Something old, something new and something borrowed

American Journal of Perinatology, 2010

We present the outcome of a relatively large cohort of women with suspected placenta accreta who underwent prophylactic pelvic artery catheterization prior to cesarean section. All pregnant women with suspected placenta accreta who delivered in one tertiary center were included in this retrospective study. All patients underwent an elective cesarean section with prophylactic pelvic artery catheterization of internal iliac arteries through femoral or brachial approach. Thirty women underwent prophylactic catheterization; placenta accreta was clinically confirmed in 25 (83.3%) cases. Embolization was performed in 23 cases (76.6%) and hysterectomy in 2 (8%). Median estimated amount of blood loss was 2000 mL (500 to 9000 mL). There were no major catheterization-related complications. Three women had a subsequent pregnancy and uncomplicated delivery by cesarean section. Prophylactic pelvic artery catheterization and embolization in women with placenta accreta is safe and effective in prevention of hysterectomy and should be considered in woman wishing to preserve fertility.

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2018

To identify the role of bilateral internal iliac artery (IIA) ligation on reducing blood loss in abnormally invasive placenta (AIP) undergoing caesarean hysterectomy. In this parallel-randomized control trial, 57 pregnant females with ultrasound features suggestive of AIP were enrolled. They were randomized into two groups; IIA group (n = 29 cases) performed bilateral IIA ligation followed by caesarean hysterectomies, while Control group (n = 28 cases) underwent caesarean hysterectomy only. The main outcome was the difference in the estimated intraoperative blood loss between the two groups. There was no significant difference between the two groups regarding the intraoperative estimated blood loss (1632 ± 804 versus 1698 ± 1251, p value0.83). The operative procedure duration (minutes) (223 ± 66 versus 171 ± 41.4, p value0.001) varied significantly between the two groups. Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended ...

The journal of obstetrics and gynaecology research, 2018

We investigated whether common iliac artery balloon occlusion (CIABO) was effective for decreasing blood loss during cesarean hysterectomy (CH) in patients with placenta previa with accreta and was safe for mothers and fetuses. Of the 67 patients who underwent CH for placenta previa with accreta at our facility from 1985 to 2014, 57 patients were eligible for the study. The amount of intraoperative bleeding during CH was compared between three groups: surgery without blood flow occlusion (13 patients), internal iliac artery ligation (15 patients) and CIABO (29 patients). Additionally, multivariate analysis was performed to assess risk factors for massive bleeding during CH. The mean blood loss in the CIABO group (2027 ± 1638 mL) was significantly lower than in the other two groups (3787 ± 2936 mL in the no occlusion, 4175 ± 1921 mL in the internal iliac artery ligation group; P < 0.05). Multivariate analysis showed that spontaneous placental detachment during surgery (odds ratio ...

Reproductive Biology and Endocrinology

Background Placenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide. Another cause of bleeding in pregnant women is Placenta accreta spectrum. Therefore, the aim of the present systematic review and meta-analysis is to determine the effect of prophylactic balloon occlusion of the internal iliac arteries in patients with placenta previa or placental accreta spectrum (PAS). Methods In this systematic review and meta-analysis, to identify and select relevant studies, the SID, MagIran, ScienceDirect, Embase, Scopus, PubMed, Web of Science, and Google Scholar databases were searched, using the keywords of internal iliac artery balloon, placenta, previa, balloon, accreta, increta and percreta, without a lower time limit and until 2020. The heterogeneity of the studies was examined using the I2 index, and subsequently a random ef...

