Conservative Management of Invasive Placenta Using Combined Prophylactic Internal Iliac Artery Balloon Occlusion and Immediate Postoperative Uterine Artery Embolization

Canadian Association of Radiologists Journal - Tập 66 - Trang 179-184 - 2015
Donna L. D'Souza1,2, John C. Kingdom3, Hagai Amsalem3, John R. Beecroft1, Rory C. Windrim3, John R. Kachura1
1Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
2University of Minnesota Minneapolis, Minnesota, USA
3Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada

Tóm tắt

Purpose The objective of the study was to evaluate the efficacy and safety of combined prophylactic intraoperative internal iliac artery balloon occlusion and postoperative uterine artery embolization in the conservative management (uterine preservation) of women with invasive placenta undergoing scheduled caesarean delivery. Methods Ten women (mean age 35 years) with invasive placenta choosing caesarean delivery without hysterectomy had preoperative insertion of internal iliac artery occlusion balloons, intraoperative inflation of the balloons, and immediate postoperative uterine artery embolization with absorbable gelatin sponge. A retrospective review was performed with institutional review board approval. Outcome measures were intraoperative blood loss, transfusion requirement, hysterectomy rate, endovascular complications, surgical complications, and postoperative morbidity. Results All women had placenta increta or percreta, and concomitant complete placenta previa. Mean gestational age at delivery was 36 weeks. In 6 women the placenta was left undisturbed in the uterus, 2 had partial removal of the placenta, and 2 had piecemeal removal of the whole placenta. Mean estimated blood loss during caesarean delivery was 1.2 L. Only 2 patients (20%) required blood transfusion. There were no intraoperative surgical complications, endovascular complications, maternal deaths, or perinatal deaths. Three women developed postpartum complications necessitating postpartum hysterectomy; the hysterectomy rate was therefore 30% and uterine preservation was successful in 70%. Conclusion Combined bilateral internal iliac artery balloon occlusion and uterine artery embolization may be an effective strategy to control intraoperative blood loss and preserve the uterus in patients with invasive placenta undergoing caesarean delivery.

Tài liệu tham khảo

10.1136/jcp.2008.055202 10.1097/01.AOG.0000207559.15715.98 10.1016/S0002-9378(97)70463-0 10.1016/S0002-9378(96)70117-5 10.1111/j.1479-828X.2004.00208.x 10.1016/j.ajog.2004.12.074 Clark S.L., 1985, Obstet Gynecol, 66, 89 10.1053/j.semperi.2008.12.003 10.1016/j.ejogrb.2006.07.050 10.1097/01.AOG.0000136086.78099.0f 10.2214/AJR.07.2417 10.1016/j.fertnstert.2008.02.170 10.1016/S0301-2115(01)00355-4 10.1016/j.fertnstert.2006.02.128 10.1080/01443610601137879 10.1016/j.ejogrb.2003.06.008 10.1080/01443610701748658 Tong S.Y., 2008, Singapore Med J, 49, e156 10.1016/S1028-4559(09)60011-5 10.1016/0301-2115(95)02141-S 10.1016/S0301-2115(01)00422-5 10.1016/S1701-2163(16)30646-6 10.1097/01.ogx.0000271133.27011.05 10.1097/00006254-197207000-00001 10.1111/j.1471-0528.2008.02037.x 10.1016/j.ijgo.2007.07.018 10.1016/j.ajog.2005.08.033 10.1017/S0965539504001251 10.1016/j.ajog.2007.08.001 10.1097/01.AOG.0000201992.80130.2c 10.1016/j.ajog.2007.05.017 10.1016/j.ijoa.2007.11.010
Thông tin
Thông tin xuất bản

Canadian Association of Radiologists Journal

Tập 66

179-184

Thông tin tác giả