scholarly journals A new scoring system for placement of abdominal aortic balloon in Placenta accreta spectrum patients with placenta previa: A retrospective cohort study

2021 ◽  
Author(s):  
Fusen Huang ◽  
Jingjie Wang ◽  
Qiuju Xiong ◽  
Wenjian Wang ◽  
Yi Xu ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Scoring System ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Operation Time ◽  
Balloon Occlusion ◽  
Abdominal Aortic ◽  
Placenta Accreta Spectrum ◽  
New Scoring

Abstract Background In recent years, abdominal aortic balloon occlusion is considered an effective method for placenta accreta spectrum patients with placenta previa. However, not all patients in this category require abdominal aortic balloon placement. This study aims to investigate whether the new scoring system is effective for the placement of the abdominal aortic balloon in Placenta accreta spectrum (PAS)patients with placenta previa. Methods PAS patients with placenta previa diagnosed by color Doppler ultrasound were included, and divided into three groups according to their scores graded by a new scoring system (grade Ⅰ group ≤ 5 points, 6 points ≤ grade Ⅱ group ≤ 9 points, grade Ⅲ group ≥ 10 points). Patients with grade Ⅲ were placed with an abdominal aortic balloon unless their families and patients strongly refused. Those with grade I were not placed with an abdominal aortic balloon. Those with grade II generally were not placed with an abdominal aortic balloon unless their families and patients strongly request. Indicators were analyzed, including postpartum hemorrhage, transfusion requirements, operation time, and the ability to preserve the uterus and fertility. Results Estimated blood loss, the number of intraoperative transfused patients, postoperative days were different among the three groups. In group 2 (grade II), there was no significant difference in other observation indexes༈intraoperative blood loss 629 ± 214 vs 758 ± 749, P = 0.488, packed red blood cells47 ± 194 vs 154 ± 445, P = 0.488, admission to ICU 0/7 vs 3/71, P = 1.000, total hysterectomies 0/7 vs 2/71, P = 1.000༉(except for the operation time81.4 ± 19.5 vs 61.7 ± 30.6, P = 0.013) between the abdominal aortic balloon and non-abdominal aortic balloon groups. In group 3 (grade III), significant differences were found in intraoperative blood loss (950 ± 390 vs 2238 ± 1052, P༜0.001), packed red blood cells(213 ± 311 vs 662 ± 528, P༜0.001), postoperative blood transfusion volume(105 ± 181 vs 300 ± 321, P = 0.008), operation time(90.0 ± 25.9 vs 115.9 ± 45.3, P = 0.013), the proportion of people who need blood transfusion(14 in the IABO vs 11 in the NIABO, P = 0.002) and the total Hysterectomies (0 in the IABO vs 2 in the NIABO, P = 0.011) between the abdominal aortic balloon and non-abdominal aortic balloon groups. Conclusion With the new scoring system, not all patients with PAS and placenta previa need a preventive temporary balloon occlusion of the subrenal abdominal aorta. We recommend placing an abdominal aortic balloon in patients with grade III, for it can control intraoperative bleeding and reduce intraoperative blood transfusion, and reduce the risk of hysterectomy. For patients with grade I and II, abdominal aortic balloon placement is not recommended.

scholarly journals Experience of Managing Suspected Placenta Accreta Spectrum with or without Internal Iliac Artery Balloon Occlusion in Two Lithuanian University Hospitals

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 345
Author(s):  
Egle Savukyne ◽  
Laura Liubiniene ◽  
Zita Strelcoviene ◽  
Ruta Jolanta Nadisauskiene ◽  
Edita Vaboliene ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Intervention Group ◽  
Balloon Occlusion ◽  
Endovascular Procedure ◽  
Intraoperative Blood Loss ◽  
Internal Iliac ◽  
Placenta Accreta Spectrum

Background and objectives: Placenta previa and placenta accreta spectrum are considered major causes of massive postpartum hemorrhage. Objective: To determine whether the placement of an occlusion balloon catheter in the internal iliac artery could reduce bleeding and other related complications during cesarean delivery in patients with placenta previa and placenta accreta spectrum. Materials and Methods: A retrospective analysis was conducted at two tertiary obstetric units of Lithuania. From January 2016 to November 2019 patients with placenta previa and antenatally suspected invasive placenta were included in the intervention group and underwent cesarean delivery with endovascular procedure. From January 2014 to December 2015 patients with placenta previa and suspected placenta accreta spectrum were included in the non-intervention group. The primary outcomes were reduction in intraoperative blood loss and transfusion volumes in the intervention group. Secondary outcomes were the incidence of hysterectomy and maternal complications. Results: Nineteen patients underwent cesarean delivery with preoperative endovascular procedure, and 47 women underwent elective cesarean delivery. The median intraoperative blood loss (1000 (400–4500) mL vs. 1000 (400–5000) mL; p = 0.616) and the need for red blood cell transfusion during operation (26% vs. 23%; p = 0.517) did not differ significantly between the patients groups. Seven patients in the intervention group and two patients in the non-intervention group underwent perioperative hysterectomy (p = 0.002). None of the patients had complications related to the endovascular procedure. Conclusion: The use of intermittent balloon occlusion catheter in patients with placenta pathology is a safe method but does not significantly reduce intraoperative blood loss during cesarean delivery.

