Abstract
Purpose
The management of women with abnormally invasive placenta remains one of the most challenging aspects of obstetric care. Various surgical and interventional radiological techniques have been developed to limit the risk of massive haemorrhage at caesarean section. Here we describe our experience with three such cases that required caesarean hysterectomy and were managed with prophylactic balloon catheterisation of the common iliac arteries.
Methods
The details of three cases that received prophylactic balloon catheterisation of the common iliac arteries for the surgical management of placenta accreta/percreta are presented. Observational conclusions from these cases as well as a review of the relevant literature are discussed.
Results
Our three cases required caesarean hysterectomy for suspected placenta accreta/percreta. The mean estimated blood loss was 3,333 ml. In one of the cases, we observed notable reduction in blood loss during occlusion of the common iliac arteries, as the balloons were deflated every 5 min to avoid lower limb ischemia.
Conclusions
The cases presented here, and also our literature review, suggest that occlusion of the common iliac arteries appears to be more effective than, and as safe as the occlusion of the internal iliac arteries. Clinicians need to be aware of the potential risks and employ measures to prevent them. Further research is required to investigate the optimum length of occlusion and balance between reducing blood loss and risking ischemia of the limbs when occluding the common iliac arteries.
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References
Royal College of Obstetricians and Gynaecologists (2011) Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and Management. Green-top Guideline No. 27. (www.rcog.org.uk/files/rcog-corp/GTG27PlacentaPraeviaJanuary2011.pdf)
Jauniaux E, Jurkovic D (2012) Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta 33:244–251
Shrivastava V, Nageotte M, Major C, Haydon M, Wing D (2007) Case-control comparison of caesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta. Am J Obstet Gynecol 197(402):e1–e5
Tan CH, Tay KH, Sheah K, Kwek K, Wong K, Tan HK, Tan BS (2007) Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta. AJR Am J Roentgenol 189:1158–1163
Matsubara S, Kuwata T, Usui R, Watanabe T, Izumi A, Ohkuchi A, Suzuki M, Nakata M (2013) Important surgical measures and techniques at caesarean hysterectomy for placenta praevia accreta. Acta Obstet Gynecol Scand 92:372–377
Levine AB, Kuhlman K, Bonn J (1999) Placenta accreta: comparison of cases managed with and without pelvic artery balloon catheters. J Matern Fetal Med 8:173–176
Clausen C, Stensballe J, Albrechtsen CK, Hansen MA, Lönn L, Langhoff-Roos J (2013) Balloon occlusion of the internal iliac arteries in the multidisciplinary management of placenta percreta. Acta Obstet Gynecol Scand 92:386–391
Carnevale FC, Kondo MM, de Oliveira Sousa W Jr, Santos AB, da Motta Leal Filho JM, Moreira AM, Baroni RH, Francisco RP, Zugaib M (2011) Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in caesarean section at risk of haemorrhage in placenta accreta. Cardiovasc Intervent Radiol 34:758–764
Mok M, Heidemann B, Dundas K, Gillespie I, Clark V (2008) Interventional radiology in women with suspected placenta accreta undergoing caesarean section. Int J Obstet Anesth 17:255–261
Knuttinen MG, Jani A, Gaba RC, Bui JT, Carrillo TC (2012) Balloon occlusion of the hypogastric arteries in the management of placenta accreta: a case report and review of the literature. Semin Intervent Radiol 29:161–168
Kidney DD, Nguyen AM, Ahdoot D, Bickmore D, Deutsch LS, Majors C (2001) Prophylactic perioperative hypogastric artery balloon occlusion in abnormal placentation. AJR Am J Roentgenol 176:1521–1524
Fuller AJ, Carvalho B, Brummel C, Riley ET (2006) Epidural anaesthesia for elective caesarean delivery with intraoperative arterial occlusion balloon catheter placement. 7 internal iliacs. Anesth Analg 102:585–587
Weeks SM, Stroud TH, Sandhu J, Mauro MA, Jaques PF (2000) Temporary balloon occlusion of the internal iliac arteries for control of haemorrhage during caesarean hysterectomy in a patient with placenta previa and placenta increta. J Vasc Interv Radiol 11:622–624
Matsubara S, Nonaka H, Kobayashi M, Kuwata T, Fujii H (2014) Intrauterine balloon occlusion during caesarean hysterectomy for placenta previa accreta: the internal or common iliac artery? Acta Obstet Gynecol Scand 93:122–123
Shih JC, Liu KL, Shyu MK (2005) Temporary balloon occlusion of the common iliac artery: new approach to bleeding control during caesarean hysterectomy for placenta percreta. Am J Obstet Gynecol 193:1756–1758
Greenberg JI, Suliman A, Iranpour P, Angle N (2007) Prophylactic balloon occlusion of the internal iliac arteries to treat abnormal placentation: a cautionary case. Am J Obstet Gynecol 197(470):e1–e4
Acknowledgments
We thank Drs Simon Lea, Mark Lipton and Tolulola Odetoyinbo, Consultant Radiologists at Arrowe Park Hospital, for performing the endovascular technique and providing useful advice.
Conflict of interest
We declare that we have no conflict of interest.
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Minas, V., Gul, N., Shaw, E. et al. Prophylactic balloon occlusion of the common iliac arteries for the management of suspected placenta accreta/percreta: conclusions from a short case series. Arch Gynecol Obstet 291, 461–465 (2015). https://doi.org/10.1007/s00404-014-3436-9
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DOI: https://doi.org/10.1007/s00404-014-3436-9