Prophylactic intraoperative uterine or internal iliac artery embolization in planned cesarean for pernicious placenta previa in the third trimester of pregnancy

Abstract

The aim of this study was to evaluate the efficacy and safety of prophylactic intraoperative bilateral uterine or internal iliac artery embolization in planned cesarean for pernicious placenta previa in the third trimester of pregnancy. The patients with pernicious placenta previa were retrospectively included from January 2011 to May 2018, being divided into embolization group and control group. Intraoperative uterine artery embolization (UAE) or internal iliac artery embolization (IIAE) was undertaken to stop intrapartum and postpartum hemorrhage in embolization group. There were no significant differences on age, pregnancy times, gestational age, neonatal weight, neonatal asphyxia, prenatal bleeding, placental implantation, and mortality between embolization group and control group (P > .05). The amount of intraoperative and postoperative bleeding in embolization group was significantly greater than that in control group (P < .05). However, the hysterectomy rate in the embolization group was significantly lower than that in the control group (P < .05). Two (6.25%, 2/32) cases had undergone the second time embolotherapy after 8 hours of cesarean surgery because of severe vaginal bleeding. One case (3.13%, 1/32) died of diffuse intravascular coagulation because of hemorrhagic shock in embolization group. Transient and self-remitted lumbosacral pain was present in 28 (95%, 28/32) patients and no other severe interventional complications were reported in embolization group. All babies in 2 groups were healthy at half to 5 years’ follow-up. The prophylactic intraoperative embolization of bilateral UAE or IIAE may be an effective strategy to treat intractable peripartum hemorrhage and preserve the fertility in patients with pernicious placenta previa.

Combined Uterine Artery Ligation, Segmental Myometrial Resection and Intrauterine Balloon to Control Bleeding from Placenta Previa Accreta during Caesarean Section

“…In agreement with the current work, Lin et al [18] reported that, BUAL followed by delivery of the placenta in females with placental invasion effectively decrease intraoperative blood loss, reduce postpartum hemorrhage [PPH], and the risk of complications [e.g., hysterectomy]. In addition, Wang et al [19] concluded that, prophylactic intraoperative bilateral uterine artery or internal iliac artery embolization represent an effective strategy to control intractable peripartum hemorrhage and preserve fertility in placenta previa.…”

Analysis of Related Influencing Factors of Hysterectomy in Patients With Placenta Accreta Spectrum Disorders After Uterine Artery Embolization

“…Compared to our research, the rate of hysterectomy during cesareans was similar to our study, while the total hysterectomy rate in the percreta group was quite higher than our results(50%) [24]. It was speculated that this was related to the fact that the patients included in our study were diagnosed with PAS by US or MR before surgery and trended to make adequate preparations to prevent severe bleeding, such as UAE, which could reduce the rate of hysterectomy, to some extent [25]. Moreover, for patients with stable hemodynamics and no lifethreatening bleeding, we preferred to leave the placenta in situ when the implanted placenta could not be separated from the uterine wall, which could reduce the occurrence of major bleeding that might cause emergency hysterectomy to a certain extent [26,27].…”

The Efficacy and Postoperative Follow-Up of Different Interventional Methods in Cesarean Section for Placenta Accreta Spectrum Disorders

“…During operation, we observed that hemorrhage was significantly reduced in the surgical field of the 2 interventional methods, which subjectively confirmed the effectiveness of our radiology technology. Previous studies also pointed out that these 2 methods were effective in controlling bleeding in placenta accreta [ 10 , 14 , 15 ]. However, there are few studies comparing the 2 techniques.…”

“…With the rapid development of interventional medicine, interventional therapy has played an increasingly important role in the multidisciplinary treatment of PAS [ 9 – 15 ], including internal iliac artery embolization, uterine artery embolization, internal iliac artery balloon block, and abdominal aortic balloon block. However, the curative effects of some techniques are limited due to extensive collateral blood supply in the uterus of PAS patients.…”