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Interventional radiology (IR) procedures for emergency and elective obstetric cases- a reduction in blood loss versus potential complications
Abstract Number: SA-08
Abstract Type: Original Research
A previous case series has demonstrated that IR can lead to reduced blood loss during placental pathology caesarean section (LSCS)but not to reduce requirements for caesarean hysterectomy.
Reference: Mok M, Heidemann B, Dundas K et al. Interventional radiology in women with suspected placenta accreta undergoing caesarean section. IJOA (2008)17, 255-261.
After discussion with obstetricians and interventional radiologists within our NHS healthboard, we were interested to see if these findings extended to emergency cases and also what complications might arise from IR procedures in both elective and emergency case settings.
Across 2 tertiary obstetric units (6000 deliveries/annum each), we undertook a 5 year retrospective analysis of obstetric cases requiring IR input. Patients were identified using theatre and critical care admissions systems and a case note review was then done. Collected data included mode of delivery, cause of haemorrhage, blood loss, transfusion requirements, cell salvage use, balloon occlusion, use of embolization techniques and maternal/ foetal complications, morbidity and mortality.
28 cases were reviewed: x7 emergency LSCS, x18 elective LSCS and x3 SVD. Underlying diagnoses were: placenta percreta x11, placenta accreta x5, placenta praevia x3, abruption x1, uterine fibroids x2 and PPH from other causes x6. Sheaths were sited electively in 17 cases and as an emergency in 11. Balloons were inserted in 17 cases and inflated in 12. Mean inflation time was 53.9 minutes. 16 patients required arterial embolization. Mean blood loss was 6069ml (range 300-17000ml). Mean blood transfusion was 6.9 units (range 0-34). Cell salvage occurred in 12 elective patients (mean salvage return 1266ml, range 0-3330ml). 14 patients required hysterectomy. Immediate complications occurred in 4 patients (pain x1, non-target embolization x1 and foetal bradycardia requiring expedited delivery x2).Later complications were noted in 5 cases, including thrombus distal to sheath x3, PTE x1, CVA x1 and acute kidney injury x1. There was no foetal or maternal mortality.
The overall hysterectomy rate was 50%. Even in spite of IR input, the mean blood loss and transfusion requirements for these cases was still high. Cell salvage occurred in less than half of patients but yielded a good blood return when utilised. IR can be a life saving measure, particularly in the emergency setting when other surgical techniques have failed. It can, however, be associated with short and long term complications that the patient should be made aware of, if possible prior to the procedure.