Safety and Efficacy of Aortic Vs Internal Iliac Balloon Occlusion for Cesarean Delivery in Coexisting Placenta Accreta a
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CLINICAL INVESTIGATION
ARTERIAL INTERVENTIONS
Safety and Efficacy of Aortic Vs Internal Iliac Balloon Occlusion for Cesarean Delivery in Coexisting Placenta Accreta and Placenta Previa Hiroyuki Tokue1
•
Azusa Tokue1 • Yoshito Tsushima1 • Takashi Kameda2
Received: 20 March 2020 / Accepted: 29 May 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To investigate safety and efficacy of intra-aortic balloon occlusion (IABO) versus internal iliac artery balloon occlusion (IIABO) for cesarean delivery in coexisting placenta accreta and placenta previa. Materials and Methods From 2006 to 2019, 60 pregnant women who had undergone preoperative IABO (n = 28) and IIABO (n = 32) for cesarean delivery in coexisting placenta accreta and placenta previa were retrospectively identified, and their medical records and relevant imaging were reviewed. Results Maternal characteristics (age, gravidity, previous cesarean delivery, gestational age, and neonatal weight) were similar in both groups. Estimated blood loss, volume of blood transfusion, length of hospitalization, and rate of hysterectomy were not significantly different between the groups. Operation time (the duration of cesarean delivery and hysterectomy, p \ 0.05), total time of balloon occlusion (p \ 0.01), and fetal radiation dose (p \ 0.001) in the IABO group were less than in the IIABO group. No severe complications related to the balloon occlusion procedure were noted in either group. Conclusion IABO and IIABO are safe and effective options for cesarean delivery in patients with combined placenta accreta and placenta previa. The average & Hiroyuki Tokue [email protected] 1
Department of Diagnostic and Interventional Radiology, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
2
Department of Obstetrics and Gynecology, Gunma University Hospital, 3-39-33 Showa-machi, Maebashi, Gunma, Japan
operation time, balloon occlusion time, and fetal radiation dose in patients with IABO are less than in patients with IIABO. There were no complications related to balloon occlusion of the aorta or internal iliac artery. Keywords Intra-abdominal aortic balloon occlusion Internal iliac artery balloon occlusion Placenta accreta Placenta previa
Introduction Placenta previa classically presents as painless vaginal bleeding in the third trimester secondary to abnormal placentation near or covering the internal cervical os. The incidence of placenta previa is approximately 0.5% of all deliveries, and it has been increasing with the increased rate of cesarean delivery globally [1]. Morbidly adherent placenta accreta is also increasing for similar reasons. It is classified into three types based on the depth of invasion: placenta accreta, a morbid attachment of the placental villi to the surface of the myometrium; placenta increta, the placental villi implanting into or penetrating the myometrium; and placenta percreta, the plac
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