The Role of Interventional Radiology in the Management of Abnormal Placentation
The prevalence of placenta previa and morbidly placenta accreta is increasing as a result of the increased rate of caesarean sections. Major placenta previa and placenta previa accreta mandate delivery by caesarean section and carry the risk of massive ha
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Contents 1
Abstract
The prevalence of placenta previa and morbidly placenta accreta is increasing as a result of the increased rate of caesarean sections. Major placenta previa and placenta previa accreta mandate delivery by caesarean section and carry the risk of massive haemorrhage and hysterectomy. Women with placenta accreta are at particular risk of major haemorrhage and its complications. The insertion of prophylactic Internal Iliac Occlusion Balloon Catheters (IIOBCs) is to be carefully considered in cases of placenta accreta and placenta previa accreta and is supported in recent published guidelines. Where IIOBCs are ineffective in controlling haemorrhage, additional gelatine foam embolisation should be considered. Prophylactic internal iliac balloon occlusion with or without embolisation has not however been demonstrated in the literature to reduce the complications of massive haemorrhage or to reduce the need for hysterectomy in placenta accreta. Complications as a result of IIOBCs are not uncommon. Many of these are related to long dwell times and displacement of the balloon catheters and may be minimised by scrupulous technique. Advances in technique, operator experience, the use of closure devices and IR suites fit for obstetric delivery may improve the efficacy and safety of the use of prophylactic IIOBCs with and without embolisation.
Introduction.......................................................................... 189
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Placenta Previa, Placenta Accreta and Placenta Previa Accreta...................................................................... 2.1 Definitions.............................................................................. 2.2 Incidence ................................................................................ 2.3 Diagnosis................................................................................ Preparations for Delivery in Placenta Previa/Previa Accreta .................................................................................. 3.1 Management of Placenta Previa/Accreta.............................. 3.2 Interventional Radiology and Transcatheter Techniques in the Management of Abnormal Placentation .................... 3.3 Evidence for Transcatheter Techniques in Abnormal Placentation............................................................................
190 190 190 190
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4 4.1 4.2 4.3
Technique.............................................................................. Technical Variations from the Literature ............................. Complications Attributed to IIOBC...................................... Anatomic Considerations for the Failure of IIOBC in Arresting Haemorrhage..................................................... 4.4 Techniques for Preserving Fertility ...................................... 5
191 191 191 191 193 193 194 196 196
Conclusions ........................................................................... 196
References...................................................................................... 19
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