Perinatology.  2019 Sep;30(3):175-178. 10.14734/PN.2019.30.3.175.

Intraoperative Use of Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhage Control in Woman with Placenta Percreta Involving the Bladder

• Chang SW
• Chang YR
• Seon YJ
• Park JW
• Kim JS

• KMID: 2460032
• DOI: http://doi.org/10.14734/PN.2019.30.3.175

Abstract

A 42-year-old woman with irregular uterine contractions and a history of two prior cesarean sections was admitted. At 35 weeks of gestation, preterm labor with vaginal bleeding led to a cesarean section. During placenta removal it was revealed to be a percreta and uncontrollable massive bleeding ensued. Intraoperative resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed, which has been used as a resuscitative adjunct for trauma patients with noncompressible torso hemorrhage and a hysterectomy was successfully completed. Gauze packing for temporary abdominal closure and angio-embolization were performed to further control bleeding. The packed gauze was removed 2 days later and the patient recovered uneventfully. To the best of our knowledge, this is the first reported case in South Korean literature of the successful application of a REBOA as a salvage treatment for hemorrhage control, and REBOA could be a life-saving procedure for patients with peripartum hemorrhaging.

Keyword

Hysterectomy; Placenta; Postpartum hemorrhage; Balloon occlusion

MeSH Terms

Adult
Aorta*
Balloon Occlusion*
Cesarean Section
Female
Hemorrhage*
Humans
Hysterectomy
Obstetric Labor, Premature
Peripartum Period
Placenta Accreta*
Placenta*
Postpartum Hemorrhage
Pregnancy
Salvage Therapy
Torso
Urinary Bladder*
Uterine Contraction
Uterine Hemorrhage

Figure

• 

  Fig. 1 Illustration of aortic occlusion shows an infrarenal resuscitative endovascular balloon occlusion of the aorta in zone 3.

• 

  Fig. 2 (A) Angiography shows the resuscitative endovascular balloon occlusion of the aorta catheter located on lower abdominal aorta via left common femoral artery (white arrows), ligated internal iliac artery (black arrow) and many collateral vessels on pelvic cavity. (B) Multifocal extravasation despite of ligation of left internal iliac artery.

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