlusion of internal iliac arteries, common iliac arteries and infrarenal abdominal aorta in pregnancies complicated by placenta accreta: a retrospective cohort study

Li, Kui; Zou, Yu; Sun, Jinhua; Hong, Wen

doi:10.1007/s00330-018-5527-7

Cited by 36 publications

(16 citation statements)

References 18 publications

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“…The hemostasis methods were not arranged in advance. The proportion of patients who underwent ABO in the massive hemorrhage group was greater than that in the moderate hemorrhage group, but the ABO was more effective (25). Therefore, the hemostasis method of ABO should not influence the results.…”

Section: Discussionmentioning

confidence: 92%

Assessment of the massive hemorrhage in placenta accreta spectrum with magnetic resonance imaging

et al. 2020

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The aim of the present study was to evaluate whether MRI features are able to predict massive hemorrhage of patients with placenta accreta spectrum (PAS). A total of 40 patients with suspected PAS after ultrasound examination were subjected to MRI. Of these, 29 patients were confirmed as having PAS. MRI data were analyzed independently by two radiologists in a blinded manner. Inter-observer agreement was determined. The 29 confirmed patients were divided into two groups (moderate and massive hemorrhage) according to the estimated blood loss (EBL) and blood transfusion, and the MRI features were compared between the two groups. The EBL, as well as blood transfusion, between the patients with and without each MRI feature were compared. The inter-observer agreement between the two radiologists for the 11 MRI features had statistical significance (P<0.05). Intra-placental thick dark bands and markedly heterogeneous placenta were the most important MRI features in predicting massive hemorrhage and blood transfusion (P<0.05). The difference in EBL between the patients with and without focal defect of the uteroplacental interface (UPI) was significant (P<0.05). The differences in blood transfusion between the patients with and without myometrial thinning, disruption of the inner layer of the UPI, increased placental vascularity and increased vascularity at the UPI were significant (P<0.05). These results indicate that MRI features may predict massive hemorrhage of patients with PAS, which may be helpful for pre-operative preparation of PAS patients.

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Section: Discussionmentioning

confidence: 92%

Assessment of the massive hemorrhage in placenta accreta spectrum with magnetic resonance imaging

et al. 2020

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“…Shrivastava et al [31] believe that the failure of internal iliac artery balloon occlusion to reduce blood loss may be due to excessive uterine blood flow during pregnancy and extensive intrapelvic vascular anastomosis. In addition to uterine artery support, the blood supply of the uterus also includes the obturator artery, ovarian artery and femoral artery [33,34]. In PAS with placenta previa, the placenta is mostly located in the lower part of the uterus, the cervix and the upper part of the vagina, where many abnormal vascular anastomotic branches exist [35,36].…”

Section: Discussionmentioning

confidence: 99%

The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study

Peng

Jiang

Cheng

et al. 2020

BMC Pregnancy Childbirth

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Background: Severe obstetric haemorrhage caused by placenta accreta spectrum (PAS) results in significant maternal morbidity and mortality. The effectiveness of prophylactic balloon occlusion of the internal iliac artery in PAS patients remains controversial. Therefore, we conducted a retrospective case-control study to investigate the clinical effectiveness of this treatment. Methods: The clinical data of 104 patients with PAS complicated with placenta previa who delivered by caesarean section between January 2016 and January 2019 were collected, and the patients were divided into two groups. The study group (48 cases) underwent internal iliac artery preset balloon occlusion before caesarean section and uterine artery embolisation according to the bleeding status after surgery, while the control group (56 cases) did not undergo internal iliac artery preset balloon occlusion before caesarean section. Results: The operation and hospitalisation times in the study group were longer than those in the control group. Additionally, the hysterectomy rate in the study group was significantly higher than that in the control group. No significant differences in blood loss, blood transfusion volume, urinary system injury, postoperative ICU transfer rate, or neonatal scores were identified between the groups. Among the patients without invasive placenta (placenta increta and percreta), blood loss was lower in the study group, and the caesarean hysterectomy rate did not significantly differ between the groups. Among the patients with invasive placenta, blood loss and the caesarean hysterectomy rate did not significantly differ between the groups. The risk of hysterectomy in the study group was related to invasive placenta penetration, a large area of placental invasion, or abnormal vascular filling. One patient in the study group had a thrombus in the left lower extremity artery.

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“…Only two procedure-related complications were described, namely thrombosis in the internal iliac arteries, without long-term complications. (32) Our interpretation of this literature is that a subset of women with placenta previa and features of either placenta increta or percreta are at risk of excessive blood loss at Cesarean delivery of their baby, despite well-developed team-based surgical skills. However, contemporary outcomes for such women in large centers does not justify the routine use of an aortic balloon.…”

Section: Percutaneous Aortic Balloon Placementmentioning

confidence: 99%

Minimizing surgical blood loss at cesarean hysterectomy for placenta previa with evidence of placenta increta or placenta percreta: the state of play in 2020

Kingdom

Hobson

Murji

et al. 2020

American Journal of Obstetrics and Gynecology

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The evolution of multidisciplinary team-based care for women with placenta accreta spectrum (PAS) disorder has delivered step-wise improvements in clinical outcomes. Central to this overall goal is the ability to limit blood loss at surgery. Placement of inflatable balloons within the pelvic arteries, most commonly in the anterior divisions of the internal iliac arteries, became popular in many centers, at the expense of prolonging surgical care, and with attendant risks of vascular injury. In tandem, the need to expose pelvic sidewall anatomy in order to safely identify the course of the ureters re-popularized the alternative strategy of ligating the same anterior divisions of the internal iliac arteries. With incremental gains in surgical expertise, described in 5 steps in this review, our teams have witnessed a steady safely performing elective cesarean hysterectomy for placenta previa-percreta, the most severe PAS disorder.

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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

Abstract: • PBO of IIA, CIA and IAA is effective in placenta accreta. • PBO of CIA and IAA is more effective. • PBO could independently predict less EBL. • Accreta depth was an independent risk factor for EBL.

Cited by 36 publications

References 18 publications

Assessment of the massive hemorrhage in placenta accreta spectrum with magnetic resonance imaging

Assessment of the massive hemorrhage in placenta accreta spectrum with magnetic resonance imaging

The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study

Minimizing surgical blood loss at cesarean hysterectomy for placenta previa with evidence of placenta increta or placenta percreta: the state of play in 2020

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