Clinical Research

Comparison of the application of abdominal aortic balloon occlusion and modified uterine artery occlusion in patients with placenta accreta undergoing repeat cesarean section

  • Dehong LIU ,
  • Xianxia CHEN ,
  • Chenmin ZHENG ,
  • Shuhua. LIU
Expand
  • Anhui Women and Children′s Medical Center,Hefei Maternal and Child Health Hospital,Hefei 230001,China

Received date: 2024-03-19

  Online published: 2024-07-09

Abstract

Objective To investigate the impact of preoperative abdominal aortic balloon occlusion and modified uterine vascular occlusion on repeat cesarean delivery in patients with placenta previa and placenta accreta spectrum disorders. Methods A total of 97 patients with placenta previa and placenta accreta spectrum disorders who underwent repeat cesarean section at Hefei Maternal and Child Health Hospital between April 2016 and December 2022 were included in this study. Among them, the control group consisted of 48 cases who underwent abdominal aortic balloon occlusion before the operation, while the observation group comprised 49 cases who underwent modified uterine vascular occlusion during the operation. Intraoperative and postoperative complications were observed and compared between the two groups. Results The number of bilateral uterine artery embolization post-operation and the average hospitalization cost in the observation group were significantly lower compared to those in the control group (P < 0.05). However, there were no significant differences observed between the two groups regarding average intraoperative blood loss, red blood cell suspension transfusion volume, hysterectomy rate, and bladder rupture rate (P > 0.05). Conclusions Both surgical methods effectively reduce intraoperative bleeding in the treatment of repeat cesarean section in patients with placenta previa and placenta accreta spectrum disorders. However, modified uterine vascular occlusion demonstrates no complications related to vascular intervention or X-ray exposure, ensuring high maternal and child safety while significantly reducing hospitalization costs. Therefore, it is highly recommended for clinical promotion.

Cite this article

Dehong LIU , Xianxia CHEN , Chenmin ZHENG , Shuhua. LIU . Comparison of the application of abdominal aortic balloon occlusion and modified uterine artery occlusion in patients with placenta accreta undergoing repeat cesarean section[J]. The Journal of Practical Medicine, 2024 , 40(13) : 1822 -1826 . DOI: 10.3969/j.issn.1006-5725.2024.13.010

