PDF herunterladen
CC BY-NC-ND 4.0 · AJP Rep 2018; 08(02): e57-e63
DOI: 10.1055/s-0038-1641736
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pilot Study of Intra-Aortic Balloon Occlusion to Limit Morbidity in Patients with Adherent Placentation Undergoing Cesarean Hysterectomy

Elizabeth Blumenthal
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, Orange County
,
Rashmi Rao
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Aisling Murphy
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Jeffrey Gornbein
3   Department of Biomathematics, University of California, Los Angeles, California
,
Richard Hong
4   Department of Anesthesia, University of California, Los Angeles, California
,
John M. Moriarty
5   Department of Interventional Radiology; University of California, Los Angeles, California
,
Daniel A. Kahn
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Carla Janzen
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
› Institutsangaben
Weitere Informationen

Publikationsverlauf

29. März 2017

23. Februar 2018

Publikationsdatum:
11. April 2018 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objective We study whether using an intra-aortic balloon (IAB) during cesarean hysterectomy decreases delivery morbidity in patients with suspected morbidly adherent placentation.

Study Design This is a retrospective cohort study of deliveries complicated by suspected abnormal placentation between 2009 and 2016 comparing maternal and neonatal outcomes with an IAB placed prior to cesarean hysterectomy versus no IAB. The primary outcome included quantified blood loss (QBL).

Results Thirty-five cases were reviewed, 16 with IAB and 19 without IAB. No difference was seen in median QBL between the two groups (1,351 vs. 1,397 mL; p = 0.90). There were no significant differences in overall surgical complications (19% IAB, 21% no IAB; p = 0.86), bladder complications (12 vs. 21%; p = 0.66), intensive care unit admissions (12 vs. 26%; p = 0.41), surgical duration (2.9 vs. 2.8 hour; p = 0.83), or blood transfusions (median 2 vs. 2; p = 0.27) between the two groups. There was one groin hematoma at the balloon site that was managed conservatively. There were no complications involving thrombosis or limb ischemia in the IAB group.

Conclusion While we did not detect statistically significant differences, larger studies may be warranted given the potential for extreme morbidity in these cases. This study highlights the potential use of an IAB in the management of these cases.

Keywords

placenta accreta - intra-aortic balloon - abnormal placentation - placenta percreta - cesarean hysterectomy
 

  • References

  • 1 Chestnut DH. The Fred Hehre Lecture 2006. Lessons learned from obstetric anesthesia. Int J Obstet Anesth 2008; 17 (02) 137-145
    CrossrefPubMedGoogle Scholar
  • 2 Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177 (01) 210-214
    CrossrefPubMedGoogle Scholar
  • 3 Belfort MA. Indicated preterm birth for placenta accreta. Semin Perinatol 2011; 35 (05) 252-256
    CrossrefPubMedGoogle Scholar
  • 4 Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol 2015; 126 (03) 654-668
    CrossrefPubMedGoogle Scholar
  • 5 Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG 2010; 117 (01) 84-93
    CrossrefPubMedGoogle Scholar
  • 6 Balayla J, Bondarenko HD. Placenta accreta and the risk of adverse maternal and neonatal outcomes. J Perinat Med 2013; 41 (02) 141-149
    CrossrefPubMedGoogle Scholar
  • 7 Govindappagari S, Wright JD, Ananth CV, Huang Y, DʼAlton ME, Friedman AM. Risk of peripartum hysterectomy and center hysterectomy and delivery volume. Obstet Gynecol 2016; 128 (06) 1215-1224
    CrossrefPubMedGoogle Scholar
  • 8 Kidney DD, Nguyen AM, Ahdoot D, Bickmore D, Deutsch LS, Majors C. Prophylactic perioperative hypogastric artery balloon occlusion in abnormal placentation. AJR Am J Roentgenol 2001; 176 (06) 1521-1524
    CrossrefPubMedGoogle Scholar
  • 9 Masamoto H, Uehara H, Gibo M, Okubo E, Sakumoto K, Aoki Y. Elective use of aortic balloon occlusion in cesarean hysterectomy for placenta previa percreta. Gynecol Obstet Invest 2009; 67 (02) 92-95
    CrossrefPubMedGoogle Scholar
  • 10 Clark SL, Phelan JP, Yeh SY, Bruce SR, Paul RH. Hypogastric artery ligation for obstetric hemorrhage. Obstet Gynecol 1985; 66 (03) 353-356
    PubMedGoogle Scholar
  • 11 Shrivastava V, Nageotte M, Major C, Haydon M, Wing D. Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta. Am J Obstet Gynecol 2007; 197 (04) 402.e1-402.e5
    CrossrefPubMedGoogle Scholar
  • 12 Harma M, Harma M, Kunt AS, Andac MH, Demir N. Balloon occlusion of the descending aorta in the treatment of severe post-partum haemorrhage. Aust N Z J Obstet Gynaecol 2004; 44 (02) 170-171
    CrossrefPubMedGoogle Scholar
  • 13 Usman N, Noblet J, Low D, Thangaratinam S. Intra-aortic balloon occlusion without fluoroscopy for severe postpartum haemorrhage secondary to placenta percreta. Int J Obstet Anesth 2014; 23 (01) 91-93
    CrossrefPubMedGoogle Scholar
  • 14 Søvik E, Stokkeland P, Storm BS, Asheim P, Bolås O. The use of aortic occlusion balloon catheter without fluoroscopy for life-threatening post-partum haemorrhage. Acta Anaesthesiol Scand 2012; 56 (03) 388-393
    CrossrefPubMedGoogle Scholar
  • 15 Irahara T, Sato N, Moroe Y, Fukuda R, Iwai Y, Unemoto K. Retrospective study of the effectiveness of Intra-Aortic Balloon Occlusion (IABO) for traumatic haemorrhagic shock. World J Emerg Surg 2015; 10 (01) 1
    CrossrefPubMedGoogle Scholar
  • 16 Wei X, Zhang J, Chu Q. , et al. Prophylactic abdominal aorta balloon occlusion during caesarean section: a retrospective case series. Int J Obstet Anesth 2016; 27: 3-8
    CrossrefPubMedGoogle Scholar