Temporary balloon occlusion of the common iliac arteries in patients with post-cesarean uterine scar and placenta accreta: Advantages and possible complications

Kurtser, Kurtser M.A.; Breslav, Breslav I.Yu.; Latyshkevich, Latyshkevich O.A.; Grigoryan, A.M.

doi:10.18565/aig.2016.12.70-5

Cited by 3 publications

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“…Тем более что в России пока не выпущены клинические рекомендации по родоразрешению беременных с врастанием плаценты, которые бы регламентировали действия врача. Самым распространенным путем хирургического лечения врастания плаценты является операция, состоящая из трех основных этапов: донное кесарево сечение, снижение объема циркулирующей крови в матке различными эндоваскулярными методами и последующее иссечение врастания плаценты в матку, в большинстве случаев заканчивающееся гистерэктомией [8][9][10][11][12]. Причем гистерэктомия предпочтительна…”

Section: Introductionunclassified

Clinical Experience with Organ-Preserving Surgery in Placenta Accreta

Arutyunyants¹,

Ovchinnikova²

2022

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. A higher number of repeated cesarean sections determine a higher risk of placental ingrowth into the scar area of the uterus. The absence of current clinical guidelines in this field necessitates the need for development of various methods for organ-preserving surgery in placenta accreta, which preserve a woman’s reproductive function, as well as reduce risks for future pregnancies and childbirth.Materials and methods. The paper presents the successful clinical experience of organ-preserving surgical treatment of placental ingrowth, excluding the stage of fundal cesarean section (Perinatal Center, Noyabrsk, Yamalo-Nenets Autonomous District).Case description. The paper describes two clinical cases of successful organ-preserving surgical treatment of placental ingrowth with preservation of reproductive function and provision of a more favorable prognosis for subsequent reproductive plans due to excluding formation of two scars on the uterus in different localizations.Results and discussion. Early dissection of adhesions in order to provide access to the surgical site is crucial and reduces the blood loss after fetal extraction and the risk of intraoperative complications such as bladder, ureteric and intestinal injury. Temporary compression hemostasis via performing endovascular temporary balloon occlusion of the infrarenal aorta, or via temporary turnstile hemostasis using a Foley catheter, allows for organpreserving surgery that excludes the formation of two scars on the uterus in different localizations without increasing the amount of blood loss.Conclusion. Surgical tactics in organ-preserving treatment of placental ingrowth excludes the stage of fundal cesarean section, and involves the cesarean section at the border of the uterine-placental hernia and the body of the uterus with subsequent metroplasty. The surgery performed demonstrate the optimal result – a relatively low blood loss, a short duration of the operation and, above all, more favorable prognosis for subsequent reproduction.

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Section: Introductionunclassified

Clinical Experience with Organ-Preserving Surgery in Placenta Accreta

Arutyunyants¹,

Ovchinnikova²

2022

Kreativnaâ hirurgiâ i onkologiâ

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“…20 The lack of a single point of view on the preference for a particular type of endovascular aid in the growth of the placenta, a small number of articles devoted to the temporary occlusion of common iliac arteries on both sides, led to this study. 21…”

Section: Introductionmentioning

confidence: 99%

Comparative characteristics of endovascular methods of stopping bleeding in placenta accrete

