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. 2017 Jan;60(1):18-25.
doi: 10.5468/ogs.2017.60.1.18. Epub 2017 Jan 19.

The efficacy of pre-delivery prophylactic trans-catheter arterial balloon occlusion of bilateral internal iliac artery in patients with suspected placental adhesion

Yoon Jin Cho  1 , Yong Taek Oh  1 , Suk Young Kim  1 , Ju Young Kim  1 , Sun Young Jung  1 , Seung Joo Chon  1 , Jeong Ho Kim  2 , Sung Su Byun  2
Affiliations

The efficacy of pre-delivery prophylactic trans-catheter arterial balloon occlusion of bilateral internal iliac artery in patients with suspected placental adhesion

Yoon Jin Cho et al. Obstet Gynecol Sci. 2017 Jan.

Abstract

Objective: Prophylactic trans-catheter arterial balloon occlusion (PTABO) before cesarean section of placenta previa totalis has been introduced to prevent massive hemorrhage. The purpose of this study is to evaluate the clinical usefulness of PTABO in cases of suspected placental adhesion and to examine antepartal risk factors and perinatal outcomes in women with placental adhesion.

Methods: Between January 2012 and December 2015, 77 patients who had undergone ultrasonography for evaluation of placenta previa were enrolled in this study. Seventeen of these patients with suspected placental adhesion by ultrasonography and Pelvic MRI underwent PTABO before cesarean section and another 59 patients underwent cesarean section without PTABO. Antepartal risk factors and peripartum maternal and neonatal outcomes were compared between patients with PTABO and those without PTABO.

Results: More advanced maternal age, longer in gestational weeks at delivery, and more common previous cesarean section history were observed in the PTABO group. Placenta adhesion, abnormal Doppler findings, and frequency of transfusion were more common in the PTABO group. However there was no significant difference in estimated blood loss, hospital days, and neonatal outcome. It had occurred 3 cases of hysterectomy and 1 case of uterine artery embolization after cesarean section in the PTABO group.

Conclusion: Close surveillance of antepartum risk factors for placental adhesion using ultrasonography and pelvic magnetic resonance imaging is important to prevention of massive hemorrhage during cesarean section. PTABO before cesarean section might result in reduced blood loss and requirement for transfusion during the operation.

Keywords: Placenta adhesion; Placenta previa; Postpartum hemorrhage; Trans-catheter arterial balloon occlusion; Uterine artery embolization.

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Conflict of interest statement

Conflict of interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. (A) Placenta lake and lacuna sign on ultrasonography and (B) uterine bulging sign on pelvic magnetic resonance imaging image in placenta adhesions.
Fig. 2
Fig. 2. Angiography during prophylactic trans-catheter arterial balloon occlusion (PTABO). (A) Equipment in PTABO, (B) angiographic image after insert arterial catheter, and (C) posture of patient with PTABO.
Fig. 3
Fig. 3. Patient distribution and management of placental adhesion. PTABO, prophylactic trans-catheter arterial balloon occlusion; CS, cesarean section.
See this image and copyright information in PMC

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