Role of interventional radiology in placenta accreta spectrum (PAS) disorders

Hawthorn, Benjamin R.; Ratnam, Lakshmi

doi:10.1016/j.bpobgyn.2021.01.007

Cited by 15 publications

(7 citation statements)

References 43 publications

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“…Serious complications of balloon occlusion are primarily vascular and result from balloon migration, balloon rupture, vessel intimal injury or pseudoaneurysm, claudication from downstream ischemia, and arterial thrombosis. 98,103 Arterial thrombosis occurs in 9-15% of those undergoing internal iliac artery or abdominal aorta occlusion. [104][105][106] Extended inflation time may result in complications such as limb ischemia, necrosis, or multiorgan dysfunction syndrome.…”

Section: Balloon Occlusionmentioning

confidence: 99%

Placenta Accreta Spectrum

Einerson

Gilner

Zuckerwise

2023

Obstetrics &Amp; Gynecology

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Section: Balloon Occlusionmentioning

confidence: 99%

Placenta Accreta Spectrum

Einerson

Gilner

Zuckerwise

2023

Obstetrics &Amp; Gynecology

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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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“…The use of IABO decreases blood loss during delivery in patients with PAS [ 11 , 12 ]. However, its use in Fontan-palliated patients could impose adverse hemodynamic effects.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of cesarean hysterectomy using intra-aortic balloon occlusion in a patient with Fontan circulation and placenta increta: a case report

et al. 2023

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Background In patients with Fontan circulation, hemorrhage can cause life-threatening circulatory collapse, since Fontan circulation strongly depends on the preload. Furthermore, parturients with placenta accreta spectrum are at a high risk of rapid and massive hemorrhage. Herein, we report the case of an intra-aortic balloon occlusion used for a Fontan-palliated parturient with placenta increta with successful anesthetic management. Case presentation A 35-year-old-female with Fontan circulation diagnosed with placenta increta underwent a cesarean hysterectomy. The main goal during anesthetic management was to maintain sufficient preload. Infrarenal intra-aortic balloon occlusion was used to reduce intraoperative hemorrhage. The hemodynamic changes caused were well tolerated in this case. Conclusions Intra-aortic balloon occlusion was used in a Fontan-palliated parturient with placenta increta with successful anesthetic management.

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Role of interventional radiology in placenta accreta spectrum (PAS) disorders

Cited by 15 publications

References 43 publications

Placenta Accreta Spectrum

Placenta Accreta Spectrum

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

Anesthetic management of cesarean hysterectomy using intra-aortic balloon occlusion in a patient with Fontan circulation and placenta increta: a case report

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