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• W2095059904 abstract "We read with great interest the article by Greenberg et al.1Greenberg J.I. Suliman A. Iranpour P. Angle N. Prophylactic balloon occlusion of the internal iliac arteries to treat abnormal placentation: a cautionary case.Am J Obstet Gynecol. 2007; 197: 470e1-470e4Abstract Full Text Full Text PDF Scopus (96) Google Scholar As noted by the authors and because of the growing number of cesarean deliveries, the frequency of abnormally invasive placentation is increasing.2Timmermans S. van Hof A.C. Duvekot J.J. Conservative management of abnormally invasive placentation.Obstet Gynecol Surv. 2007; 62: 529-539Crossref PubMed Scopus (194) Google Scholar Despite improved prenatal diagnosis (ultrasound scans and magnetic resonance imaging), the management of placentas accreta and percreta remains difficult, especially when these placentas are previa. The surgical procedures, which is either cesarean hysterectomy or conservative management with the placenta in situ, are most often hemorrhagic, even when performed by trained surgeons. In our experience, conservative management does not prevent significant (or even severe) perioperative bleeding. That is the reason that our practice insists on performing systematic hypogastric arteries ligation (HAL) in case of placenta accreta. We make the ligation immediately after the cesarean delivery as soon as the diagnosis of invasive placentation has been confirmed. Once the bilateral ligation has been made, we perform either a hysterectomy or a conservative procedure.3Kayem G. Anselem O. Schmitz T. et al.Conservative versus radical management in cases of placenta accreta: a historical study.J Gynecol Obstet Biol Reprod. 2007; 36: 680-687Crossref PubMed Scopus (29) Google Scholar In our experience (> 100 HALs in obstetric hemorrhages, > 20 HALs in cases of abnormal placentation) and as reported in the literature, HAL is an effective procedure to decrease hemorrhage that is related to the delivery of patients with a placenta accreta.4Sziller I. Hupuczi P. Papp Z. Hypogastric artery ligation for severe hemorrhage in obstetric patients.J Perinat Med. 2007; 35: 187-192Crossref PubMed Scopus (44) Google Scholar Because patients with a prenatal diagnosis of abnormal placentation have to be treated by trained teams, we assume HAL is doable technically and can be performed immediately after the delivery. We consider it to be an interesting and safe alternative to balloon occlusion or to arterial embolization. Prophylactic balloon occlusion of the internal iliac arteries to treat abnormal placentation: a cautionary caseAmerican Journal of Obstetrics & GynecologyVol. 197Issue 5PreviewMassive hemorrhage from abnormal placentation is a leading cause of postpartum maternal death and hysterectomy after cesarean section. The endovascular surgeon and radiologist are increasingly asked to assist in the management of these complex patients with the placement of bilateral internal iliac artery balloon catheters. We report the case of a 27-year-old woman with placenta percreta with preemptive bilateral internal iliac artery balloons who had iliac artery thrombosis and acute limb ischemia develop 7 hours after cesarean hysterectomy. Full-Text PDF ReplyAmerican Journal of Obstetrics & GynecologyVol. 199Issue 3PreviewThe use of prophylactic balloon occlusion to thwart massive obstetric hemorrhage is increasing in patients with abnormal placentation. In our report,1 we critically reviewed the available literature in support of this practice and found not only a lack of level I evidence but also a divided experience, even in retrospective case series. We thus concluded that there seems to be a discrepancy between the utility that practitioners find in this procedure and outcome data concerning uterine preservation and hemostasis. Full-Text PDF" @default.
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• W2095059904 title "The ligation of hypogastric arteries is a safe alternative to balloon occlusion to treat abnormal placentation" @default.
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