Divisao de Radiologia Intervencionista, Departamento de Imagens Medicas, Hematologia e Oncologia Clinica, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR.
Divisao de Obstetricia, Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR.
Clinics (Sao Paulo). 2019;74:e946. doi: 10.6061/clinics/2019/e946. Epub 2019 Jun 19.
Women with invasive placentation (IP) are at high risk of life-threatening hemorrhage. In the last two decades, less invasive surgical approaches combined with endovascular procedures have proven to be safe. Most case series describe the use of temporary balloon occlusion and embolization, either combined or not. Concerning hemorrhage rates, each separate interventional approach performs better than surgery alone does, yet it is not clear whether the combination of multiple interventional techniques can be beneficial and promote a lower incidence of intrapartum bleeding. We aim to evaluate whether combining temporary balloon occlusion of the internal iliac artery and uterine artery embolization promotes better hemorrhage control than do other individual interventional approaches reported in the scientific literature in the context of cesarean birth followed by hysterectomy in patients with IP.
This is a retrospective analysis of patients with confirmed IP who underwent temporary balloon occlusion and embolization of the internal iliac arteries followed by puerperal hysterectomy. We compared patient results to data extracted from a recent systematic review and meta-analysis of the current literature that focused on interventional procedures in patients with IP.
A total of 35 patients underwent the procedure during the study period in our institution. The mean volume of packed red blood cells and the estimated blood loss were 487.9 mL and 1193 mL, respectively. Four patients experienced complications that were attributed to the endovascular procedure.
The combination of temporary balloon occlusion and uterine artery embolization does not seem to promote better hemorrhage control than each procedure performed individually does.
患有侵袭性胎盘（IP）的女性有发生危及生命的大出血的高风险。在过去的二十年中，微创外科方法结合血管内介入技术已被证明是安全的。大多数病例系列报告描述了临时球囊闭塞和栓塞的使用，无论是联合使用还是单独使用。关于出血率，每种单独的介入方法的效果都优于单独手术，但尚不清楚多种介入技术的联合是否有益，并能降低分娩期间出血的发生率。我们旨在评估在接受剖宫产和子宫切除术后，与其他单独的介入方法相比，联合使用髂内动脉临时球囊闭塞和子宫动脉栓塞是否能更好地控制出血，这些单独的介入方法在科学文献中均有报道。
这是一项回顾性分析，纳入了在我院接受临时髂内动脉球囊闭塞和栓塞联合产后子宫切除术的确诊为 IP 的患者。我们将患者的结果与最近的一项系统性回顾和荟萃分析中的数据进行了比较，该分析主要关注了 IP 患者的介入治疗。
在研究期间，我院共有 35 例患者接受了该手术。平均红细胞压积和估计出血量分别为 487.9ml 和 1193ml。有 4 例患者发生了与血管内介入手术相关的并发症。
临时球囊闭塞与子宫动脉栓塞的联合使用并不能比单独使用每种方法更好地控制出血。
