Application of "one-stage" dual interventional technique in treatment of pernicious placenta previa with placenta accrete undergoing cesarean section

Abstract

Objective: To analyze the efficacy of one-stage temporary bilateral internal iliac arteries balloon occlusion and selective artery embolization in treatment of women with pernicious placenta previa complicated with placenta accreta undergoing cesarean section. Methods: A total of 23 cases of pernicious placenta previa complicated with placenta accreta were treated in the hybrid operation room in our hospital during May 2016 to November 2017. Balloons were placed in bilateral internal iliac arteries before cesarean section. After the fetus was delivered and the umbilical cord was ligated, the balloons were filled up. Then the balloon and the catheter sheath were pulled out immediately after cesarean section, together uterine artery embolization was implemented. The amount of blood loss during cesarean section, postoperative volume of blood loss within 24 h, the X-ray exposure time and radiation dose for balloon placement, uterine hysterectomy rate, length of stay and postoperative complications were recorded. Results: Successful bilateral internal iliac artery balloon implantation was accomplished in all 23 patients (as to the balloon specification, 5 cases were 8 mm×40 mm, 11 cases were 10 mm×40 mm, 7 cases were 12 mm×40 mm) . After the delivery of placenta, the balloon and the catheter sheath were pulled out. The patients were all found with different levels of active bleeding through the gentle press on the fundus of eterus by obstetrician, and then uterine artery embolization was carried out. The uterine blood supply artery of 22 cases were originated from internal iliac artery, and 1 case was simultaneous combined from external iliac artery. Active bleeding was improved after embolization in all cases. The placenta of one patient penetrated through myometrium to percreta, and partially into the bladder, and then resection of the uterus together with partial repair of bladder was operated. The mean X-ray exposure time for balloon placement was (88.7±16.8) s; the mean radiation dose for balloon placement was (18.2±4.5) mGy; the mean amount of blood loss during cesarean section was 1 000 ml (500-3 000 ml) ; the mean postoperative volume of blood loss within 24 h was 580 ml (70-1 200 ml) ; the mean hospitalization time was 7 d (4-10 d) . Of all the 23 newborns, Apgar scores within 1 min: 19 cases scored 10 points, 2 cases scored 9; with additional 2 cases, scored 8 and 7 each; and for all neonates, Apgar scores within 5 min were all rated as 10. During follow-up, significant complications were not found during and after operation. Conclusions: One-stage dual interventional technique not only can reduce the amount of blood loss during and after cesarean section, but also can greatly reduce the risk of undesirable hysterectomy, and the hybrid operation room can provide an optimal treatment platform for patients with pernicious placenta previa complicated with placenta accrete. Key words: Pemicious placenta previa; Internal iliac artery occlusion; Selective vascular embolism