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A Participant-assigned Interventional Research of Precesarean Internal Iliac Artery Balloon Catheterization for Managing Intraoperative Hemorrhage of Placenta Previa and Placenta Accreta Spectrum Disorders After Cesarean Section

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Summary

Placenta accreta spectrum disorder (PASD) and placenta previa (PP) are two of the most hideous obstetric complications which are usually associated with a history of cesarean section (CS). Moreover, women with PASD, PP and/or a cesarean scarred uterus are more likely to have adverse pregnancy outcomes, including blood transfusion, hysterectomy, pelvic organs damage, postpartum hemorrhage, disseminated intravascular coagulation, multi-organ dysfunction syndrome and even maternal or fetal death. This study aimed to investigate the efficacy of precesarean internal iliac artery balloon catheterization (BC) for managing severe hemorrhage caused by PASD and PP with a history of CS. This participant-assigned interventional study was conducted in Tongji Hospital. We recruited 128 women with suspected PASD, PP and a history of CS. Women in the BC group accepted precesarean BC of bilateral internal iliac arteries before the scheduled cesarean delivery. Women in the control group underwent a conventional cesarean delivery. Intraoperative hemorrhage, transfusion volume, radiation dose, exposure time, complications and neonatal outcomes were discussed. There were significant differences in calculated blood loss (CBL) between BC group and control group (1015.0±144.9 vs. 1467.0±171.0 mL, P=0.04). Precesarean BC could reduce intraoperative red blood cell (RBC) transfusion as compared with control group (799.5±136.1 vs. 1286.0±161.6 mL, P=0.02) and lessen the rate of using blood products (57.1% vs. 76.4%, P=0.02). The incidence of hysterectomy was also lower in BC group than in control group. Postpartum outcomes showed no significant differences between the two groups, except that postoperation hospitalization was longer in BC group than in control group (6.7±0.4 vs. 5.8±0.2 days, P=0.03). Precesarean BC of internal iliac artery is an effective method for managing severe hemorrhage caused by PASD and PP with a cesarean scarred uterus, as it could reduce intraoperative blood loss, lessen intraoperative RBC transfusions and potentially decrease hysterectomies.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Yao Fan, Xun Gong, Ling Feng, Fu-yuan Qiao, Su-hua Chen, Wan-jiang Zeng, Hai-yi Liu, Yuan-yuan Wu, Qiong Zhou, Yuan Tian, Qiang Li, Yin Xie, Fan-fan Li, Meng-zhou He, Rajluxmee Beejadhursing, Dong-rui Deng & Xiao-yan Xu

  2. Department of Interventional Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Nan Wang & Ke-tao Mu

Authors
  1. Yao Fan
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  2. Xun Gong
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  3. Nan Wang
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  4. Ke-tao Mu
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  5. Ling Feng
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  7. Su-hua Chen
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  8. Wan-jiang Zeng
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  10. Yuan-yuan Wu
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  11. Qiong Zhou
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  12. Yuan Tian
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  13. Qiang Li
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  14. Yin Xie
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  15. Fan-fan Li
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  16. Meng-zhou He
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  17. Rajluxmee Beejadhursing
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  18. Dong-rui Deng
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  19. Xiao-yan Xu
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Corresponding author

Correspondence to Dong-rui Deng.

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Conflict of Interest Statement

The authors declare that there is no conflict of interest with any financial organization or corporation or individual that can inappropriately influence this work.

This research was supported by grants from the National Science & Technology Pillar Program of China during the Twelfth Five-year Plan Period (No. 2014BAI05B05), the National Natural Science Foundation of China (No. 81873843) and the Foundation at Research Funds for the Central Universities (No. 2017kfyXJJ102 and No. 2019kfyXKJC053).

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Fan, Y., Gong, X., Wang, N. et al. A Participant-assigned Interventional Research of Precesarean Internal Iliac Artery Balloon Catheterization for Managing Intraoperative Hemorrhage of Placenta Previa and Placenta Accreta Spectrum Disorders After Cesarean Section. CURR MED SCI 41, 336–341 (2021). https://doi.org/10.1007/s11596-021-2352-z

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