Journal of Turkish Society of Obstetric and Gynecology, 2018

Plasenta previa perkreata aşırı kanama ile sonuçlanabilen ciddi bir gebelik durumudur. Yaşamı tehdit eden kanamalar genellikle sezaryen histerektomi veya fertilite korumaya yönelik bir yöntem olarak damar ligasyonları ile kontrol edilir. Plasenta previa perkreata sebebiyle uterus devaskülarizasyonu ve pelvik kompresi takiben gelişen bilateral eksternal iliak arter trombozu olgusu sunulmaktadır. Hasta ultrason ve manyetik rezonans görüntüleme ile tanısı konan plasenta previa perkreata nedeniyle sezaryen operasyonuna alındı, ameliyat öncesinde masif kanama durumunda uterus koruyucu cerrahi tercih ettiğini belirtti. Operasyon sırasında spontan kanama fark edildi. Bilateral uterin ve hipogastrik arterlerin bağlanması ardından pelvik kompres uygulandı. Sol eksternal iliak arter sol hipogastrik arter ile karıştırılarak bağlandı, bir dakika içerisinde fark edilerek sütür açıldı. Post operatif dönemde hastanın bacak ağrısı tarif etmesi üzerine acil anjiyografi çekildiğinde bilateral eksternal iliak arter trombozu fark edildi. Bilateral tıkanıklıklar için kardiyoloji uzmanı tarafından anjiyoplasti uygulandı. Plasenta invazyon anormallikleri cerrahın acil müdahalesini gerektiren komplikasyonlarla sonuçlanabilecek olan pelvik kompres veya damar ligasyonları ile opere edilebilir.

Journal of vascular …, 2006

1. J Vasc Interv Radiol. 2006 Dec;17(12):1871-9. Development of a research agenda for uterine artery embolization: proceedings from a multidisciplinary research consensus panel. Spies JB, Rundback JH, Ascher S, Bradley ...

Journal of Medicine in Scientific Research, 2018

Objective The aim was to detect the effects of bilateral internal iliac artery ligation (IIAL) either before or after placental separation on the intraoperative and postoperative maternal outcomes. Background Morbidly adherent placenta (MAP) is abnormal adherence of the placenta to the underlying uterine wall. It can cause significant adverse maternal consequences including the risk of severe intrapartum and/or postpartum bleeding, cesarean hysterectomy, intensive care unit admission, and prolonged hospitalization days. Early diagnosis of MAP helps optimal management with decrease of maternal and neonatal compromise. Uterine sparing can be attempted for patients seeking for fertility preservation. For those patients, several surgical hemostatic techniques including the prophylactic IIAL seemed to reduce blood supply to the pelvic organs and consequently, prevent life-threatening intraoperative blood loss and reduce transfusion requirements. Participants and methods The research is a...

International Journal of Reproduction, Contraception, Obstetrics and Gynecology

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...

Texila International Journal of Public Health, 2025

The Placenta accreta spectrum (PAS) encompasses several conditions including placenta accreta, increta, and percreta. These conditions are characterized by abnormal placental attachment and invasive growth into the uterine wall, often resulting from defects in the endometrial-myometrial interface and inadequate decidualization at sites of previous uterine scars. This case report highlights the importance of early and proactive intervention with vessel embolization in managing PAS. A 26year-old female with a history of lower segment cesarean section (LSCS) was diagnosed with placenta accreta. A multidisciplinary approach was employed to manage her condition. The patient underwent an elective cesarean section combined with bilateral internal iliac artery embolization. The removal of an invasive placenta is associated with a high risk of massive blood loss during the peripartum period. Prophylactic intraoperative uterine artery embolization (UAE) significantly mitigated this risk by reducing blood loss associated with the removal of the invasive placenta. For patients with placenta accreta who wish to preserve their fertility, UAE is considered a safer and more effective option. The use of UAE as a preventive measure before or during delivery helps manage bleeding complications and supports better outcomes in the management of PAS.

Taiwanese Journal of Obstetrics and Gynecology, 2010

Objective: To evaluate the efficacy and safety of temporary cross-clamping of the infrarenal abdominal aorta for controlling operative blood loss during cesarean hysterectomy in severe invasive placentation. Case Report: A 35-year-old woman with a significant risk factor of four previous cesarean sections and placenta previa was referred to Taichung Veterans General Hospital with suspected abnormal placentation at 37 weeks of gestation. Obstetric ultrasonography and magnetic resonance imaging showed a bulky inhomogeneous placenta with extensive uterine serosa-bladder interface hypervascularity and suspicious focal bladder invasion. Cesarean hysterectomy was performed with the use of temporary cross-clamping of the infrarenal abdominal aorta. The duration of aortic cross-clamping was 1 hour, and the estimated blood loss was 2,000 mL. The patient was discharged home on postoperative day 11 with no postoperative sequelae. Conclusion: With this limited experience, we are encouraged by the apparent reduction in operative blood loss after the use of temporary cross-clamping of the infrarenal abdominal aorta during cesarean hysterectomy. Further investigation is needed to determine the efficacy and safety of this procedure.