Department of Radiology, University of California, Davis, Sacramento, CA.
Department of Radiology, University of California, San Francisco, San Francisco, CA.
Am J Obstet Gynecol MFM. 2020 Feb;2(1):100065. doi: 10.1016/j.ajogmf.2019.100065. Epub 2019 Nov 9.
Morbidly adherent placenta, also known as placenta accreta spectrum, is associated with severe maternal morbidity and mortality. Multiple adjunctive procedures have been proposed to improve outcomes, and at many institutions, interventional radiologists will play a role in assisting obstetricians in these cases.
The objective of the study was to evaluate the outcomes of women with morbidly adherent placenta who underwent cesarean hysterectomy with aortic balloon occlusion or internal iliac artery balloon occlusion catheters, compared with cesarean hysterectomy with surgical ligation of the iliac arteries, or cesarean hysterectomy without adjunctive procedures.
A retrospective review of women with morbidly adherent placenta treated with cesarean hysterectomy was performed at 5 institutions from May 2014 to April 2018. The balloon occlusion group had either prophylactic aortic or iliac balloons placed prior to cesarean hysterectomy. Comparison groups included those who underwent internal iliac artery ligation prior to hysterectomy or a control group if they underwent cesarean hysterectomy without adjuvant procedures. Evaluated outcomes include estimated blood loss, transfusion requirements, intensive care unit admission, and adverse event rates.
There were 171 women with morbidly adherent placenta included in the study. Twenty-eight had balloon placement prior to cesarean hysterectomy, 18 had intraoperative internal iliac artery ligation, and there were 125 control women who underwent cesarean hysterectomy without any adjunctive procedures. Compared with the women who underwent cesarean hysterectomy without adjunctive procedures, women who underwent aortic or iliac artery balloon occlusion prior to hysterectomy had significantly lower estimated blood loss (30.9% decrease, P < .001), transfusion requirements (76.8% decrease, P < .001), intensive care unit admission rates (0% vs 15.2%, P < .001), and intensive care unit stay lengths (0.0 vs 3.1 days, P < .001). Compared with women who underwent surgical ligation of the internal iliac arteries prior to hysterectomy, women who underwent aortic or iliac artery balloon occlusion prior to cesarean hysterectomy had lower estimated blood loss (54.2% decrease, P < .01), transfusion requirements (90.5% decrease, P < .001), operating room times (40.0% decrease, P < .01), intensive care unit admissions rates (0% vs 77.8%, P < .001), intensive care unit stay lengths (0.0 vs 1.4 days, P < .001), and adverse events (3.6% vs 44.4%, P < .01).
Aortic and iliac artery balloon occlusion are associated with lower estimated blood loss, transfusion requirements, intensive care unit admission rates, and adverse event rates compared with women who underwent internal iliac artery ligation prior to cesarean hysterectomy or women who had no adjunctive interventions prior to cesarean hysterectomy for morbidly adherent placenta.
病态粘连胎盘，也称为胎盘植入谱系疾病，与严重的产妇发病率和死亡率相关。已经提出了多种辅助程序来改善结果，在许多机构中，介入放射科医生将在这些情况下协助妇产科医生。
本研究的目的是评估接受剖宫产子宫切除术并使用主动脉球囊闭塞或髂内动脉球囊闭塞导管的病态粘连胎盘患者的结局，与行剖宫产子宫切除术并结扎髂内动脉、或行剖宫产子宫切除术且不使用辅助程序的患者进行比较。
在 2014 年 5 月至 2018 年 4 月期间，对 5 家机构的病态粘连胎盘患者进行了剖宫产子宫切除术回顾性研究。球囊闭塞组在剖宫产子宫切除术前行预防性主动脉或髂动脉球囊放置。对照组包括在子宫切除术前行髂内动脉结扎的患者，或未行辅助手术而行剖宫产子宫切除术的患者。评估的结局包括估计失血量、输血需求、重症监护病房（ICU）入住率和不良事件发生率。
本研究共纳入 171 例病态粘连胎盘患者。28 例患者在剖宫产子宫切除术前行球囊放置，18 例行术中髂内动脉结扎，125 例患者为对照组，行剖宫产子宫切除术且无任何辅助手术。与未行辅助手术的患者相比，在子宫切除术前行主动脉或髂动脉球囊闭塞的患者的估计失血量明显减少（减少 30.9%，P<0.001），输血需求减少（减少 76.8%，P<0.001），ICU 入住率（0% vs 15.2%，P<0.001），ICU 住院时间（0.0 天 vs 3.1 天，P<0.001）。与在子宫切除术前行髂内动脉结扎的患者相比，在子宫切除术前行主动脉或髂内动脉球囊闭塞的患者的估计失血量（减少 54.2%，P<0.01），输血需求（减少 90.5%，P<0.001），手术时间（减少 40.0%，P<0.01），ICU 入住率（0% vs 77.8%，P<0.001），ICU 住院时间（0.0 天 vs 1.4 天，P<0.001），以及不良事件（3.6% vs 44.4%，P<0.01）均较低。
与在剖宫产子宫切除术前行髂内动脉结扎的患者或在行剖宫产子宫切除术且不使用辅助手术的患者相比，主动脉和髂动脉球囊闭塞与较低的估计失血量、输血需求、ICU 入住率和不良事件发生率相关。
