Citation: Archives of gynecology and obstetrics. 2014 Sep 2. [Epub ahead of print]
Author: Minas V, Gul N, Shaw E, Mwenenchanya S
Abstract: PURPOSE: The management of women with abnormally invasive placenta remains one of the
most challenging aspects of obstetric care. Various surgical and interventional
radiological techniques have been developed to limit the risk of massive
haemorrhage at caesarean section. Here we describe our experience with three
such cases that required caesarean hysterectomy and were managed with
prophylactic balloon catheterisation of the common iliac arteries.
METHODS: The details of three cases that received prophylactic balloon catheterisation
of the common iliac arteries for the surgical management of placenta
accreta/percreta are presented. Observational conclusions from these cases as
well as a review of the relevant literature are discussed.
RESULTS: Our three cases required caesarean hysterectomy for suspected placenta
accreta/percreta. The mean estimated blood loss was 3,333 ml. In one of the
cases, we observed notable reduction in blood loss during occlusion of the
common iliac arteries, as the balloons were deflated every 5 min to avoid lower
limb ischemia.
CONCLUSIONS: The cases presented here, and also our literature review, suggest that
occlusion of the common iliac arteries appears to be more effective than, and as
safe as the occlusion of the internal iliac arteries. Clinicians need to be
aware of the potential risks and employ measures to prevent them. Further
research is required to investigate the optimum length of occlusion and balance
between reducing blood loss and risking ischemia of the limbs when occluding the
common iliac arteries.
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