Salim Raed, Zafran Noah, Chulski Alexander, Shalev Eliezer
The Department of Obstetrics and Gynecology, HaEmek Medical Center, Afula.
Harefuah. 2010 Jun;149(6):370-3, 403.
Placenta accreta is a relatively rare event, in which the placenta is abnormally implanted into the uterine myometrium. The most significant complication of abnormal placentation is bleeding, mainly during labor. The bleeding increases especially when manual lysis of the placenta is attempted. Cesarean hysterectomy is the recommended form of management of most cases where placenta accerta is encountered. During recent years, inserting intravascular balloon catheter for occlusion and/or arterial embolization, was introduced as an adjuvant therapy in order to minimize blood loss during cesarean hysterectomy. In selective cases the placement of a balloon catheter was performed with conservative management, with the intent of avoiding hysterectomy, thereby preserving fertility. Contradicting reports exist regarding the effectiveness and safety of employing balloon catheters in cases of placenta accreta. The objective of this review was to evaluate the role of balloon catheter for occlusion and/or embolization of the pelvic vasculature in women diagnosed with abnormal placentation, treated either conservatively or by cesarean hysterectomy.
胎盘植入是一种相对罕见的情况,即胎盘异常植入子宫肌层。异常胎盘植入最严重的并发症是出血,主要发生在分娩期间。尤其是在尝试手动剥离胎盘时,出血会增加。剖宫产子宫切除术是处理大多数胎盘植入病例的推荐治疗方式。近年来,插入血管内球囊导管进行阻塞和/或动脉栓塞被作为辅助治疗引入,以尽量减少剖宫产子宫切除术期间的失血。在某些选择性病例中,放置球囊导管采用保守治疗,目的是避免子宫切除术,从而保留生育能力。关于在胎盘植入病例中使用球囊导管的有效性和安全性存在相互矛盾的报道。本综述的目的是评估球囊导管对诊断为异常胎盘植入、接受保守治疗或剖宫产子宫切除术的女性盆腔血管进行阻塞和/或栓塞的作用。