From the University of California Davis Medical Center, Department of Surgery (C.M.T., T.N.R., J.M.G., R.M.R.), Sacramento, California; and Rutgers Cancer Institute of New Jersey, Department of Gynecologic Oncology (E.G.), New Brunswick, New Jersey.
J Trauma Acute Care Surg. 2022 Jan 1;92(1):e10-e17. doi: 10.1097/TA.0000000000003420.
Hemorrhage is a leading cause of maternal death worldwide, with increased risk in women with abnormal placentation. Aortic balloon occlusion (ABO), including resuscitative endovascular balloon occlusion, has been used for obstetrical hemorrhage for 20 years, and is associated with decreased operative blood loss, fewer transfusions, and lower rates of hysterectomy. However, the effect of aortic occlusion on fetal/neonatal outcomes is not well known.
A literature review on ABO for obstetrical or traumatic hemorrhage was performed. Cases were included if fetal/neonatal outcomes were reported. Data were collected on timing of balloon inflation (predelivery or postdelivery), fetal/neonatal mortality, and Apgar scores. Secondary maternal outcomes included blood loss, need for hysterectomy, ABO-related complications, and mortality.
Twenty-one reports of ABO in 825 cases of obstetrical hemorrhage were reviewed (nine case reports/series and twelve comparative studies). 13.5% (111/825) had aortic occlusion prior to delivery of the fetus. Comparative cohorts included 448 patients who underwent iliac artery balloon occlusion (n = 219) or no vascular balloon occlusion (n = 229). The most common neonatal outcome reported was Apgar scores, with no difference in fetal/neonatal outcomes between ABO and non-ABO patients in any study. One neonatal mortality occurred in the sole reported case of ABO use in a pregnant trauma patient at 24 weeks gestation. One maternal mortality occurred because of aortic dissection. Five comparative studies reported significantly decreased blood loss in ABO patients compared to non-ABO patients, and four studies reported significantly lower rates of hysterectomy in ABO patients. ABO-related complications were reported in 1.6% of patients (13/825).
Obstetrical hemorrhage is a devastating complication, and ABO may potentially decrease blood loss and reduce the hysterectomy rate without compromising fetal and neonatal outcomes. Further research is needed to determine the safety of predelivery aortic occlusion as this occurred in 14% of the cases.
出血是全球范围内导致产妇死亡的主要原因，异常胎盘的女性风险增加。主动脉球囊闭塞（ABO），包括抢救性血管内球囊闭塞，已用于产科出血 20 年，与手术失血量减少、输血减少和子宫切除率降低有关。然而，主动脉闭塞对胎儿/新生儿结局的影响尚不清楚。
对 ABO 在产科或创伤性出血中的应用进行了文献回顾。如果报告了胎儿/新生儿结局，则纳入病例。收集球囊充气的时间（分娩前或分娩后）、胎儿/新生儿死亡率和 Apgar 评分的数据。次要的产妇结局包括出血量、需要子宫切除术、ABO 相关并发症和死亡率。
共回顾了 825 例产科出血 ABO 的 21 份报告（9 份病例报告/系列和 12 项对照研究）。13.5%（111/825）在胎儿分娩前进行了主动脉闭塞。对照队列包括 448 例接受髂动脉球囊闭塞（n = 219）或无血管球囊闭塞（n = 229）的患者。报道的最常见新生儿结局是 Apgar 评分，在任何研究中，ABO 组和非 ABO 组的胎儿/新生儿结局均无差异。唯一一例妊娠创伤患者在 24 周妊娠时使用 ABO 的病例报告了 1 例新生儿死亡。1 例产妇死亡是由于主动脉夹层。5 项对照研究报道 ABO 组患者的出血量明显减少，4 项研究报道 ABO 组患者的子宫切除率明显降低。ABO 相关并发症在 1.6%的患者（13/825）中报告。
产科出血是一种毁灭性的并发症，ABO 可能在不影响胎儿和新生儿结局的情况下减少出血量并降低子宫切除率。需要进一步研究确定分娩前主动脉闭塞的安全性，因为这种情况发生在 14%的病例中。
