Panici Pierluigi Benedetti, Anceschi Maurizio, Borgia Maria Luisa, Bresadola Luciano, Masselli Gabriele, Parasassi Tiziana, Perrone Giuseppina, Brunelli Roberto
Department of Gynecology, Obstetrics and Urology, Universita Sapienza, Roma, Italy.
J Matern Fetal Neonatal Med. 2012 Dec;25(12):2512-6. doi: 10.3109/14767058.2012.712566. Epub 2012 Sep 20.
To evaluate whether aorta balloon occlusion decreases the rate of hysterectomies and maternal morbidity during extirpative surgery of placenta previa accreta or increta.
We prospectively assessed 33 consecutive patients with placenta praevia and MRI diagnosis of multifocal accreta or increta. Manual removal of the placenta was performed during a scheduled caesarean delivery. In 15 patients, surgery was preceded by balloon catheterization of the abdominal aorta (Intra Abdominal Balloon Occlusion: IABO); 18 patients refusing IABO were considered as controls. We used Fisher's exact test for categorical variables and Mann-Whitney test for continuous variables.
In the IABO group we observed significant decreases in incidence of hysterectomy, estimated blood loss, number of transfused units of red blood cells, postoperative stay and admission to Intensive Care Unit. No IABO-related complications were reported.
During scheduled caesarean section for placenta previa multifocally accreta or increta, IABO can prevent hysterectomy in many cases and improves perioperative outcome as it gives the operator time to achieve the haemostasis via curettage and oversewing of the implantation site with acceptable blood loss.
评估主动脉球囊阻断术是否能降低前置胎盘植入或穿透性植入患者子宫切除术的发生率及孕产妇发病率。
我们前瞻性评估了33例经MRI诊断为多灶性胎盘植入或穿透性植入的前置胎盘患者。在计划性剖宫产时进行人工剥离胎盘。15例患者在手术前进行了腹主动脉球囊导管插入术（腹主动脉球囊阻断术：IABO）；18例拒绝IABO的患者作为对照。分类变量采用Fisher精确检验，连续变量采用Mann-Whitney检验。
在IABO组中，我们观察到子宫切除术的发生率、估计失血量、红细胞输注单位数、术后住院时间和入住重症监护病房的人数均显著降低。未报告与IABO相关的并发症。
在计划性剖宫产治疗多灶性胎盘植入或穿透性植入的前置胎盘时，IABO在许多情况下可避免子宫切除术，并改善围手术期结局，因为它能让术者有时间通过刮宫和对植入部位进行缝合止血，且失血量可接受。
