Does temproray bilateral balloon occlusion of the common iliac arteries reduce the need for intra‐operative blood transfusion in cases of placenta accretism?

Al-Hadethi, Sinan; Fernando, Shane; Hughes, Simon M.; Thakorlal, Ajay; Seruga, Adam; Scurry, Bonnie

doi:10.1111/1754-9485.12560

Cited by 18 publications

(10 citation statements)

References 17 publications

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“…Since Shih et al .’s study,13 a number of reports have demonstrated the efficacy of CIABO,14, 15 while Sinan et al . reported that there was no significant difference in intraoperative blood loss or transfusion between 25 patients who underwent CH with and 27 who underwent CH without the use of CIABO for placenta previa with accreta 16. Because the numbers of patients were limited in these retrospective studies, a large‐scale, multicenter prospective study needs to be performed.…”

Section: Discussionmentioning

confidence: 99%

Study of the utility and problems of common iliac artery balloon occlusion for placenta previa with accreta

Ono

Murayama

Era

et al. 2018

J of Obstet and Gynaecol

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AimsWe investigated whether common iliac artery balloon occlusion (CIABO) was effective for decreasing blood loss during cesarean hysterectomy (CH) in patients with placenta previa with accreta and was safe for mothers and fetuses.MethodsOf the 67 patients who underwent CH for placenta previa with accreta at our facility from 1985 to 2014, 57 patients were eligible for the study. The amount of intraoperative bleeding during CH was compared between three groups: surgery without blood flow occlusion (13 patients), internal iliac artery ligation (15 patients) and CIABO (29 patients). Additionally, multivariate analysis was performed to assess risk factors for massive bleeding during CH.ResultsThe mean blood loss in the CIABO group (2027 ± 1638 mL) was significantly lower than in the other two groups (3787 ± 2936 mL in the no occlusion, 4175 ± 1921 mL in the internal iliac artery ligation group; P < 0.05). Multivariate analysis showed that spontaneous placental detachment during surgery (odds ratio [OR] 49.174, 95% confidence interval [CI] 4.98–1763.67), a history of ≥ 2 cesarean sections (OR 9.226, 95% CI 1.07–231.15) and no use of CIABO (OR 26.403, 95% CI 3.20–645.17) were significantly related to massive bleeding during surgery. There was no case of necrosis resulting from ischemia. The mean radiation dose during balloon placement never exceeded the threshold value for fetal exposure.ConclusionBleeding during CH for placenta previa with accreta can be decreased by CIABO. This study also confirmed the safety of CIABO in regard to maternal lower limb ischemia and fetal radiation exposure during balloon placement.

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Section: Discussionmentioning

confidence: 99%

Study of the utility and problems of common iliac artery balloon occlusion for placenta previa with accreta

Ono

Murayama

Era

et al. 2018

J of Obstet and Gynaecol

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“…Now placement of occlusion balloons is becoming a popular alternative to surgical management in controlling uterine hemorrhage, although its benefits remain a subject of debate. There were particularly conflicting results when the balloons were placed in the IIA or CIA, [ 9 – 15 ] but the results were more consistent when placed in the IAA. [ 16 – 20 ] Viana et al [ 12 ] reported a randomized trial including 27 women suspected MAP, and found no benefit to hemostasis by the use of IIA balloon.…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of occlusion of IIA or CIA is limited by rapid recruitment of an extensive collateral system in the pelvis. [ 9 – 15 ]…”

Section: Introductionmentioning

confidence: 99%

Preoperative infrarenal abdominal aorta balloon catheter occlusion combined with Bakri tamponade reduced maternal morbidity of placenta increta/percreta

et al. 2017

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Background:Placenta increta/percreta is an increasingly common and life-threatening obstetric complication. It poses a management challenge to clinicians. The present study aimed to evaluate efficacy and safety of preoperative placement of infrarenal abdominal aorta balloon catheter (IAABC) alone or combined with Bakri tamponade for the management of cases with placenta increta/percreta.Methods:We retrospectively analyzed all cases with placenta increta/percreta at a tertiary referral teaching hospital in China between the year 2014 and 2017. Statistical analysis considered the individual subgroups: IAABC placed group and control group (without IAABC), and compared their maternal–fetal outcomes.Results:The study covered 86 cases with placenta increta. For cases in the IAABC placed group (n = 48), significant reductions were noted in maternal morbidity including estimated blood loss (EBL), EBL ≥ 2000 mL, blood products transfusions, postpartum hemorrhage, operative time, intensive care unit admission, and postoperative days (P < .05 for all). The overall rate of hysterectomy was much lower (4.2%vs 23.7%, P = .018), compared with those in the control group (n = 38). Furthermore, in the IAABC placed group, hysterectomy was avoided in a further 17 cases combined with Bakri tamponade. In the control group, 10 cases were successful in preserving uterus by Bakri tamponade. Four cases failed and needed reoperation (3 uterine arterial embolism, 1 hysterectomy). There were no differences in fetal outcomes between the 2 groups. Eighteen cases were diagnosed with placenta percreta. Almost all the cases (17/18) inevitably underwent caesarean hysterectomy. Only 1 case was treated with a combination of IAABC and Bakri tamponade, and successfully reserved uterus. No differences were observed in any other outcomes, except for a significant less mean operative time (P = .017) in cases with IAABC placed (n = 10), compared with those without IAABC (n = 8). Only 1 case had a femoral artery thrombosis directly related to IAABC placement and recovered after conservative treatment. There was no maternal or neonatal death in this study.Conclusion:Prophylactic insertion of IAABC alone or combined with Bakri tamponade should be safe and effective in controlling intraoperative bleeding due to placenta increta, thus hysterectomy could be avoided. It seems to be less beneficial to women with placenta percreta. Bakri tamponade can be a good choice in the management of placenta increta/percreta before more aggressive surgeries.

