Key result
Angiographic visualization of collateral circulation from the round ligament artery to the uterus was present in 75% of patients with massive bleeding compared to 32% without, identifying it as a risk factor during cesarean section with BOIA.
Why the study?
Risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta undergoing internal iliac artery balloon occlusion during cesarean section were unknown.
Does angiographic visualization of collateral circulation from the round ligament artery predict massive bleeding in patients with placenta previa and accreta undergoing BOIA during cesarean section?
Observational (n=42)
Blinded image interpretations by two investigators
No
Does angiographic visualization of collateral circulation from the round ligament artery predict massive bleeding in patients with placenta previa and accreta undergoing BOIA during cesarean section?
Angiographic visualization of collateral circulation from the round ligament artery to the uterus is a significant risk factor for massive bleeding in patients with placenta previa and accreta undergoing prophylactic internal iliac artery balloon occlusion.
Answers are grounded in this paper and cite their sources.
Round ligament artery collaterals were associated with massive bleeding after BOIA; leaves open prospective validation of angiographic predictors.
Objective: We evaluated the risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery (BOIA) during cesarean section. Methods: We performed a retrospective analysis using the clinical records of 42 patients with placenta previa and accreta who underwent BOIA during cesarean section between 2006 and 2017 in Gunma university hospital. We reviewed incidence of collateral arteries to the uterus on the initial aortography. We evaluated the visualization of the ovarian artery arising directly from the abdominal aorta, round ligament artery arising from the external iliac artery/inferior epigastric artery, and the iliolumbar artery. In addition, the clinical characteristics were reviewed. Patients with an estimated blood loss during delivery of >2500 ml, >4 packed red blood cell transfusions, uterine artery embolization after delivery, or hysterectomy were defined as the massive bleeding group. We compared between the massive and non-massive bleeding groups. Results: 20 patients (48%) had a massive bleeding. No procedure-related severe complications were observed. The massive and non-massive bleeding groups differed in terms of operation time (p < 0.001), hysterectomy (p < 0.001), post-operative hospital stay (p < 0.05), and visualization of round ligament arteries to the uterus [15/20 (75%) patients, p < 0.01]. Conclusion: The incidence of collateral blood supply from a round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section. Advances in knowledge: Angiographic visualization of collateral circulation from the round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section.
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Tokue et al. (2019) conducted an observational in Placenta previa and accreta (n=42). Massive bleeding during cesarean section vs. Non-massive bleeding was evaluated on Visualization of round ligament arteries to the uterus (p=<0.01). Angiographic visualization of collateral circulation from the round ligament artery to the uterus was present in 75% of patients with massive bleeding compared to 32% without, identifying it as a risk factor during cesarean section with BOIA.
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