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

Abstract

A 37-year-old primigravida at 35 weeks of gestation presented with known anterior wall dominant placenta previa totalis and suspected placenta accreta was successfully treated with transfundal uterine (transverse) incision performed with prophylactic common iliac artery balloon occlusion. This new surgical approach could be an alternative procedure for avoiding excessive blood loss during caesarean delivery.

Local injection of vasopressin reduces the blood loss during cesarean section in placenta previa

“…28 Furthermore, one case report has demonstrated that making a transfundal uterine incision with prophylactic common iliac artery balloon occlusion for a patient with placenta previa totalis avoided massive bleeding and successfully preserved the uterus. 29 In other hands, a case series of 22 pregnant mothers who underwent prophylactic balloon catheterization demonstrated three who had severe complications, one of which was a popliteal artery thrombosis, the others being ischemia of the sciatic nerve and necrosis of the proximal vagina and cervix. 30 Mutual cooperation between the interventional radiology and practicing obstetric teams is required to carry out this procedure safely.…”

“…The prophylactic use of temporary balloon catheter occlusion of the internal iliac arteries has been reported to reduce blood loss in patients with placenta accreta during cesarean hysterectomy without maternal or fetal mortality related to the procedure . Furthermore, one case report has demonstrated that making a transfundal uterine incision with prophylactic common iliac artery balloon occlusion for a patient with placenta previa totalis avoided massive bleeding and successfully preserved the uterus . In other hands, a case series of 22 pregnant mothers who underwent prophylactic balloon catheterization demonstrated three who had severe complications, one of which was a popliteal artery thrombosis, the others being ischemia of the sciatic nerve and necrosis of the proximal vagina and cervix .…”

Transverse uterine fundal incision - an alternative to vertical uterine incision for anterior placenta accreta involving the entire uterine wall: a case report

“…There are reports which have successfully used this approach. 5 TFUI is not a widely used incision due to anticipated high risk of uterine rupture in the subsequent pregnancies. 6 The downside of TFUI approach is that its association with higher morbidity.…”