Soyer Philippe, Barat Maxime, Loffroy Romaric, Barral Matthias, Dautry Raphael, Vidal Vincent, Pellerin Olivier, Cornelis Francois, Kohi Maureen P, Dohan Anthony
Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.
Université de Paris, Descartes-Paris 5, Paris, France.
Quant Imaging Med Surg. 2020 Jun;10(6):1370-1391. doi: 10.21037/qims-20-548.
Abnormally invasive placenta (AIP) is a potentially severe condition. To date, arterial embolization in women with postpartum hemorrhage due to AIP is the treatment option for which highest degrees of evidence are available. However, other techniques have been tested, including prophylactic catheter placement, balloon occlusion of the iliac arteries and abdominal aorta balloon occlusion. In this systematic review, we provide an overview of the currently reported interventional radiology procedures that are used for the treatment of postpartum hemorrhage due to AIP and suggest recommendations based on current evidences. Owing to a high rate of adverse events, prophylactic occlusion of internal iliac arteries should be used with caution and applied when the endpoint is hysterectomy. On the opposite, when a conservative management is considered to preserve future fertility, uterine artery embolization should be the preferred option as it is associated with a hysterectomy rate of 15.5% compared to 76.5% with prophylactic balloon occlusion of the internal iliac arteries and does not result in fetal irradiation. Limited data are available regarding the application of systematic prophylactic embolization and no comparative studies with arterial embolization are available.
异常侵入性胎盘（AIP）是一种潜在的严重病症。迄今为止，对于因AIP导致产后出血的女性，动脉栓塞是有最高级别证据支持的治疗选择。然而，也已对其他技术进行了测试，包括预防性导管置入、髂动脉球囊闭塞和腹主动脉球囊闭塞。在本系统评价中，我们概述了目前报道的用于治疗因AIP导致产后出血的介入放射学程序，并根据现有证据提出建议。由于不良事件发生率较高，髂内动脉预防性闭塞应谨慎使用，且仅在以子宫切除术为终点时应用。相反，当考虑采取保守治疗以保留未来生育能力时，子宫动脉栓塞应是首选方案，因为其子宫切除率为15.5%，而髂内动脉预防性球囊闭塞的子宫切除率为76.5%，且不会导致胎儿受到辐射。关于系统性预防性栓塞的应用，可用数据有限，且尚无与动脉栓塞的对比研究。
