J Korean Med Sci.  2010 Apr;25(4):651-655. 10.3346/jkms.2010.25.4.651.

Prophylactic Hypogastric Artery Ballooning in a Patient with Complete Placenta Previa and Increta

Affiliations
  • 1Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea. mjohmd@korea.ac.kr
  • 2Department of Radiology, College of Medicine, Korea University, Seoul, Korea.

Abstract

Abnormal attachment of the placenta (Placenta accreta, increta, and percreta) is an uncommon but potentially lethal cause of maternal mortality from massive postpartum hemorrhage. A 33-yr-old woman, who had been diagnosed with a placenta previa, was referred at 30 weeks gestation. On ultrasound, a complete type of placenta previa and multiple intraplacental lacunae, suggestive of placenta accreta, were noted. For further evaluation of the placenta, pelvis MRI was performed and revealed findings suspicious of a placenta increta. An elective cesarean delivery and subsequent hysterectomy were planned for the patient at 38 weeks gestation. On the day of delivery, endovascular catheters for balloon occlusion were placed within the hypogastric arteries, prior to the cesarean section. In the operating room, immediately after the delivery of the baby, bilateral hypogastric arteries were occluded by inflation of the balloons in the catheters previously placed within. With the placenta retained within the uterus, a total hysterectomy was performed in the usual fashion. The occluding balloons were deflated after closure of the vaginal cuff with hemostasis. The patient had stable vital signs and normal laboratory findings during the recovery period; she was discharged six days after delivery without complications. The final pathology confirmed a placenta increta.

Keyword

Placenta Increta; Hypogastric Artery; Balloon Occlusion

MeSH Terms

Adult
Arteries/*surgery
*Catheterization
Cesarean Section
Female
Gestational Age
Humans
Hysterectomy/*methods
Placenta/*blood supply/ultrasonography
Placenta Accreta/*surgery/ultrasonography
Placenta Previa/*surgery/ultrasonography
Postpartum Hemorrhage/*prevention & control
Pregnancy
Treatment Outcome

Figure

  • Fig. 1 (A) Multiple hypoechoic spaces (arrows) were noted on the placenta with ultrasound. (B) Axial T2-weighted MRI image shows a complete placenta previa with invasion into posterior myometrium of the uterus, suggestive of a placenta increta (arrow).

  • Fig. 2 Fluoroscopy shows the endovascular balloons positioned in the main lumen of the hypogastric arteries bilaterally (A: right and B: left) for occlusion.

  • Fig. 3 Microscopic findings. (A) Cut surface of the uterus with attached placenta and umbilical cord. The left end of the uterus is the uterine cervix (arrow), and the right end of uterus is the uterine fundus. The cut surface shows abnormal placental adherence in the low uterine segment (placenta previa). The placenta invades into the myometrium, but does not penetrate through it (placenta increta). (B) The placenta invades the myometrium without intervening decidua. It is partially separated from focally hyalinized myometrial smooth muscle cells by a layer of fibrin. Partial or complete absence of decidua basalis, which may be replaced by loose connective tissue, is the cardinal feature in microscopic examination (H&E stain, ×100).


Cited by  1 articles

Recent Update of Embolization of Postpartum Hemorrhage
Chengshi Chen, Sang Min Lee, Jong Woo Kim, Ji Hoon Shin
Korean J Radiol. 2018;19(4):585-596.    doi: 10.3348/kjr.2018.19.4.585.


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