Prophylactic Perioperative Hypogastric Artery Balloon Occlusion in  Abnormal Placentation

Kidney, David D.; Nguyen, Alison M.; Ahdoot, David; Bickmore, Dan; Deutsch, Larry-Stuart; Majors, Carol

doi:10.2214/ajr.176.6.1761521

Cited by 102 publications

(81 citation statements)

References 9 publications

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“…These successes were confirmed in further studies [18,21]. Kidney et al [23] showed reliable hemostasis with only minimal complications via temporary occlusion without particle embolization in the case of placenta accreta. Polytransfusions were needed in only one patient in another study by Li et al [8], while only a single blood transfusion and volume substitutions were sufficient in 12 of 21 patients [8].…”

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confidence: 76%

Intraoperative Intermittent Blocking of the Common Iliac Arteries in Cases of Placenta Percreta without the Use of Fluoroscopy

Heinze

Filsinger

Kastenholz

et al. 2016

Fortschr Röntgenstr

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Background: The number of patients with placenta accreta, percreta and increta is increasing. The morbidity and mortality are higher mostly due to hemorrhage. Therefore, new methods to reduce the risk of severe bleeding are necessary. Methods: Three patients were treated in collaboration by obstetricians, urologists, anesthesiologists, and radiologists. An MRI of the pelvis was performed and the diameters and lengths of the iliac arteries were measured to?avoid fluoroscopy during the preoperative placement of catheter balloons into the iliac arteries. During the operational procedure the balloons were inflated and deflated depending on the operative site and the occurrence of bleeding. Results: In comparison to the literature, severe bleeding was clearly reduced. No complications of the intervention were observed. Conclusion: The presented method to reduce severe bleeding might represent significant progress in the management of abnormal placenta implantation. Nevertheless, further controlled studies are needed in order to establish evidence-based recommendations. Key Points: ??Reduction of perioperative hemorrhage in cases of placenta accreta, percreta, and increta. ??A preinterventional MRI of the pelvis allows measurement of the illiac arteries so that the fetus is not exposed to radiation. ??The short occlusion time (under the nominal pressure of the balloon) of the common iliac arteries reduced interventional complications. Citation Format: ??Heinze S, Filsinger B, Kastenholz G et?al. Intraoperative Intermittent Blocking of the Common Iliac Arteries in Cases of Placenta Percreta without the Use of Fluoroscopy. Fortschr R?ntgenstr 2016; 188: 1151???1155

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confidence: 76%

Intraoperative Intermittent Blocking of the Common Iliac Arteries in Cases of Placenta Percreta without the Use of Fluoroscopy

Heinze

Filsinger

Kastenholz

et al. 2016

Fortschr Röntgenstr

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“…Hysterectomy can be performed 2 to 6 weeks later on an elective basis. Pelvic arterial embolization or balloon catheter occlusion significantly reduces uterine blood flow and allow reduced blood loss during surgery [6]. Other adjunctive procedures like methotrexate therapy, uterine compression sutures, internal iliac vessels embolization, resection of the affected segment of the uterus and oversewing of the placental bed may help [7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Placenta Previa Combined with Placenta Accreta and Fetal Congenital High Airway Obstruction- Failed Ex Utero Intrapartum Treatment

Solanki¹

2015

Glob J Anesth

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057within normal limits. Blood pressure was 110/80 mmHg and heart rate was 82/minute. Airway examination revealed mouth opening of 3 cm. She was mallampatti class II with full range of neck movement. Tablet ranitidine 150 mg and metoclopramide 10 mg was given night before surgery and in morning on day of surgery. In the operating room, standard 5 leads ECG, NIBP and pulse oximetry were attached and baseline parameters were noted. Two large bore (16 G) venous cannulae were secured in upper limbs and normal saline infusion was started. ENT and pediatric surgeons were kept ready for surgery and procedures on baby. After preoxygenation with 100% for 5 minute (target endtidal oxygen >90%), rapid sequence anesthesia was induced with IV thiopentone 325 mg and IV suxamethonium 125 mg. Trachea was secured with 7.0 mm ID tracheal tube. IV atracurium 25 mg was given once the effect of suxamethonium was tapered. Anesthesia was maintained with isoflurane in a mixture of oxygen and nitrous oxide (30:70). Right internal jugular central venous catheterization was done and radial artery was cannulated for continuous invasive blood pressure monitoring. Surgical plan was to perform ex utero intrapartum treatment (EXIT) on fetus after classical cesarean incision if the maternal bleeding will be under control. Surgery was allowed to start. Uterus was opened and baby was delivered out. As soon as the baby was delivered profuse bleeding was started from uterus and placenta. It was decided not to perform EXIT procedure and cord was clamped and cut. Bleeding was continued from uterus and placenta. Three units of packed red blood cells and three units of fresh frozen plasma were transfused. Meanwhile ENT surgeon performed tracheostomy on baby and airway was secured but baby died after half an hour. All measures to control the bleeding were failed. Bleeding was continued from uterus and placenta, hysterectomy was done. Blood loss was around 2500 IntroductionPlacental abnormalities like placenta previa and accreta are more common in parturient with prior history of cesarean delivery. They are prone to cause massive bleeding during cesarean and emergency cesarean hysterectomy has to be performed to save the life of mother. If such a condition is associated with fetal airway abnormalities then condition may be even worse. We here describe a case of parturient with placenta previa-accreta and fetal congenital high airway obstruction posted for cesarean section. Case ReportA 26 year old G2P1001 parturient was admitted at 32 weeks of pregnancy for obstetric services. She was a diagnosed case of placenta previa grade III with placenta accreta. Ultrasonography (USG) at 16 weeks of pregnancy showed normal fetal skull, spine and stomach. At 26 weeks of pregnancy USG showed low lying placenta anteriorly covering internal os, moderate to severe fetal hydrocephalus with dilated lateral ventricles (1.9 cm), single upper limb and short other limbs, skeletal dysplasia and over-distended fetal abdomen with large cystic masses. Level II obstetric USG at 28...

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“…In most studies internal iliac artery balloons inflated immediately after delivery of the fetus [7]. The major anastomotic channels of the female pelvis will function after internal iliac artery balloon occlusion, thus balloon inflation provides only transient relief in intraoperative blood loss [7,16,18]. The reduction of blood flow to pelvic structures may be successful, although complete cessation of perfusion probably cannot be accomplished [16].…”

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confidence: 99%

“…Those patients, have significantly higher mean intraoperative blood loss and transfusion requirements as a result of the time and the efforts to avoid cesarean hysterectomy [7,18].…”

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confidence: 99%

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Perioperative Internal Iliac Artery Balloon Occlusion in Patients with Abnormal Placental Invasion

Georgios¹,

Decavalas²

2013

J Community Med Health Educ

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Prophylactic Perioperative Hypogastric Artery Balloon Occlusion in Abnormal Placentation

Abstract: We conclude that balloon occlusion of the hypogastric arteries is a safe and effective adjunct to cesarean hysterectomy in an attempt to minimize blood loss in patients with abnormal placentation.

Cited by 102 publications

References 9 publications

Intraoperative Intermittent Blocking of the Common Iliac Arteries in Cases of Placenta Percreta without the Use of Fluoroscopy

Intraoperative Intermittent Blocking of the Common Iliac Arteries in Cases of Placenta Percreta without the Use of Fluoroscopy

Placenta Previa Combined with Placenta Accreta and Fetal Congenital High Airway Obstruction- Failed Ex Utero Intrapartum Treatment

Perioperative Internal Iliac Artery Balloon Occlusion in Patients with Abnormal Placental Invasion

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