Prophylactic balloon artery catheterisation for suspected abnormal placentation can cause foetal compromise
Abstract Number: 56
Abstract Type: Case Report/Case Series
Selective pelvic vessel catheterisation and embolisation is being commonly used 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 catheterisation.
The records of 14 women at risk of major haemorrhage (secondary to placenta praevia, accreta) who underwent prophylactic uterine artery balloon catherisation in the radiology suite followed by Caesarean section in the maternity unit under combined spinal epidural anaesthesia were reviewed. Intermittent foetal heart rate monitoring was performed and women with foetal bradycardia were immediately transferred back to the operating room for emergency Caesarean section. The neonates were assessed using the umbilical artery blood pH (UApH) and Apgar scores.
Serious foetal bradycardia (< 70 bpm) was noted in two women in the radiology suite. Both had emergency caesarean section. The UApH and five minute Apgar score of neonate one was 6.9 and 5 respectively. This baby was admitted to the neonatal unit. The UApH and the five minute Apgar score of neonate two was 7.01 and 9 respectively. Two more babies without witnessed foetal bradycardia had UApH of 7.1 and 7.11 and the mean Apgar score in our case series was 7.21. All babies were discharged home well.
Vascular complications with interventional procedures can vary from simple haematoma to major thrombosis and vessel rupture. Catheterisation of the artery can cause spasm, which in case of an end artery such as the uterine, can severely compromise the foetal blood supply. Uterine arterial spasm may have been the cause of serious foetal bradycardia in our study. Difficulty in conclusive diagnosis of placenta accreta may result in women being offered interventions with limited evidence support1, but with an inherent risk of foetal compromise. Even though 13 of the fourteen women in our study needed arterial balloon inflation, in a study by Clark et al2, only six out of thirteen women needed balloon inflation. Interventions for prevention of major post partum hemorrhage must be balanced against the risks of potential foetal compromise.
1. 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
2. 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