scholarly journals Efficacy of Precesarean Infrarenal Abdominal Aorta Balloon Occlusion Among Women With Pernicious Placenta Previa and Placenta Accreta: A Retrospective Cohort Analysis

2021 ◽  
Author(s):  
Xuemin Wei ◽  
Yan Chen ◽  
Weiwei Cheng
Keyword(s):  
Blood Loss ◽  
Abdominal Aorta ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Balloon Occlusion ◽  
Neonatal Outcomes ◽  
Control Group ◽  
Study Group ◽  
Estimated Blood Loss ◽  
Infrarenal Abdominal Aorta

Abstract Purpose To evaluate the efficacy and safety of prophylactic balloon occlusion of the infrarenal abdominal aorta among women with pernicious placenta previa and placenta accreta.Methods This retrospective study included 110 patients with pernicious placenta previa and placenta accreta. The control group consisted of 55 patients who underwent cesarean section alone, and the study group included 55 patients who underwent precesarean prophylactic balloon occlusion of the infrarenal abdominal aorta. In addition, both of the groups were further divided according to FIGO clinical grading standards. Prevention of hysterectomy was the primary outcome evaluated. The secondary outcomes included operative duration, estimated blood loss, blood transfusion, intensive care unit admission, total hospital stay (days), and puerperal morbidity, and these data were compared between the two groups. Additionally, the neonatal outcomes were compared.Results There were no significant differences in maternal and neonatal outcomes in the PAS 2 and PAS 3 groups (P > 0.05). However, in the PAS 4 and PAS 5 groups, the amount of bleeding in the study group was significantly less than that in the control group (3533.3 ± 2391.4 vs 4293.6 ± 1235.4, P < 0.05), and the total hysterectomy rate was also lower (7.8% vs 13.2%, P < 0.05).Conclusion Precesarean infrarenal abdominal aortic balloon occlusion is an effective and safe option for treating pernicious placenta previa and placenta accreta and can effectively reduce the risk of hysterectomy and intraoperative blood loss in women with PAS grade 4-5.

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 Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252654
Author(s):  
Sara Ornaghi ◽  
Alice Maraschini ◽  
Serena Donati ◽  
Keyword(s):  
Blood Transfusion ◽  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Geographical Area ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Source Population ◽  
Italian Regions ◽  
Placenta Accreta Spectrum

Introduction Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and repeated cesarean section in Europe; nonetheless, there is a paucity of high-quality Italian data on PAS. The aim of this paper was to estimate the prevalence of PAS in Italy and to evaluate its associated factors, ante- and intra-partum management, and perinatal outcomes. Also, since severe morbidity and mortality in Italy show a North-South gradient, we assessed and compared perinatal outcomes of women with PAS according to the geographical area of delivery. Material and methods This was a prospective population-based study using the Italian Obstetric Surveillance System (ItOSS) and including all women aged 15–50 years with a diagnosis of PAS between September 2014 and August 2016. Six Italian regions were involved in the study project, covering 49% of the national births. Cases were prospectively reported by a trained clinician for each participating maternity unit by electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. Results A cohort of 384 women with PAS was identified from a source population of 458 995 maternities for a prevalence of 0.84/1000 (95% CI, 0.75–0.92). Antenatal suspicion was present in 50% of patients, who showed reduced rates of blood transfusion compared to unsuspected patients (65.6% versus 79.7%, P = 0.003). Analyses by geographical area showed higher rates of both concomitant placenta previa and prior CS (62.1% vs 28.7%, P<0.0001) and antenatal suspicion (61.7% vs 28.7%, P<0.0001) in women in Southern compared to Northern Italy. Also, these women had lower rates of hemorrhage ≥2000 mL (29.6% vs 51.2%, P<0.0001), blood transfusion (64.5% vs 87.5%, P = 0.001), and severe maternal morbidity (5.0% vs 11.1%, P = 0.036). Delivery in a referral center for PAS occurred in 71.9% of these patients. Conclusions Antenatal suspicion of PAS is associated with improved maternal outcomes, also among high-risk women with both placenta previa and prior CS, likely because of their referral to specialized centers for PAS management.

Comparison of temporary abdominal aortic occlusion with internal iliac artery occlusion for patients with placenta accreta – a non-randomised prospective study

VASA ◽  
2017 ◽  
Vol 46 (1) ◽  
pp. 53-57 ◽  
Author(s):  
Yan-Li Wang ◽  
Xu-Hua Duan ◽  
Xin-Wei Han ◽  
Ling Wang ◽  
Xian-Lan Zhao ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Placenta Accreta ◽  
Artery Occlusion ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Iliac Artery Occlusion ◽  
Abdominal Aortic ◽  
Internal Iliac

