Selective Endovascular Balloon–Occlusion for Cesarean Delivery in Patients with Abnormal Placentation: Review of Literature and Presentation of a Case

摘要

Background: Removal of abnormal placentation is associated with severe bleeding and is a recognized cause of maternal morbidity and mortality. Complications of abnormal placentation include excessive bleeding during placental removal and the need for cesarean hysterectomy. Newer technologic advances, in the form of obstetrical ultrasound and advanced computed tomography and magnetic resonance imaging, have enabled antenatal diagnosis of these abnormalities and, therefore, allow elective management, instead of on an emergency basis. Case: In this article, we report a case that demonstrates the use of electively placed, bilateral intravascular balloons guided within the common iliac arteries to control bleeding in a patient with placenta percreta. Review: We also complete a review on the literature pertaining to the role of vascular balloon occlusion in abnormal placentation. The use of occlusive balloons and/or embolization has recently been described to reduce postoperative blood loss in patients with abnormal placentation; however, several described anastomoses can explain the continued bleeding. A review of all publications was completed, regarding abnormal placentation, where an endovascular occlusive balloon and/or embolization were used to reduce blood loss. Conclusions: We conclude that a multidisciplinary approach between the interventional radiologist and the obstetrician are important for a favorable outcome. Prophylactic bilateral common iliac artery balloons placed immediately before surgery in patients with abnormal placentation is the safest method by which a reduction in blood loss may be obtained. However, further research and prospective studies are needed to properly assess the efficacy of each of the described techniques for better control of bleeding in these patients, as well as the most appropriate timing for repeated occlusive periods, to minimize unfavorable ischemic events. (J GYNECOL SURG 25:113)