Nagata Koshiro, Hirakawa Toyofumi, Izuchi Daisuke, Urushiyama Daichi, Yotsumoto Fusanori
Department of Obstetrics and Gynecology Faculty of Medicine, Fukuoka University, Fukuoka, JPN.
Cureus. 2024 Dec 15;16(12):e75732. doi: 10.7759/cureus.75732. eCollection 2024 Dec.
An adherent placenta is a life-threatening condition that impairs the mother's life owing to hemorrhagic shock and disseminated intravascular coagulation. Profound hemorrhage resulting from placental abruption is often managed using hysterectomy to preserve the mother's life, although the consequent loss of fertility can be devastating, particularly in younger women. Thus, strategies that facilitate fertility preservation while effectively controlling hemorrhage should be considered viable alternatives. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is commonly performed in patients experiencing traumatic hemorrhagic shock; however, its application in obstetric cases remains infrequent. Herein, we report a case in which REBOA was used to control hemorrhage following the manual removal of an adherent placenta, with the aim of preserving the uterus. A 28-year-old woman presented to our hospital with hemorrhagic shock owing to extensive bleeding from an adherent placenta. As the patient was a young, primiparous woman with a strong desire to preserve her uterus, we opted for manual placental removal. However, manual removal poses a risk of exacerbating the hemorrhage. Therefore, REBOA was performed by emergency physicians to reduce bleeding during placental abruption, and intrauterine balloon tamponade was used to achieve hemostasis without compromising the patient's condition. The use of REBOA in the management of placenta accreta not only improves survival rates but may also provide crucial time for fertility-preserving interventions.
胎盘植入是一种危及生命的情况，由于出血性休克和弥散性血管内凝血，会损害母亲的生命。胎盘早剥导致的严重出血通常采用子宫切除术来挽救母亲的生命，尽管随之而来的生育能力丧失可能是毁灭性的，尤其是对年轻女性而言。因此，在有效控制出血的同时促进生育能力保留的策略应被视为可行的替代方案。复苏性血管内主动脉球囊阻断术（REBOA）通常用于创伤性出血性休克患者；然而，其在产科病例中的应用仍然很少。在此，我们报告一例在人工剥离胎盘植入后使用REBOA控制出血以保留子宫的病例。一名28岁女性因胎盘植入大量出血导致出血性休克被送往我院。由于患者是一名年轻的初产妇，强烈希望保留子宫，我们选择了人工剥离胎盘。然而，人工剥离有加重出血的风险。因此，急诊医生进行了REBOA以减少胎盘早剥期间的出血，并使用宫内球囊压迫止血，同时不影响患者的病情。REBOA在胎盘植入管理中的应用不仅提高了生存率，还可能为生育保留干预提供关键时间。