References

1 JAUNIAUX E, AYRES-DE-CAMPOS D. FIGO consensus guidelines on placenta accreta spectrum disorders:Introduction[J]. Int J Gynaecol Obstet, 2018,140(3):261-264. doi:10.1002/ijgo.12406
2 PENG X, CHEN D, XU J, et al. Parallel transverse uterineincisions,a novel approach for managing heavy hemorrhage and preserving the uterus: A retrospective cohort study for patients with anterior placenta previa and accreta[J]. Medicine (Baltimore),2019,98(44):e17742. doi:10.1097/md.0000000000017742
3 LUBIS M, YAZNIL M, BARUS M, et al. Maternal Outcomes of Hysterectomy and Conservative Surgery in Placenta Accreta[J].Curr Womens Health R, 2020,16(3): 201-205. doi:10.2174/1573404816666200303123850
4 MATSUZAKI S, MANDELBAUM R S, SANGARA R N, et al. Trends, characteristics, and outcomes of placenta accreta spectrum: a national study in the United States[J]. Am J Obstet Gynecol,2021,225(5):534.e1-534.e38. doi:10.1016/j.ajog.2021.04.233
5 WANG Z X, ZHAO Y F, LI L. Is prophylactic intraoperative abdominal aortic balloon occlusion beneficial in pregnancies with placenta previa and placenta accreta spectrum during cesarean section? A 5-year retrospective study[J]. Int J Gynecol Obstet,2023,163(2):572-578. doi:10.1002/ijgo.14852
6 CHEN L, WANG X, WANG H, et al. Clinical evaluation of prophylactic abdominal aortic balloon occlusion in patients with placenta accreta: a systematic review and meta-analysis[J]. BMC Pregnancy Childbirth, 2019,19(1):30. doi:10.1186/s12884-019-2175-0
7 郭晓玥,石慧峰,史晓明,等. 胎盘植入性疾病的精细化管理[J]. 中国卫生质量管理,2022,29(3):37-39.
8 YE C, LING L, LI S, et al. Comparisons of the diagnostic accuracy of the ultrasonic sign-score method and MRI for PA, PI and PP in high-risk gravid women: a retrospective study[J]. Ann Transl Med, 2023, 11(2): 81. doi:10.21037/atm-22-6508
9 JAUNIAUX E, AYRES-DE-CAMPOS D, LANGHOFF-ROOS J,et al. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders[J]. Int J Gynaecol Obstet, 2019,146(1):20-24. doi:10.1002/ijgo.12761
10 李思思,郭广丽,于璨,等. 河北省孕产妇前置胎盘流行病学特点和危险因素分析[J]. 实用医学杂志, 2020,36(2):249-253.
11 JAUNIAUX E, GR?NBECK L, BUNCE C, et al. Epidemiology of placenta previa accreta: a systematic review and meta-analysis[J]. BMJ Open, 2019, 9(11): e031193. doi:10.1136/bmjopen-2019-031193
12 李晓琴,杨朝霞,马萍,等. 止血带捆绑下子宫修复成形术治疗凶险性前置胎盘合并穿透性胎盘植入疗效分析[J]. 中国实用妇科与产科杂志, 2018, 34(6):684-687.
13 LIN J X, LIN F N, ZHANG Y L. Uterine artery ligation before placental delivery during caesarean in patients with placenta previa accreta[J]. Medicine, 2019, 98(36):e16780-e16780. doi:10.1097/md.0000000000016780
14 王冉,李宛玲,姜克萍,等. 宫颈子宫下段环形缝合术在前置胎盘伴胎盘植入剖宫产中的应用效果观察[J]. 中国实用医刊,2021,48(7):44-46. doi:10.3760/cma.j.cn115689-20201212-06121
15 MATSUBARA S, TAKAHASHI H, BABA Y, et al. Aortic balloon occlusion for placenta previa accreta:surgical details are important[J]. Cardiovasc Intervent Radiol, 2017,40(3):478?479. doi:10.1007/s00270-016-1485-0
16 AZAR M, HUTCHEON J A, SHILIANG L,et al.Contribution of placenta accreta to the incidence of postpartum hemorrhage and severe postpartum hemorrhage[J]. Obstet Gynecol, 2015,125(4):814-821. doi:10.1097/aog.0000000000000722
17 柴国路,许培,陈兢思,等. 胎盘植入性疾病的危险因素及妊娠结局分析[J]. 中华产科急救电子杂志, 2020,9(1):49-53. doi:10.3877/cma.j.issn.2095-3259.2020.01.011
18 PAN Y, ZHOU X, YANG Z, et al. Retrospective cohort study of prophylactic intraoperative uterine artery embolization for abnormally invasive placenta[J]. Int J Gynecol Obstet, 2017, 137(1):45-50. doi:10.1002/ijgo.12090
19 SHEIKH G T, NAJAFI A, CUNIER M, et al. Angiographic Detection of Utero-Ovarian Anastomosis and Influence on Ovarian Function After Uterine Artery Embolization[J]. Cardiovasc Inter Rad, 2019, 43(2): 231-237. doi:10.1007/s00270-019-02305-7
20 ZHANG H, DOU R, YANG H, et al. Maternal and neonatal outcomes of placenta increta and percreta from a multicenter study in China[J]. J Matern Fetal Neonatal Med, 2019,32(16):2622-2627. doi:10.1080/14767058.2018.1442429
21 GU D F, DENG C. Balloon displacement during caesarean section with pernicious placenta previa: A case report[J]. World J Clin Cases, 2023, 11(36): 8574-8580. doi:10.12998/wjcc.v11.i36.8574
22 LIU J, WANG Y, JIAO D, et al. Prophylactic Occlusion Balloon Placement in the Abdominal Aorta Combined with Uterine or Ovarian Artery Embolization for the Prevention of Cesarean Hysterectomy Due to Placenta Accreta: A Retrospective Study[J]. Cardiovasc Inter Rad, 2019, 42(6): 829-834. doi:10.1007/s00270-019-02170-4
23 WANG Y, JIANG T, HUANG G, et al. Long-term follow-up of abdominal aortic balloon occlusion for the treatment of pernicious placenta previa with placenta accreta[J]. J Interv Med, 2020, 3 (1): 34-36. doi:10.1016/j.jimed.2020.01.004
24 TOKUE H, TOKUE A, TSUSHIMA Y, et al. Safety and Efficacy of Aortic Vs Internal Iliac Balloon Occlusion for Cesarean Delivery in Coexisting Placenta Accreta and Placenta Previa[J]. Cardiovasc Inter Rad, 2020, 43(9): 1277-1284. doi:10.1007/s00270-020-02548-9
25 ZHU H, WANG S, SHI J, et al. Prophylactic endovascular balloon occlusion of the aorta in cases of placenta accreta spectrum during caesarean section: points from the anaesthesiologist's perspective[J]. BMC Pregnancy Childbirth, 2020, 20(1): 446. doi:10.1186/s12884-020-03136-y
26 LIU J, LI Y, HAN X, et al. Comparison of Efficacy between Internal Iliac Artery and Abdominal Aorta Balloon Occlusions in Pernicious Placenta Previa Patients with Placenta Accrete[J]. Gynecol Obstet Inves, 2019, 84(6): 623-624. doi:10.1159/000500891
Outlines

/