///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Prophylactic uterine artery balloon catheterisation for suspected abnormal placentation can cause foetal compromise

Abstract Number: 268
Abstract Type: Case Report/Case Series

JAGADISH SADASHIVAIAH MBBS, MD, FRCA1 ; GORDON LYONS MD FRCA2; HAMISH MCLURE FRCA3; DAVID CAMPBELL FRCOG4; ROWAN WILSON MRCP FRCA5

Introduction

Selective prophylactic pelvic vessel catheterisation and embolisation is indicated in women at high risk of major obstetric haemorrhage. We report a case series of women with suspected abnormal placentation presenting for caesarean section following uterine artery balloon catheterisation.

Methods

Records of 14 women at risk of major haemorrhage from placenta accreta, who had prophylactic uterine artery balloon catheterisation in the Radiology suite followed by caesarean section in the maternity unit, under combined spinal epidural anaesthesia were reviewed. Intermittent fetal heart rate monitoring was performed in the Radiology suite. The neonates were assessed using the umbilical artery blood pH (UApH) and Apgar scores.

Results

Serious fetal bradycardia (< 70 bpm) was noted in two women in the Radiology suite. Both were transferred immediately to the maternity unit for emergency caesarean section. The UApH and five minute Apgar score of neonate one were 6.9 and 5 respectively. This baby was admitted to the neonatal unit. The UApH and the five minute Apgar score of neonate two were 7.01 and 9 respectively. Two more babies without witnessed fetal bradycardia had UApH of 7.1 and 7.11 and the mean UApH in our case series was 7.21. All babies were discharged home well. The estimated blood loss in our study varied from 300 - 1500 ml. Eight of the fourteen women in our case series did not need blood transfusion while in the remaining six, 1-4 units of blood was transfused. None of the women needed hysterectomy.

Discussion

Vascular complications with interventional procedures can vary from simple haematoma to major thrombosis and vessel rupture. Catheterisation of the artery can cause spasm, with possible compromise of the fetal blood supply. Uterine arterial spasm may have been the cause of serious fetal bradycardia in our study. Clarke1 et al, who used internal iliac artery embolisation, had a maximum estimated blood loss (EBL) of 28L and two women needed hysterectomy, compared to our study where the maximum EBL was 1500 ml and none of the women needed hysterectomy. There was no incidence of fetal compromise in Clarks study. Difficulty in conclusive diagnosis of placenta accreta may result in women being offered interventions with limited evidence support2, but with an inherent risk of fetal compromise.

Reference

1.Mok M, Heidemann B, Dundas K, Gillespie I, V Clark. Interventional radiology in women with suspected placenta accreta undergoing caesarean section. Int J Obstet Anaesth 2008; 17: 255-61

2.Greenburg J, Suliman A, Iranpour P, Angle N. Prophylactic balloon occlusion of internal iliac arteries to treat abnormal placentation: a cautionary case. Am J Obstet Gynecol 2007; 197: 470-71

SOAP 2009