RESUMO
PURPOSE: Prophylactic placement of endovascular balloon occlusion catheters has grown to be part of the surgical plans to control intraoperative hemorrhage in cases of abnormal placentation. We performed a systematic literature review to investigate the safety and effectiveness of the use of REBOA during cesarean delivery in pregnant woman with morbidly adherent placenta. METHODS: A systematic review was performed. Relevant case reports and nonrandomized studies were identified by the literature search in MEDLINE. We included studies involving pregnant woman with diagnosis of abnormal placentation who underwent cesarean delivery with REBOA placed for hemorrhage control. MINORS' criteria were used to evaluate the risk of bias of included studies. A formal meta-analysis was not performed. RESULTS: Eight studies were included in cumulative results. These studies included a total of 392 patients. Overall, REBOA was deployed in 336 patients. Six studies reported the use of REBOA as an adjunct for prophylactic hemorrhage control in pregnant woman with diagnosis of morbidly adherent placenta undergoing elective cesarean delivery. In two studies, REBOA was deployed in patients already in established hemorrhagic shock at the moment of cesarean delivery. REBOA was deployed primarily by interventional radiologists; however, one study reported a surgeon as the REBOA provider. The results from our qualitative synthesis indicate that the use of REBOA during cesarean delivery resulted in less blood loss with a low rate complications occurrence. CONCLUSION: REBOA is a feasible, safe, and effective means of prophylactic and remedial hemorrhage control in pregnant women with abnormal placentation undergoing cesarean delivery.
Assuntos
Aorta , Oclusão com Balão/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea , Placenta Acreta , Hemorragia Pós-Parto/prevenção & controle , Adulto , Feminino , Humanos , Gravidez , Ressuscitação/métodosRESUMO
OBJECTIVE: To determine growth of the alpaca conceptus during early gestation, using ultrasonography. ANIMALS: 40 pregnant alpacas (20 multiparous, 20 nulliparous). PROCEDURE: Transrectal ultrasonography with a 5-MHz probe was performed 3 times weekly from days 7 through 45 after copulation (day of copulation = day 0). Blood samples were collected for progesterone assay on days of ultrasonography. RESULTS: Forty embryonic vesicles and embryos were identified and measured. Embryonic vesicles were first detected on day 12 after copulation and appeared spherical. Cumulative percentage of embryonic vesicles detected was 50, 82.5, and 100% on days 12, 14, and 16, respectively. Embryos were first detected by day 22 and heartbeats by day 24. Similarly, cumulative percentage of embryos detected was 17.5, 82.5 and 100% for 22, 24, and 26 days after copulation, respectively. Embryonic vesicles occupied both uterine horns beginning on day 19. A positive correlation existed between length and width of embryonic vesicles. Size of embryonic vesicles and embryos and progesterone concentrations did not differ between multiparous and nulliparous females. Five sets of twins were detected from days 21 through 33 after copulation, but the conceptus identified in the right uterine horn became nondetectable between days 28 and 33. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasonography was useful in detecting the earliest appearance of alpaca embryonic vesicles and determining the changes in growth from days 12 through 45 after copulation. Embryos were first detected by day 22. Transrectal ultrasonography was not harmful to animals and did not provoke embryonic death in this study.