Grewal Mandeep, Magro Michael, Premnath Krishna Prasad Bellam, Bologa Sorina, Otigbah Chineze
Department of Obstetrics and Gynaecology, Queen's Hospital, Romford, England, United Kingdom.
Department of Interventional Radiology, Queen's Hospital, Romford, England, United Kingdom.
J Clin Imaging Sci. 2023 Feb 18;13:9. doi: 10.25259/JCIS_141_2022. eCollection 2023.
Placenta accreta spectrum (PAS) disorder is one of the most dangerous conditions that can affect pregnancy and its incidence is increasing secondary to rising cesarean section rates worldwide. The standard treatment is frequently elective hysterectomy at the time of cesarean delivery; however, uterine and fertility preserving surgery is becoming more common. In the pursuit of a reduction in blood loss and associated maternal morbidity, occlusive vascular balloons are increasingly used at the time of surgery, usually placed with fluoroscopic guidance. Occlusive balloons placed in the infrarenal aorta have been shown in the literature to be superior in terms of blood loss and hysterectomy rates than those placed more distally, such as within iliac or uterine arteries. We present the first five cases performed in Europe of ultrasound-guided infrarenal aortic balloon placement before cesarean for PAS disorder, and describe the technique we used, which provided reduced blood loss, a clearer operating field and avoided fetal and maternal exposure to radiation and intravenous contrast.
胎盘植入谱系障碍（PAS）是影响妊娠的最危险情况之一，其发生率因全球剖宫产率上升而呈上升趋势。标准治疗通常是剖宫产时进行选择性子宫切除术；然而，保留子宫和生育功能的手术越来越普遍。为了减少失血和相关的孕产妇发病率，手术时越来越多地使用闭塞性血管球囊，通常在荧光镜引导下放置。文献表明，置于肾下主动脉的闭塞性球囊在失血和子宫切除率方面优于置于更远端的球囊，如髂动脉或子宫动脉内的球囊。我们介绍了欧洲首例剖宫产术前超声引导下为PAS障碍患者放置肾下主动脉球囊的5例病例，并描述了我们使用的技术，该技术减少了失血，提供了更清晰的手术视野，避免了胎儿和产妇暴露于辐射和静脉造影剂。
