Can the combination of internal iliac temporary occlusion and uterine artery embolization reduce bleeding and the need for intraoperative blood transfusion in cases of invasive placentation?

OBJECTIVES: Women with invasive placentation (IP) are at high risk of life-threatening hemorrhage. In the last two decades, less invasive surgical approaches combined with endovascular procedures have proven to be safe. Most case series describe the use of temporary balloon occlusion and embolization, either combined or not. Concerning hemorrhage rates, each separate interventional approach performs better than surgery alone does, yet it is not clear whether the combination of multiple interventional techniques can be beneficial and promote a lower incidence of intrapartum bleeding. We aim to evaluate whether combining temporary balloon occlusion of the internal iliac artery and uterine artery embolization promotes better hemorrhage control than do other individual interventional approaches reported in the scientific literature in the context of cesarean birth followed by hysterectomy in patients with IP. METHODS: This is a retrospective analysis of patients with confirmed IP who underwent temporary balloon occlusion and embolization of the internal iliac arteries followed by puerperal hysterectomy. We compared patient results to data extracted from a recent systematic review and meta-analysis of the current literature that focused on interventional procedures in patients with IP. RESULTS: A total of 35 patients underwent the procedure during the study period in our institution. The mean volume of packed red blood cells and the estimated blood loss were 487.9 mL and 1193 mL, respectively. Four patients experienced complications that were attributed to the endovascular procedure. CONCLUSION: The combination of temporary balloon occlusion and uterine artery embolization does not seem to promote better hemorrhage control than each procedure performed individually does.

Prenatal diagnosis of morbidly adherent placenta using gray-scale, color doppler, three-dimensional power doppler ultrasound and magnetic resonance imaging – A case report / Philippine Journal of Obstetrics and Gynecology

Background@#Morbidly adherent placenta (MAP) refers to a spectrum of conditions characterized by abnormal adherence of the placenta to the implantation site. It is usually associated with peripartum hysterectomies, excessive blood loss, and bladder and bowel injuries. Reliable antenatal diagnosis of MAP is needed as unexpected encounter with such condition can lead to catastrophic outcomes. It allows the pre-operative assembly of a multidisciplinary team in the surgical management of such cases, an approach which has been shown to improve maternal and fetal outcomes.@*Case summary@#A case of a morbidly adherent placenta diagnosed antenatally using gray-scale, Color Doppler, 3-Dimensional power Doppler ultrasound and Magnetic Resonance Imaging is reported. A multidisciplinary team consisting of OB - GYN ultrasonologist, radiologist, maternal fetal medicine specialist, gynecologic oncologist, anesthesiologist, neonatologist, internist, urologic-oncologist, vascular and general surgeons, was used to manage the case. Favorable maternal and fetal outcomes resulted from the use of this team.@*Conclusion@#Prenatal diagnosis of MAP with gray-scale, Color Doppler, 3-Dimensional power Doppler ultrasound and Magnetic Resonance Imaging and the use of standardized imaging descriptors for AIP allowed the development of a multidisciplinary care team approach during delivery which provided a safe outcome for both mother and baby.