Obstet Gynecol Sci.  2017 Jan;60(1):18-25. 10.5468/ogs.2017.60.1.18.

The efficacy of pre-delivery prophylactic trans-catheter arterial balloon occlusion of bilateral internal iliac artery in patients with suspected placental adhesion

• Cho YJ
• Oh YT
• Kim SY
• Kim JY
• Jung SY
• Chon SJ
• Kim JH
• Byun SS

• KMID: 2383203
• DOI: http://doi.org/10.5468/ogs.2017.60.1.18

Abstract

OBJECTIVE
Prophylactic trans-catheter arterial balloon occlusion (PTABO) before cesarean section of placenta previa totalis has been introduced to prevent massive hemorrhage. The purpose of this study is to evaluate the clinical usefulness of PTABO in cases of suspected placental adhesion and to examine antepartal risk factors and perinatal outcomes in women with placental adhesion.
METHODS
Between January 2012 and December 2015, 77 patients who had undergone ultrasonography for evaluation of placenta previa were enrolled in this study. Seventeen of these patients with suspected placental adhesion by ultrasonography and Pelvic MRI underwent PTABO before cesarean section and another 59 patients underwent cesarean section without PTABO. Antepartal risk factors and peripartum maternal and neonatal outcomes were compared between patients with PTABO and those without PTABO.
RESULTS
More advanced maternal age, longer in gestational weeks at delivery, and more common previous cesarean section history were observed in the PTABO group. Placenta adhesion, abnormal Doppler findings, and frequency of transfusion were more common in the PTABO group. However there was no significant difference in estimated blood loss, hospital days, and neonatal outcome. It had occurred 3 cases of hysterectomy and 1 case of uterine artery embolization after cesarean section in the PTABO group.
CONCLUSION
Close surveillance of antepartum risk factors for placental adhesion using ultrasonography and pelvic magnetic resonance imaging is important to prevention of massive hemorrhage during cesarean section. PTABO before cesarean section might result in reduced blood loss and requirement for transfusion during the operation.

Keyword

Placenta adhesion; Placenta previa; Postpartum hemorrhage; Trans-catheter arterial balloon occlusion; Uterine artery embolization

MeSH Terms

Balloon Occlusion*
Cesarean Section
Female
Hemorrhage
Humans
Hysterectomy
Iliac Artery*
Magnetic Resonance Imaging
Maternal Age
Peripartum Period
Placenta
Placenta Previa
Postpartum Hemorrhage
Pregnancy
Risk Factors
Ultrasonography
Uterine Artery Embolization

Figure

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  Fig. 1 (A) Placenta lake and lacuna sign on ultrasonography and (B) uterine bulging sign on pelvic magnetic resonance imaging image in placenta adhesions.

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  Fig. 2 Angiography during prophylactic trans-catheter arterial balloon occlusion (PTABO). (A) Equipment in PTABO, (B) angiographic image after insert arterial catheter, and (C) posture of patient with PTABO.

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  Fig. 3 Patient distribution and management of placental adhesion. PTABO, prophylactic trans-catheter arterial balloon occlusion; CS, cesarean section.

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