Brandão Alexandre Malta, Raymundo Selma Regina de Oliveira, Miquelin Daniel Gustavo, Miquelin André Rodrigo, Reis Fernando, da Silva Gabriela Leopoldino, Galão Heloisa Aparecida, Veloso Maria Lucia Luiz Barcelos
Faculdade Regional de Medicina de São José do Rio Preto - FAMERP, Departamento de Cardiologia e Cirurgia Cardiovascular e Hospital de Base, São José do Rio Preto, SP, Brasil.
Hospital Austa, São José do Rio Preto, SP, Brasil.
J Vasc Bras. 2019 Jun 26;18:e20180134. doi: 10.1590/1677-5449.180134.
Placenta accreta is an important factor in maternal morbidity and mortality and is responsible for approximately 64% of emergency hysterectomy cases and about 2/3 of cases of puerperal bleeding.
To describe a series of cases of prophylactic uterine catheterization performed to prevent significant postpartum bleeding or during caesarean delivery in pregnant women with a previous diagnosis of accretion.
A retrospective analysis was conducted of medical records of cases of uterine artery catheterization performed during elective or emergency caesarean sections of patients at high risk of postpartum bleeding.
The catheterization of uterine arteries procedure was performed in fourteen patients. Mean duration of surgery and hospital stay were 214.64 minutes (± 42.16) and 7 days, respectively. All patients underwent obstetric hysterectomy. No patient required embolization. There was no bleeding or need to revisit any patient and there were no complications related to puncture. There was one fetal death and no maternal deaths.
In this study, prophylactic uterine artery catheterization with temporary occlusion of blood flow proved to be a safe technique with low fetal mortality, no maternal mortality, and a low rate of blood transfusion and can be considered an important and effective therapeutic strategy for reduction of maternal morbidity and mortality, especially in pregnant women with anomalous placental attachment. Furthermore, the possibility of uterine preservation with the use of this method is an excellent contribution to therapeutic management of this group of patients. However, randomized clinical trials are needed to evaluate the effectiveness of routine use of the technique.
胎盘植入是孕产妇发病和死亡的重要因素，约占紧急子宫切除术病例的64%，以及产后出血病例的约三分之二。
描述一系列为预防有胎盘植入既往诊断的孕妇产后大出血或在剖宫产时进行预防性子宫导管插入术的病例。
对在择期或急诊剖宫产时对有产后出血高风险患者进行子宫动脉导管插入术的病例的病历进行回顾性分析。
对14例患者进行了子宫动脉导管插入术。手术平均持续时间和住院时间分别为214.64分钟（±42.16）和7天。所有患者均接受了产科子宫切除术。没有患者需要栓塞治疗。没有患者出现出血或需要再次就诊，也没有与穿刺相关的并发症。有1例胎儿死亡，无孕产妇死亡。
在本研究中，预防性子宫动脉导管插入术并临时阻断血流被证明是一种安全的技术，胎儿死亡率低，无孕产妇死亡，输血率低，可被视为降低孕产妇发病率和死亡率的重要且有效的治疗策略，尤其是对于胎盘附着异常的孕妇。此外，使用该方法保留子宫的可能性对这组患者的治疗管理有很大贡献。然而，需要进行随机临床试验来评估该技术常规使用的有效性。