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“…Preokliuziniai balionėliai turi būti išpučiami iš karto po naujagimio gimimo ir virkštelės užspaudimo, tokiu būdu blokuojama gimdos kraujotaka tuoj po gimimo, o naujagimis apsaugomas nuo hipoksijos [4,[10][11][12][16][17][18]. Šis balionėlių išpūtimo momentas buvo pasirinktas ir mūsų aprašytais atvejais.…”

Section: Diskusija Ir Literatūros Apžvalgaunclassified

“…Literatūroje dažniausiai aprašomi atvejai, kai balionė-liai išleidžiami dar operacijos metu, siekiant užtikrinti hemostazę [12, [16][17][18]. Išleidus balionėlius stebima, ar nėra kraujavimo.…”

Section: Diskusija Ir Literatūros Apžvalgaunclassified

Preokliuzinių balionėlių naudojimas perioperaciniam kraujavimui mažinti esant invazyviai placentai: tretinio lygio stacionaro patirtis ir literatūros apžvalga

Morozovaitė¹,

Šiaudinytė²,

Volochovič³

et al. 2017

LietChirur

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Įvadas / tikslasNenormalus choriono gaurelių skverbimasis ir placentos prisitvirtinimas vadinamas invazyvia placenta. Pavojingiausias šios patologijos variantas yra peraugusi placenta. Viena sunkiausių peraugusios placentos komplikacijų yra masyvus kraujavimas. Vienas galimų būdų sumažinti netekto kraujo kiekį operacijos metu yra preokliuzinių balionėlių išpūtimas gimdą maitinančiose kraujagyslėse. Straipsnio tikslas -aptarti preokliuzinių balionėlių naudojimą pacientėms, kurioms antenataliniu laikotarpiu diagnozuota peraugusi placenta, palyginti kraujavimo profilaktikos taktiką ir pateikti literatūros apžvalgą. Tyrimo medžiaga ir metodai Atlikta retrospektyvioji dviejų pacienčių medicininės dokumentacijos analizė, palyginti taikytos intervencinės radiologijos metodikos ypatumai bei pateikta literatūros apžvalga. 205Preokliuzinių balionėlių naudojimas perioperaciniam kraujavimui mažinti esant invazyviai placentai: tretinio lygio stacionaro patirtis ir literatūros apžvalga RezultataiAntenataliniu laikotarpiu diagnozavus invazyvią placentą, nutarta pacientėms prieš suplanuotas cezario pjūvio operacijas masyvaus kraujavimo profilaktikai išpūsti į gimdą maitinančias kraujagysles įstumtus preokliuzinius balionėlius iškart po naujagimio gimimo. Pirmuoju atveju balionėliai išleisti tik perkėlus pacientę į skyrių. Praėjus 4 valandoms po operacijos dėl vidinio kraujavimo buvo atlikta relaparatomija, revizuotos kraujagyslių bigės, papildoma perrišta kairė vidinė klubinė arterija. Antruoju atveju balionėliai išleisti ir ištraukti prieš užbaigiant cezario pjūvio operaciją, dar kartą patikrinta hemostazė. Išvados Peraugusi placenta yra grėsminga akušerinė patologija, galinti sukelti masyvų kraujavimą. Pacienčių gydymas turi būti iš anksto atsakingai planuojamas. Intervencinės radiologijos metodai padeda sumažinti netekto kraujo kiekį. Norint užtikrinti adekvačią hemostazę, preokliuzinius balionėlius reikėtų išleisti prieš baigiant operaciją. Reikšminiai žodžiai: invazyvi placenta, kraujavimas akušerijos praktikoje, intervencinė radiologija, preokliuziniai balionėliai Background / ObjectiveAbnormal penetration of chorionic villi into the wall of uterus is called invasive placenta. The most dangerous type is placenta percreta. It can lead to massive bleeding, which is one of the most serious complications. In order to reduce blood loss during operation intraoperative balloon occlusion of uterus supplying vessels could be use. Our aim is to present the management of perioperative balloon occlusion for two patients with antenatal diagnosis of placenta percreta, compare the prophylaxis of bleeding and review literature. Patients and MethodsWe carried out a retrospective analysis of medical history of two patients, compared interventional radiology methods between these cases and performed a literature review. ResultsTwo patients with antenatal diagnosis of placenta percreta were determined to undergo an elective cesarean section. Preoperative balloon insertion and inflation after birth was used for massive bleeding prophylaxis. I...

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Does temproray bilateral balloon occlusion of the common iliac arteries reduce the need for intra‐operative blood transfusion in cases of placenta accretism?

Abstract: Our study was not able to detect a significant difference in blood loss or blood product requirement between patients who underwent CIA balloon in the setting of caesarean section for placenta accreta. This remains a challenging scenario requiring a multidisciplinary approach.

Cited by 18 publications

References 17 publications

Study of the utility and problems of common iliac artery balloon occlusion for placenta previa with accreta

Study of the utility and problems of common iliac artery balloon occlusion for placenta previa with accreta

Preoperative infrarenal abdominal aorta balloon catheter occlusion combined with Bakri tamponade reduced maternal morbidity of placenta increta/percreta

Preokliuzinių balionėlių naudojimas perioperaciniam kraujavimui mažinti esant invazyviai placentai: tretinio lygio stacionaro patirtis ir literatūros apžvalga

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