Prophylactic Hypogastric Artery Ballooning in a Patient with Complete Placenta Previa and Increta

Abstract

Abnormal attachment of the placenta (Placenta accreta, increta, and percreta) is an uncommon but potentially lethal cause of maternal mortality from massive postpartum hemorrhage. A 33-yr-old woman, who had been diagnosed with a placenta previa, was referred at 30 weeks gestation. On ultrasound, a complete type of placenta previa and multiple intraplacental lacunae, suggestive of placenta accreta, were noted. For further evaluation of the placenta, pelvis MRI was performed and revealed findings suspicious of a placenta increta. An elective cesarean delivery and subsequent hysterectomy were planned for the patient at 38 weeks gestation. On the day of delivery, endovascular catheters for balloon occlusion were placed within the hypogastric arteries, prior to the cesarean section. In the operating room, immediately after the delivery of the baby, bilateral hypogastric arteries were occluded by inflation of the balloons in the catheters previously placed within. With the placenta retained within the uterus, a total hysterectomy was performed in the usual fashion. The occluding balloons were deflated after closure of the vaginal cuff with hemostasis. The patient had stable vital signs and normal laboratory findings during the recovery period; she was discharged six days after delivery without complications. The final pathology confirmed a placenta increta.

Morbidly Adherent Placenta: Its Management and Maternal and Perinatal Outcome

“…Abnormal placentation (accreta, increta and percreta) has emerged over uterine atony as the leading indication for peripartum hysterectomy. However, these placental abnormalities rarely get detected before delivery [1][2][3]. Once a rare occurrence, morbidly adherent placenta is now becoming an increasingly common complication of pregnancy, mainly due to the increasing rate of Caesarean delivery over the past 50 years [4].…”

Transfundal Uterine Incision Performed with Prophylactic Common Iliac Artery Balloon Occlusion for Patient with Placenta Previa Totalis

“…While it requires assessment of next pregnancy, our surgical technique and IVR would provide the patient for some benefits including avoidance of blood transfusion, safety of operation, security with controlled bleeding by IVR, and uterine preservation. Even if the placentation was just a previa not an accreta, IVR prior to a cesarean delivery can minimize the blood flow, consequently the amount of bleeding and subsequent maternal morbidity might be reduced 1. Our procedure gave satisfactory results with no blood transfusion requirement under stable intraoperative conditions.…”

“…In case with some difficulty in delivering fetus, a vertical incision (isthmus-corpus) is performed, in addition to the low-segment transverse incision. When there are complications of placenta accrete and/ or uncontrolled bleeding from the placental adhesion site would require other hemostatic techniques such as ligation of internal common iliac artery or uterine artery, B-lynch method, several interventional radiology (IVR) and cesarean hysterectomy finally 1–4. Due to the development of hemostatics during cesarean section, cesarean hysterectomy in recent years has been reported to have declined 5.…”

Management of Placenta Invasion Anomaly and Cesarean Hysterectomy: Eight-year Experience of A Tertiary Center

“…Ancak bu yöntemlerin etkinli¤i ve güvenilirli¤i tart›flmal›d›r. Kollateral dolafl›m nedeniyle ortalama kanama miktar›n›n azalmad›¤›n› savunan yazarlar vard›r (14) .Bununla beraber, obstetrik kanama için uygulanan embolizasyonun vaskuler tromboz, parestezi, infeksiyon, postembolizasyon sendromu, iliak arter perforasyonu ve iskemiye ba¤l› vajina ve mesane nekrozu gibi komplikasyonlar› bildirilmifltir (15,16) . Bu konudaki tecrübe azl›¤›, komplikasyonlar›n fazlal›¤› ve uygulaman›n pratik olmay›fl› nedeniyle klini¤imizde profilaktik amaçl› ‹brahim Kalelio¤lu ve ark.…”