Abstract. Background: To compare the efficacy of temporary abdominal aortic occlusion with internal iliac artery occlusion for the management of placenta accreta. Patients and methods: 105 patients with placenta accreta were selected for treatment with temporary abdominal aortic occlusion (n = 57, group A) or bilateral iliac artery occlusion (n = 48, group B). Temporary abdominal aortic and internal iliac artery balloon occlusions were performed during caesarean sections. Data regarding the clinical success, blood loss, blood transfusion, balloon insertion time, fluoroscopy time, balloon occlusion time, foetal radiation dose, and complications were collected. Results: Temporary abdominal aortic occlusion and bilateral internal iliac artery occlusion were technically successful in all patients. The amount of blood loss (P < 0.001), amount of blood transfusion (P < 0.001), balloon insertion time (P < 0.001), foetal radiation dose (P < 0.001) and fluoroscopy time (P < 0.01) in group A were significantly lower than those of patients in group B. No marked differences were found between these 2 groups with respect to age, mean postoperative hospital stay, balloon occlusion time, and Apgar score (p > 0.05). Conclusions: Temporary abdominal aortic balloon occlusion resulted in better clinical outcomes with less blood loss, blood transfusion, balloon insertion time, fluoroscopy time and foetal radiation dose than those in bilateral internal iliac balloon occlusion.


scholarly journals Discussion on the Timing of Balloon Occlusion of the Abdominal Aorta during a Caesarean Section in Patients with Pernicious Placenta Previa Complicated with Placenta Accreta

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Baoju Zhu ◽  
Kaili Yang ◽  
Lina Cai
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Abdominal Aorta ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Balloon Occlusion ◽  
Intraoperative Blood Loss ◽  
Transverse Incision ◽  
Aortic Balloon Occlusion ◽  
Group B

Objective. This paper is aimed at investigating the role and value of the timing of balloon occlusion of the abdominal aorta during caesarean section in patients with pernicious placenta previa complicated with placenta accreta. Methods. 79 cases admitted to the Second Affiliated Hospital of Zhengzhou University from September 2015 to December 2016 were treated with ultrasound mediated abdominal aortic balloon occlusion. Among them, 42 cases, whose balloon occlusion time was selected before the delivery and transverse incision was taken, were group A. The other 37 cases were group B, whose timing of balloon occlusion was selected after the delivery and the uterine incision made trying to avoid the placenta or double incisions. The intraoperative blood loss, utilization of blood, and other indicators were compared between the two groups. Results. The intraoperative blood loss in groups A and B was 413.8 ± 105.9 ml and 810.3 ± 180.3 ml, and the utilization of blood products in groups A and B was 30.23% and 89.2%. The total hysterectomy rate was 2.53% (2/79), with no hysterectomies in groups A and 2 cases in group B. Conclusion. The balloon occlusion of the abdominal aorta before the delivery combined with a transverse incision is more effective.

scholarly journals Management Placenta Percreta Succesfully With Total Abdominal Hysterectomy. A Case Review :

2019 ◽  
Vol 5 (1) ◽  
pp. 52
Author(s):  
Rajuddin Rajuddin ◽  
Roziana Roziana ◽  
Munawar Munawar ◽  
Muhammad Iqbal
Keyword(s):  
United States ◽  
Blood Transfusion ◽  
Cesarean Section ◽  
Antenatal Care ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
The United States ◽  
Placenta Percreta ◽  
Risk Of Bleeding ◽  
Placenta Accreta Spectrum

Background: Placenta accreta spectrum is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. The management of placenta accrete spectrum will be discussed here and is essentially the same. The following discussion of management of placenta accreta spectrum applies to all depths of placental invasion. Incidence: In 1950 placentaaccreta was rare, occurring 1 in 30.000 deliveries in the United States. Duringbetween 2008 and 2011 in a cohort of over 115.000 deliveries in 25 hospitals in the United States reaching 1 in 731 deliveries. The marked increase has been attributed to the increasing prevalence of cesarean delivery in recent decades.The incidence of placenta accreta spectrum will also increase due to increasing of caesarean section rate. Case: Mrs.44 yo, G3P2 36-37weekslive, previous cesarean section 2 time,placenta previa totalis, placenta percreta. She’s comes with a chief complaint of lower abdominal cramps, patients regularly antenatal care at obstetrician. Ultrasound finding, a single fetus lives at transvers lie, dorso superior, corresponding to 36-37 weeks, placenta previa, placenta percreta (PAI:83%). This patient planned for elective conservative surgery management, due to cesarean section and or cesarean hysterectomy. Discussion:Surgical conservative management giving birth a baby without a placenta, followed by a hysterectomy, has been shown to reduce the risk of bleeding and the need for blood transfusion. The discovery of placenta accreta spectrum earlier when antenatal care, better birth planning than multidisciplinary science includedfetomaternal, gyneco-oncologist, anesthesiologist, thorac& cardiovascular surgeon, radiology intervention, intensivist - obstetric intensive care, urologist and neonatology can determine the success of handling cases of placenta accreta spectrum so as to reduce maternal, fetal morbidity and mortality. Conclusions:  The discovery of placenta accreta spectrum earlier when antenatal care, planning delivery is better than multidisciplinary science. Management with corporal incisions away from placental implantation, giving birth baby without a placenta, followed by a hysterectomy, has been shown to reduce the risk of bleeding and the need for blood transfusion.

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