Применение временной баллонной окклюзии внутренних подвздошных артерий при родоразрешении беременных с плацентарной адгезивно-инвазивной патологией

Abstract

Study Objective: to evaluate the effects of temporary bilateral balloon occlusion of the internal iliac arteries on the volume of blood loss during operative delivery of pregnant women with placental adhesive-invasive pathology to internal cervical os and complete placenta previa. Study Design: randomized study. Materials and Methods. We analyzed 37 histories of patients with placental adhesive-invasive pathology to internal cervical os and complete placenta previa, who had operative delivery during 2018–2019. All examined women were divided into two clinical groups. The fact of using X-ray endovascular methods during delivery by caesarean section was the main principle of dividing the study participants. Group I is represented by women (n = 18) who underwent temporary balloon occlusion of the internal iliac arteries, group II (n = 19) is represented by women who delivered without X-ray endovascular methods. Study Results. Among the risk factors for placental adhesive-invasive pathology, the following can be distinguished: in the main group, 7 women (38.9%) had miscarriage in early pregnancy, 3 women (16.7%) had genital tract infection, 2 patients (11.1%) had endometriosis, myomectomy — in 1 case (5.5%), intrauterine interventions in 5 cases (27.8%), in the comparison group: 8 (42.1%), 5 (26.3%), 3 (15.8%), 1 (5.3%),2 (10.5%) respectively. In the main group, 7 patients (38.9%) had one operative delivery in history, 5 pregnant women (27.7%) had two cesarean sections, 3 women (16, 7%) had a scar on the uterus after 3 cesarean sections, and 3 women (16,7%) had a scar on the uterus after 4 caesarean sections, in the comparison group — 4 (21.05%), 8 (42.1%), 3 (15.8%), 4 (21.05%) respectively. In both groups, in 100% of cases, the operations were organ-preserving. In the main group, the volume of intraoperative blood loss, taking into account the volume of blood collected by the CellSaver device and by the gravimetric method, was 650.0 [500.0; 800.0] ml versus 866.0 [750.0; 1400.0] ml in the comparison group and was significantly lower (p < 0.05). 7 (36.8%) patients from the comparison group required transfusion of fresh frozen blood plasma to replace the deficiency of coagulation factors. Assessment of newborns on the Apgar scale at 1/5 minutes did not show significant differences in the study groups. Conclusion. Endovascular temporary bilateral balloon occlusion of the internal iliac arteries is becoming an extremely necessary procedure to ensure the elimination of blood flow in the system of internal iliac arteries, reduce the collateral blood supply to the uterus and reduce intraoperative blood loss. This technique can reduce the amount of intraoperative blood loss by 33–43% in case of patients having placental adhesive-invasive pathology to internal cervical os and placenta previa. Keywords: placenta previa, pregnancy, placental adhesive-invasive pathology, temporary balloon occlusion of the internal iliac arteries.