Academic Unit of Radiology, University of Sheffield, Glossop Road, Sheffield, S10 2JF, UK.
Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK.
Eur Radiol. 2018 Jul;28(7):2713-2726. doi: 10.1007/s00330-017-5222-0. Epub 2018 Feb 5.
To examine the evidence regarding the effectiveness and safety of endovascular interventional modalities for haemorrhage control in abnormal placentation deliveries.
MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to July 2017. Blood loss volume was regarded as the primary endpoint. Other important results are described. Random and fixed effects models were used for the meta-analysis.
Of 385 studies identified, 69 (1,811 patients, mean age 32.9 years, range 23-39 years) were included. Mean gestational age at delivery was 35.1 weeks (range 27-38 weeks). Of 1,395 patients who underwent endovascular intervention, 587 (42%) had placenta accreta, 254 (18%) placenta increta and 313 (22%) placenta percreta. Prophylactic balloon occlusion of the internal iliac arteries (PBOIIA) was performed in 470 patients (33.6%), of the abdominal aorta (PBOAA) in 460 patients (33%), of the uterine artery (PBOUA) in 181 patients (13%), and of the common iliac arteries (PBOCIA) in 21 patients (1.5%). Primary embolization of the UA was performed in 246 patients (18%), of the pelvic collateral arteries in 12 patients (0.9%), and of the anterior division of the IIA in 5 patients (0.3%). Follow-up ranged from 0.5 to 42 months. Endovascular intervention was associated with less blood loss than no endovascular intervention (p < 0.001) with the lowest blood loss volume in patients who underwent PBOAA (p < 0.001). PBOAA was associated with a lower rate of hysterectomy (p = 0.030). Endovascular intervention did not result in increases in operative time or hospital stay.
Endovascular intervention is effective in controlling haemorrhage in abnormal placentation deliveries. PBOAA was associated with a lower rate of hysterectomy and less blood loss than other modalities.
• Endovascular intervention in abnormal placentation deliveries is effective in reducing blood loss. • Endovascular intervention did not result in longer operative time or hospital stay. • Prophylactic balloon occlusion of the abdominal aorta is superior to other modalities.
研究血管内介入治疗在异常胎盘分娩中控制出血的有效性和安全性的证据。
从建库到 2017 年 7 月，检索 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库（CENTRAL）。以失血量为主要结局指标。描述其他重要结果。采用随机和固定效应模型进行荟萃分析。
在 385 项研究中，有 69 项（1811 例患者，平均年龄 32.9 岁，范围 23-39 岁）符合纳入标准。分娩时的平均孕龄为 35.1 周（范围 27-38 周）。1395 例行血管内介入治疗的患者中，587 例（42%）胎盘植入，254 例（18%）胎盘植入，313 例（22%）胎盘穿透。470 例（33.6%）行髂内动脉预防性球囊闭塞术（PBOIIA），460 例（33%）行腹主动脉预防性球囊闭塞术（PBOAA），181 例（13%）行子宫动脉预防性球囊闭塞术（PBOUA），21 例（1.5%）行髂总动脉预防性球囊闭塞术（PBOCIA）。246 例（18%）行子宫动脉一期栓塞术，12 例（0.9%）行盆腔侧支动脉栓塞术，5 例（0.3%）行髂内动脉前支栓塞术。随访时间 0.5-42 个月。血管内介入治疗组的失血量少于未行血管内介入治疗组（p < 0.001），其中行腹主动脉预防性球囊闭塞术组的失血量最少（p < 0.001）。腹主动脉预防性球囊闭塞术组的子宫切除术率较低（p = 0.030）。血管内介入治疗并未导致手术时间或住院时间延长。
血管内介入治疗在异常胎盘分娩中控制出血是有效的。腹主动脉预防性球囊闭塞术与其他方法相比，可降低子宫切除术率，减少失血量。
异常胎盘分娩中血管内介入治疗可有效减少失血量。
血管内介入治疗未导致手术时间或住院时间延长。
腹主动脉预防性球囊闭塞术优于其他方法。
