Mohan Bishav, Wander Gurleen, Bansal Raahat, Mutti Jasmine, Tandon Pooja, Juneja Sunil, Puri Suman
Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India.
Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK.
J Obstet Gynaecol. 2020 Apr;40(3):324-329. doi: 10.1080/01443615.2019.1621817. Epub 2019 Jul 25.
Patients of abnormally invasive placenta (AIP) undergoing caesarean delivery are at increased risk of haemorrhage. Conventional management includes piecemeal removal of placenta or placenta left . However, they often require hysterectomy after delivery. Post-delivery prophylactic uterine artery embolisation (UAE) can help reduce morbidity and preserve fertility. We created an adjoining operating theatre and catheter lab (OT/CL complex). This is a retrospective case control study in which 37 patients of AIP were evaluated. Sixteen subjects (cases) had UAE immediately after caesarean delivery, and 21 subjects (controls) had usual care with traditional methods of controlling postpartum haemorrhage and hysterectomy where required. The hysterectomy rate (18.7% vs. 85.7%), mean duration of hospital stay (6.8 ± 2.6 vs. 13.9 ± 8.1) and number of units of blood transfusion required were significantly less in the case group as compared with controls. UAE is an effective conservative treatment along with caesarean delivery in patients with AIP.Impact statement AIP is associated with high rates of PPH, maternal morbidity and mortality and need for hysterectomy after delivery. UAE has been advocated to preserve fertility and reduce PPH in these patients along with caesarean delivery. We created an adjoining operating theatre and catheter lab (OT/CL complex) in a tertiary care centre and managed these patients with prompt UAE after caesarean delivery with team approach. We have shown significant reduction in morbidity and hospital stay with this coordinated management. UAE with caesarean delivery is a preferred mode of delivery for patients of AIP. These patients should be diagnosed and referred to tertiary care centres with such facilities electively so as to provide optimal care to these patients. Cooperation between interventionist and obstetrician and adjoining availability of OT and catheter lab can further help in reducing the time to embolisation after delivery. A hybrid operating theatre with digital subtraction angiography (DSA) facilities would be ideal for the management of such patients.
接受剖宫产的异常侵入性胎盘（AIP）患者出血风险增加。传统管理方法包括胎盘的逐块切除或胎盘保留。然而，她们产后常需行子宫切除术。产后预防性子宫动脉栓塞术（UAE）有助于降低发病率并保留生育能力。我们设立了一个相邻的手术室和导管室（OT/CL联合体）。这是一项回顾性病例对照研究，评估了37例AIP患者。16名受试者（病例组）在剖宫产后立即接受UAE，21名受试者（对照组）采用传统方法控制产后出血，并在必要时行子宫切除术。与对照组相比，病例组的子宫切除率（18.7%对85.7%）、平均住院时间（6.8±2.6对13.9±8.1）和所需输血单位数显著更低。对于AIP患者，UAE与剖宫产联合是一种有效的保守治疗方法。影响声明AIP与产后出血、孕产妇发病率和死亡率高以及产后需要子宫切除术有关。有人主张在这些患者中，UAE与剖宫产联合可保留生育能力并减少产后出血。我们在一家三级护理中心设立了一个相邻的手术室和导管室（OT/CL联合体），并采用团队方法在剖宫产后迅速对这些患者进行UAE治疗。我们已经证明，这种协调管理可显著降低发病率和缩短住院时间。UAE与剖宫产联合是AIP患者的首选分娩方式。这些患者应被诊断并选择性地转诊至具备此类设施的三级护理中心，以便为这些患者提供最佳护理。介入科医生与产科医生之间的合作以及手术室和导管室相邻可进一步有助于缩短产后栓塞时间。配备数字减影血管造影（DSA）设备的杂交手术室对于此类患者的管理将是理想的。
