scholarly journals Delayed bleeding after prophylactic bilateral internal iliac artery balloon occlusion in elective caesarean hysterectomy for the management of placenta accreta

2017 ◽  
Vol 6 (4) ◽  
pp. 1656
Author(s):  
Abdul Karim Othman ◽  
Noraslawati Razak ◽  
Mohd Hanif Che Mat
Keyword(s):  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Placenta Previa ◽  
Balloon Occlusion ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
Internal Iliac ◽  
Life Threatening ◽  
Caesarean Hysterectomy ◽  
Placenta Accrete

Morbidly adherent placenta (MAP) can be divided into placenta accrete, placenta increta and placenta percreta. It is associated with high parity, multifetal gestation, advanced maternal age, assisted reproductive technologies, placenta previa, and more importantly a history of caesarean section or uterine surgery. Globally, the incidence of placenta accrete has increased and seems to be in parallel with the increasing rate of caesarean section delivery.Despite rapidly evolving diagnostic imaging, and growing of surgical expertise, morbidly adherent placenta (MAP) remains an important cause of maternal morbidity and mortality, especially related with life-threatening postpartum haemorrhage. Although the choice of treatment for placenta accrete is puerperal hysterectomy, this procedure itself involves a greater risk of intra-operative haemorrhage.Elective caesarean hysterectomy using prophylactic bilateral internal iliac artery balloon occlusion offer an interesting approach which can minimize the risk of intra-operative haemorrhage. However, our case report describes the case of a 28-year old Gravida 3 Para 2 morbidly obese parturient diagnosed to have placenta previa type 3 posterior with accrete who experienced a complication of life threatening massive bleeding post-operatively after an elective caesarean hysterectomy using a prophylactic bilateral internal iliac artery balloon occlusion intra-operatively.

scholarly journals Assessment of different management options used in morbidly adherent placenta and pregnancy outcomes

2020 ◽  
Vol 3 (2) ◽  
pp. 01-05
Author(s):  
Waleed Tawfik
Keyword(s):  
Iliac Artery ◽  
Pregnancy Outcomes ◽  
Internal Iliac Artery ◽  
Placenta Previa ◽  
Management Options ◽  
Artery Ligation ◽  
Morbidly Adherent Placenta ◽  
Internal Iliac Artery Ligation ◽  
Adherent Placenta ◽  
Internal Iliac

The aim of this work is evaluation of different management options for patients with morbidly adherent placenta and its effect on pregnancy outcomes to find the best method of management to decrease morbidity and mortality. In this prospective study, there were 42 patients diagnosed as having morbidly adherent placenta previa and hospitalized between January 2019 to February 2020. Different management options performed to patients with morbidly adherent placenta previa were recorded, blood loss was estimated for each patient, operative procedures, maternal and fetal outcome was recorded. The results showed the following: Different methods were tried to preserve the uterus including bilateral uterine artery ligation in 13 (59%) cases, bilateral ovarian artery ligation in 3 (13.6%) cases, bilateral internal iliac artery ligation in 3 (13.6%) cases, intrauterine tamponade in 4 (18.1%) cases and hemostatic sutures in placental bed in 11(50%) cases, while B-lynch suture was not done, while procedures which were performed to control pelvic hemorrhage after hysterectomy included internal iliac artery ligation in 8 (27.5%) cases, pelvic packing in 5 (17.2%) cases and internal iliac balloon inflation to control hemorrhage in 1 (3.4%) case. The postoperative complications were DIC occurred in 2 patients (4.8%), ICU admission occurred in 5 cases (11.9%), two cases required reoperations, one patient (2.4%) had wound infection, Postpartum collapse occurred in 2 case (4.8%). Pulmonary embolism occurred in 1 case (2.4%), Median duration of hospital stay was 4 days (range: 2-25).

The Clinical Evaluation of IIA Balloon Occlusion for Pernicious Placenta Previa Patients with Placenta Accreta: A Retrospective Study

2021 ◽  
Author(s):  
Ling Hong ◽  
Aner Chen ◽  
Jinliang Chen ◽  
Xiuxiu Li ◽  
Wenming Zhuang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Iliac Artery ◽  
Caesarean Delivery ◽  
Internal Iliac Artery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Balloon Occlusion ◽  
Control Group ◽  
Estimated Blood Loss ◽  
Internal Iliac

Abstract Objective: This study aimed to evaluate the clinical efficacy of internal iliac artery(IIA) balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta. Background: Pernicious placenta previa is frequently reported to be complicated with placenta accreta, which contributes to serious consequences such as severe obstetric postpartum hemorrhage or even maternal mortality. Methods: Fifty-eight pernicious placenta previa patients complicated with placenta accreta were retrospectively reviewed. The ballon group consisted of 23 patients, who underwent a caesarean delivery with internal iliac artery occlusion. 35 patients were in the control group, who had a standard caesarean delivery. The primary outcomes were estimated blood loss (EBL), cesarean hysterectomy, and blood transferring volume. The secondary outcomes were operating time, intraoperative hemostatic approaches, surgical complications, balloon catheter–related complications, length of maternal stay, cost of hospitalization, and neonatal outcomes.Results: No difference was observed in estimated blood loss (EBL), blood transferring percentages and volume, additional measures to secure hemostasis , surgical complications, hospital stay postoperatively and newborn outcomes. More than 40% of the balloon group underwent hysterectomy because of uncontrollable postpartum bleeding (10[43.48%] vs. 11[31.43%],P=0.350).Complications related to occlusion of IIA did not occur.The duration of the surgery of the balloon group was significantly longer than that of the control group(123.52 min±74.76 versus 89.17±48.68,P=0.038), and the total hospitalization cost was also significantly higher than that of the control group(45116.67±9358.67 yuan versus 30615.41±11587.44yuan,P=0.000).Conclusion: IIA balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta did not reduce the hysterectomy rate during cesarean section, nor did it reduce blood loss and blood transfusion, but it prolonged the duration of the surgery and increased the total cost.

scholarly journals Risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery during cesarean section

2019 ◽  
Vol 92 (1102) ◽  
pp. 20190127
Author(s):  
Hiroyuki Tokue ◽  
Azusa Tokue ◽  
Yoshito Tsushima ◽  
Takeshi Kameda
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Placenta Previa ◽  
Massive Bleeding ◽  
Balloon Occlusion ◽  
Round Ligament ◽  
Internal Iliac ◽  
Angiographic Findings

Objective: We evaluated the risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery (BOIA) during cesarean section. Methods: We performed a retrospective analysis using the clinical records of 42 patients with placenta previa and accreta who underwent BOIA during cesarean section between 2006 and 2017 in Gunma university hospital. We reviewed incidence of collateral arteries to the uterus on the initial aortography. We evaluated the visualization of the ovarian artery arising directly from the abdominal aorta, round ligament artery arising from the external iliac artery/inferior epigastric artery, and the iliolumbar artery. In addition, the clinical characteristics were reviewed. Patients with an estimated blood loss during delivery of >2500 ml, >4 packed red blood cell transfusions, uterine artery embolization after delivery, or hysterectomy were defined as the massive bleeding group. We compared between the massive and non-massive bleeding groups. Results: 20 patients (48%) had a massive bleeding. No procedure-related severe complications were observed. The massive and non-massive bleeding groups differed in terms of operation time (p < 0.001), hysterectomy (p < 0.001), post-operative hospital stay (p < 0.05), and visualization of round ligament arteries to the uterus [15/20 (75%) patients, p < 0.01]. Conclusion: The incidence of collateral blood supply from a round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section. Advances in knowledge: Angiographic visualization of collateral circulation from the round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section.

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