A theoretical analysis of prophylactic common iliac arterial occlusion for potential massive bleeding during cesarean delivery: Decision-making considerations - A 2-year retrospective study

Wei-Ting Chao; Hui-Hsuan Ke; Shu-Huei Shen; Chang-Ching Yeh; Peng-Hui Wang; Chiu-Ming Ho; Huann-Cheng Horng

doi:10.1016/j.tjog.2022.02.016

A theoretical analysis of prophylactic common iliac arterial occlusion for potential massive bleeding during cesarean delivery: Decision-making considerations - A 2-year retrospective study

Taiwan J Obstet Gynecol. 2022 Mar;61(2):282-289. doi: 10.1016/j.tjog.2022.02.016.

Authors

Wei-Ting Chao¹, Hui-Hsuan Ke², Shu-Huei Shen³, Chang-Ching Yeh⁴, Peng-Hui Wang⁵, Chiu-Ming Ho⁶, Huann-Cheng Horng⁷

Affiliations

¹ Faculty of Medicine, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
² Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
³ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁴ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁵ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC.
⁶ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: [email protected].
⁷ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: [email protected].

PMID: 35361389
DOI: 10.1016/j.tjog.2022.02.016

Abstract

Objective: According to the American College of Obstetricians and Gynecologists, there has been a rapid increase in the total cesarean birth rates. The rate of placenta accreta is increasing, and previous cesarean delivery is the most common risk factor. Labor is a major challenge in cases with an abnormally invasive placenta, considering the risk of massive blood loss during cesarean delivery and patient wishes for uterine preservation.

Materials and methods: We retrospectively obtained clinical data and surgical outcomes of high-risk cases of placenta previa totalis and placenta accreta admitted between March 2018 and September 2020. A multidisciplinary discussion was conducted before surgery. We also constructed an organizational flowchart detailing this decision-making process.

Results: Patients who underwent cesarean delivery for suspected placenta accreta or placenta previa totalis with clinical risk factors were reviewed. No patient required an emergency hysterectomy or intensive care unit admission.

Conclusion: We shared our experience of multidisciplinary decision-making by presenting high-risk cases of placenta previa totalis with clinical risk factors or suspected placenta accreta. Based on our multidisciplinary decision-making process, all patients were discharged without complications.

Keywords: Common iliac arterial occlusion; Placenta accreta; Placenta previa totalis.

MeSH terms

Cesarean Section / adverse effects
Female
Humans
Placenta Accreta* / etiology
Placenta Accreta* / surgery
Placenta Previa* / etiology
Placenta Previa* / surgery
Postpartum Hemorrhage* / etiology
Postpartum Hemorrhage* / prevention & control
Pregnancy
Retrospective Studies