Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan.
Department of Obstetrics and Gynecology, Gunma University Hospital, Gunma, Japan.
Br J Radiol. 2019 Oct;92(1102):20190127. doi: 10.1259/bjr.20190127. Epub 2019 Jul 23.
We evaluated the risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery (BOIA) during cesarean section.
We performed a retrospective analysis using the clinical records of 42 patients with placenta previa and accreta who underwent BOIA during cesarean section between 2006 and 2017 in Gunma university hospital. We reviewed incidence of collateral arteries to the uterus on the initial aortography. We evaluated the visualization of the ovarian artery arising directly from the abdominal aorta, round ligament artery arising from the external iliac artery/inferior epigastric artery, and the iliolumbar artery. In addition, the clinical characteristics were reviewed. Patients with an estimated blood loss during delivery of >2500 ml, >4 packed red blood cell transfusions, uterine artery embolization after delivery, or hysterectomy were defined as the massive bleeding group. We compared between the massive and non-massive bleeding groups.
20 patients (48%) had a massive bleeding. No procedure-related severe complications were observed. The massive and non-massive bleeding groups differed in terms of operation time ( < 0.001), hysterectomy ( < 0.001), post-operative hospital stay ( < 0.05), and visualization of round ligament arteries to the uterus [15/20 (75%) patients, < 0.01].
The incidence of collateral blood supply from a round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section.
Angiographic visualization of collateral circulation from the round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section.
我们评估了在剖宫产术中进行髂内动脉球囊阻断（BOIA）的前置胎盘伴胎盘植入患者的血管造影发现的大出血风险因素。
我们对 2006 年至 2017 年在群马大学医院行 BOIA 的 42 例前置胎盘伴胎盘植入患者的临床记录进行了回顾性分析。我们回顾了初始主动脉造影中子宫侧支动脉的发生率。我们评估了卵巢动脉直接发自腹主动脉、圆韧带动脉发自髂外动脉/腹壁下动脉、髂腰动脉的显影情况。此外，还回顾了临床特征。术中出血量>2500ml、>4 单位红细胞悬液输注、产后行子宫动脉栓塞或子宫切除的患者定义为大出血组。我们比较了大出血组和非大出血组。
20 例（48%）患者发生大出血。无与操作相关的严重并发症。手术时间（<0.001）、子宫切除术（<0.001）、术后住院时间（<0.05）和圆韧带动脉至子宫的显影情况（15/20[75%]患者，<0.01）在大出血组和非大出血组之间存在差异。
剖宫产术中行 BOIA 的前置胎盘伴胎盘植入患者，圆韧带动脉至子宫侧支血供的发生率可能是大出血的危险因素。
子宫圆韧带动脉侧支循环的血管造影显影可能是剖宫产术中行 BOIA 的前置胎盘伴胎盘植入患者发生大出血的危险因素。
