Minimizing surgical blood loss at cesarean hysterectomy for placenta previa with evidence of placenta increta or placenta percreta: the state of play in 2020.
Minimizing surgical blood loss at cesarean hysterectomy for placenta previa with evidence of placenta increta or placenta percreta: the state of play in 2020.
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DOI：
10.1016/j.ajog.2020.01.044
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发表时间：
2020-09
影响因子：
9.8
通讯作者：
Fox KA
中科院分区：
文献类型：
--
作者：
Kingdom JC;Hobson SR;Murji A;Allen L;Windrim RC;Lockhart E;Collins SL;Soleymani Majd H;Alazzam M;Naaisa F;Shamshirsaz AA;Belfort MA;Fox KA
针对侵入性胎盘谱系障碍女性的多学科团队护理的发展已经逐步改善了临床结果。这一总体目标的核心是限制手术失血的能力。在骨盆动脉内放置充气球囊（最常见的是髂内动脉前部）在许多中心变得流行，但代价是延长手术护理时间并伴随血管损伤的风险。与此同时，暴露骨盆侧壁解剖结构以安全识别输尿管走向的需要重新普及了结扎髂内动脉相同前部的替代策略。随着外科专业知识的不断进步（本次审查中描述的 5 个步骤），我们的团队见证了手术失血量的稳步下降。然而，一部分女性患有最严重的侵入性胎盘，即前置胎盘。这些女性在手术期间面临来自髂内动脉区域以外的血管的大出血的风险。这些额外的血液供应主要来自髂外动脉，即使在经验丰富的人手中也会造成严重失血的巨大风险。为了解决这一风险，一些中心（主要是中国）采取了常规放置肾下主动脉球囊的方法，失血率极低，并且能够通过切除胎盘和受影响的子宫壁部分来保护子宫。我们在针对前置胎盘（最严重的侵入性胎盘谱系疾病）安全地进行择期剖宫产子宫切除术的背景下回顾了这些文献的进展。
The evolution of multidisciplinary team-based care for women with placenta accreta spectrum disorder has delivered stepwise improvements in clinical outcomes. Central to this overall goal is the ability to limit blood loss at surgery. Placement of inflatable balloons within the pelvic arteries, most commonly in the anterior divisions of the internal iliac arteries, became popular in many centers, at the expense of prolonging surgical care and with attendant risks of vascular injury. In tandem, the need to expose pelvic sidewall anatomy to safely identify the course of the ureters re-popularized the alternative strategy of ligating the same anterior divisions of the internal iliac arteries. With incremental gains in surgical expertise, described in 5 steps in this review, our teams have witnessed a steady decline in surgical blood loss. Nevertheless, a subset of women has the most severe form of placenta accreta spectrum, namely placenta previa-percreta. Such women are at risk of major hemorrhage during surgery from vessels arising outside the territories of the internal iliac arteries. These additional blood supplies, mostly from the external iliac arteries, pose significant risks of major blood loss even in experienced hands. To address this risk, some centers, principally in China, have adopted an approach of routinely placing an infrarenal aortic balloon, with both impressively low rates of blood loss and an ability to conserve the uterus by resecting the placenta with the affected portion of the uterine wall. We review these literature developments in the context of safely performing elective cesarean hysterectomy for placenta previa-percreta, the most severe placenta accreta spectrum disorder.
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