ABSTRACT
A 37-year-old pregnant woman who had undergone three previous cesarean sections was diagnosed as having placenta percreta. We decided to perform cesarean hysterectomy with bilateral common iliac artery balloon occlusion (CIABO). The duration of surgery was 2 h and 2 min and total estimated blood loss was 2600 mL. Surgery was completed without any surgical complications, but the pulse oximeter waveform of the left leg became undetectable during surgery. We immediately performed angiography after closure of laparotomy and found abnormal pooling of contrast media at the left common iliac artery in the region in which the balloon was positioned. We made a diagnosis of left common iliac artery dissection caused by CIABO. We performed emergent revascularization by intravascular stenting. We conclude that CIABO can cause common iliac artery dissection by mechanical stimulation of the inflated balloon. Careful intraoperative evaluation of limb ischemia and preparation of intravascular treatment is needed for a safe procedure.
Subject(s)
Balloon Occlusion , Placenta Accreta , Adult , Balloon Occlusion/adverse effects , Blood Loss, Surgical , Dissection , Female , Humans , Hysterectomy , Iliac Artery/diagnostic imaging , Iliac Artery/surgery , Placenta Accreta/surgery , PregnancyABSTRACT
Cesarean section for placenta previa accreta spectrum carries a significant risk of massive hemorrhage. Hence, it is necessary to understand the various hemostatic procedures, damage control surgery and resuscitation for massive hemorrhage, and systemic management against hypovolemic shock and coagulopathy. In cases of placenta previa with previous cesarean section, the operation should be performed in a tertiary medical facility with well-trained staff and blood availability for transfusion. Preoperative placement of an intra-arterial balloon occlusion catheter in the common iliac artery or aorta is useful for preventing massive hemorrhage.
ABSTRACT
Objective To investigate the clinical application of temporary balloon occlusion of the common iliac artery in performing cesarean section for patients with pernicious placenta previa and placenta accreta.Methods A total of five cases with ultrasound or MRI diagnosed pernicious placenta previa and placenta accreta were analyzed retrospectively.One of the cases was diagnosed Rh(-)blood type.Prophylactic temporary balloon implantation in bilateral common iliac arteries were carried out before cesarean section.Digital subtraction angiography ensured the position of balloon catheter and the catheter was fixed.The balloon was inflated immediately after the removal of the fetus.The balloon was removed at 6-8 hours after the cesarean section.The amount of blood loss,transfusion requirement,cesarean hysterectomy rate, and X-ray exposured time and dose during the procedure were recorded.Results Temporary balloon implantation in bilateral common iliac arteries in all five patients were obtained successfully.The blood loss was seen <500 mL in one patient and 500-1 000 mL in other four patients.Because of placenta implantation over depth of serosa and placenta percreta in one case,massive intractable hemorrhage occurred in short time,partial hysterectomy had to be carried out.The uterus was retained in other four cases.Conclusion The temporary balloon occlusion of the common iliac artery in performing cesarean section is a safe and effective technique,and it can reduce the amount of blood loss,transfusion requirement and secondary risk due to uncontrollable bleeding during surgery.
ABSTRACT
A 37-year-old primigravida at 35 weeks of gestation presented with known anterior wall dominant placenta previa totalis and suspected placenta accreta was successfully treated with transfundal uterine (transverse) incision performed with prophylactic common iliac artery balloon occlusion. This new surgical approach could be an alternative procedure for avoiding excessive blood loss during caesarean delivery.