Ma¹,

Am²,

Breslav³

et al. 2018

IPCB

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Introduction: Currently, relatively rare complications of the early twentieth century, placenta accretes was transformed into perhaps the most common obstetric pathology requiring removal of the uterus. In the modern development of endovascular surgery becomes possible to significantly reduce the blood loss during childbirth and to preserve fertility. Material and methods:The paper presents the experience of using endovascular methods to reduce blood loss. Depending on the kind of care for endovascular patients were divided into two groups. The first group (n=38) consisted of patients whose delivery is accompanied by temporary balloon occlusion of the common iliac arteries on both sides, and the second group (n=59) -the patient underwent embolization of the uterine arteries.Results: Patients in both groups the use of modern technology -temporary balloon occlusion of the common iliac arteries and embolization of the uterine arteries in conjunction with hardware reinfusion of autologous eritrotsity-allowed to perform organsparing surgery all patients. The average intraoperative blood loss in patients of group I amounted to 1642±1146 ml (27.5±22.0% BCC), 26.3% of patients recorded minimal blood loss (700ml). Complications of the postoperative period was observed in 2 (6.25%) patients -in one case there was thrombosis of the common femoral artery requiring thrombectomy and execution in one patient, massive blood loss (4000 ml), filled with large doses of fresh frozen plasma and donor red blood cell mass. In group II, the intraoperative blood loss averaged 1974±1445ml or 29.7±22.4% BCC, the volume of blood loss in one patient, demanded its transfer to the ventilation. Conclusion:Temporary balloon occlusion of the common iliac arteries and uterine artery embolization are effective methods of reducing blood loss during delivery of patients with placenta accretа and uterine scar after cesarean section. With the availability of both techniques, preferably holding a temporary balloon occlusion, providing a significant reduction in blood loss volume.It can be recommended for use in hospitals level III.

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On the Issue of Optimizing Surgical Tactics and Blood-Saving Techniques in Case of Placenta Ingrowth Into the Uterine Scar

Каримов¹,

Абдикулов²

2023

Neotložnaâ med. pomoŝʹ

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AIM OF STUDY The study of the results of delivery of pregnant women with placenta ingrowth in the uterine scar depending on the clinical status and the methods of blood saving.MATERIAL AND METHODS The design of a selective retrospective study included 54 pregnant women with central placenta previa and uterine scar after caesarean section (CS), with histologically confirmed results of placenta accreta. Among blood-saving methods we used: ligation of three pairs of main vessels of the uterus, ligation of the internal iliac arteries, complex compression hemostasis according to R.G. Shmakov, temporary clamping of the common iliac arteries.RESULTS CS with fundal incision was performed in 47 women (87.0%) out of 54. Hysterectomy was performed in 17 women (31.5%) out of 54. In the remaining 37 cases (68.5%), metroplasty and organ preservation were performed. There was no relaparotomy; there was no maternal mortality; perinatal mortality was 4 (7.4%); forced opening, bladder resection were performed in 7 (13.0%) cases; opening of the bladder without wall resection — in 2 (3.7%); 2 near miss cases; there were no complications associated with temporary clamping of the common iliac arteries; endometritis (recovery after conservative treatment) was revealed in 2 women (3.7%). Histologic examination results: 15 (27.8%) of placenta accreta, 30 (55.6%) of placenta increta, 8 (14.8%) of placenta percreta. In 8 cases, there was a combination of placenta increta into the uterine scar region of different depths, and in 2 (3.7%) cases, a combined deeply invasive lesion of the posterior wall of the lower segment and the body of the uterus.CONCLUSION Complex compression hemostasis according to R.G. Shmakov is the most rational and promising method of blood saving, acceptable among the majority of patients with placenta accreta spectrum. Temporary clamping of the common iliac arteries is advisable in case of damage to the posterior wall of the bladder. Preservation of the uterus: in case of a deeply invasive lesion, including cases of combined damage to the posterior wall of the lower segment of the uterus or the body of the uterus, significant blood loss before the woman enters the hospital, it is not an imperative of surgical tactics.

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Temporary balloon occlusion of the common iliac arteries in patients with post-cesarean uterine scar and placenta accreta: Advantages and possible complications

Cited by 3 publications

References 0 publications

Clinical Experience with Organ-Preserving Surgery in Placenta Accreta

Clinical Experience with Organ-Preserving Surgery in Placenta Accreta

Comparative characteristics of endovascular methods of stopping bleeding in placenta accrete

On the Issue of Optimizing Surgical Tactics and Blood-Saving Techniques in Case of Placenta Ingrowth Into the Uterine Scar

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