Alternative management of placenta accreta

Abstract

A 27-year-old lady presented at 32 weeks gestation complaining of shortness of breath, headache, palpitations and feeling generally unwell for 1 day. Her current pregnancy was complicated by major placenta praevia. Because she developed worsening symptoms of pre-eclampsia and raised blood pressure, a decision was made to deliver her by an elective Caesarean section. The Caesarean section was complicated by a morbidly adherent placenta. There was no plane of cleavage between the placenta and the uterine wall. She had severe haemorrhages of 2.5 l following delivery, and to stem the bleeding, a B-lynch suture was placed and a Rusch tamponade balloon was inserted to achieve haemostasis. Although her condition improved and she did not have any further bleeding, she developed infection 3 weeks later and had a hysterectomy. We present this case to demonstrate that balloon tamponade and Blynch suture are valuable developments in management of obstetric haemorrhage due to placenta accreta.

Selective Endovascular Balloon–Occlusion for Cesarean Delivery in Patients with Abnormal Placentation: Review of Literature and Presentation of a Case

“…Successful cases have also been reported of tamponade of the placental site with a specially designed balloon inflated in the uterine cavity. 18 The use of catheter-based balloon arterial occlusion was first described by Paull et al 4 in 1995, where he used an 18-mm infrarenal aortic balloon. This was followed by several case reports describing the use of occlusive balloons to block IIAs with or without endovascular embolization.…”

Case Report: Management Options of Morbidly Adherent Placenta

“…During cesarean section classical or trans-fundal longitudinal uterine incisions to leave the placenta in situ, and postoperative methotrexate injection or uterine artery embolization can be performed 6 . In one study, the B-lynch suture was used to prevent uterine relaxation due to the retained placenta, while the tamponade balloon was used to control bleeding from the lower segment 7 . In the first case the diagnosis was doneintraoperatively there was a complete failure of separation of the placenta within more than 30 minutes and there was regular blood loss, the placenta was left insitu, with intra-operative/postoperative Oxytocin and Prostaglandin with single dose of Methotrexate 50mg IM injection postoperatively, no blood transfusion was needed.…”

Peripartum Hysterectomy

“…The conservative treatment for massive obstetric hemorrhage has the advantage of preserving fertility and menstrual function, and reducing blood loss [36,39]. It is however only possible in the presence of a stable hemodynamic condition and adequate technical support.…”

“…These alternatives to hysterectomy include effective and consistent use of oxytocics, packing of the uterus with gauze after removal of the placenta, uterine and internal arteries ligation, B-lynch uterine compression suture, balloon tamponade, uterine artery embolization, uterine repair for ruptured uterus, and argon beam coagulation of the placental site [36,39,41,42].…”