Perioperative management of abdominal aortic balloon occlusion in patients compli-cated with placenta percteta:a case report
10.3969/j.issn.1671-167X.2015.06.026
- VernacularTitle:穿透型胎盘植入行腹主动脉球囊置入的围术期管理1例
- Author:
Hong ZENG
;
Yan WANG
;
Yang WANG
;
Xiangyang GUO
- Publication Type:Journal Article
- Keywords:
Placenta accreta;
Aorta;
abdominal;
Balloon occlusion;
Anesthesia
- From:
Journal of Peking University(Health Sciences)
2015;47(6):1031-1033
- CountryChina
- Language:Chinese
-
Abstract:
SUMMARY When placenta previa complicated with placenta percreta, the exposure of operative field is difficult and the routine methods are difficult to effectively control the bleeding, even causing life-threatening results. A 31-year-old woman, who had been diagnosed with a complete type of placenta pre-via and placenta percreta with bladder invasion at 34 weeks gestation. Her ultrasound results showed a complete type of placenta previa and there was a loss of the decidual interface between the placenta and the myometrium on the lower part of the uterus, suggestive of placenta increta. For further evaluation of the placenta, pelvis magnetic resonance imaging was performed, which revealed findings suspicious of a placenta percreta. She underwent elective cecarean section at 36 weeks of gestation. Firstly, two ureteral stents were placed into the bilateral ureter through the cystoscope. After the infrarenal abdominal aorta catheter was inserted via the femoral artery ( 9 F sheath ) , subarachnoid anesthesia had been estab-lished. A healthy 2 510 g infant was delivered, with Apgar scores of 10 at 1 min and 10 at 5 min. Imme-diately after the baby was delivered, following which there was massive haemorrhage and general anaes-thesia was induced. The balloon catheter was immediately inflated until the wave of dorsal artery disap-peared. With the placenta retained within the uterus, a total hysterectomy was performed. The occluding time was 30 min. The intraoperative blood loss was 2 500 mL. The occluding balloon was deflated at the end of the operation. The patient had stable vital signs and normal laboratory findings during the recovery period and the hemoglobin was 116 g/L. She was discharged six days after delivery without intervention-related complications. This case illustrates that temporary occlusion of the infrarenal abdominal aorta using balloon might be a safe and effective treatment option for patients with placenta previa complicated with placenta percreta, who were at high risk for peripartum hemorrhage. Early removal of the endovascu-lar catheter and close postoperative surveillance of the vascular system are required with this procedure to minimize the risk of vascular complications. However, further studies are needed to determine whether the potential benefits of temporary occlusion of the infrarenal abdominal aorta using balloon outweigh the potential risks.
