Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.180134
Jornal Vascular Brasileiro
Original Article

Cateterização profilática de artérias uterinas com oclusão temporária do fluxo sanguíneo em pacientes de alto risco para hemorragia puerperal: é uma técnica segura?

Prophylactic catheterization of uterine arteries with temporary blood flow occlusion in patients at high risk of pospartum hemorrhage: is it a safe technique?

Alexandre Malta Brandão; Selma Regina de Oliveira Raymundo; Daniel Gustavo Miquelin; André Rodrigo Miquelin; Fernando Reis Neto; Gabriela Leopoldino da Silva; Heloisa Aparecida Galão; Maria Lucia Luiz Barcelos Veloso

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Resumo

Resumo: Contexto: A placenta acreta é um importante causa de morbimortalidade materna, sendo responsável por aproximadamente 64% dos casos de histerectomia de urgência e em torno de 2/3 dos casos de sangramento puerperal.

Objetivos: Descrever uma série de casos de cateterização uterina profilática para evitar sangramento significativo no pós-parto ou durante parto cesárea em gestantes com diagnóstico prévio de acretismo.

Métodos: Foi realizada uma análise retrospectiva de prontuários dos casos de cateterização da artéria uterina durante cesarianas eletivas ou de urgência em pacientes com alto risco de sangramento puerperal.

Resultados: O procedimento foi realizado em 14 pacientes. O tempo médio do procedimento cirúrgico e da internação foi de 214,64 minutos (± 42,16) e 7 dias, respectivamente. Todas as pacientes foram submetidas a histerectomia por indicação obstétrica. Nenhuma paciente necessitou de embolização. Não houve sangramento ou necessidade de reabordagem em nenhuma paciente e nenhuma complicação relacionada à punção. Houve apenas um caso de morte fetal e nenhuma morte materna.

Conclusões: Neste estudo, a cateterização profilática de artérias uterinas com oclusão temporária do fluxo sanguíneo demonstrou ser uma técnica segura, pois apresentou baixa mortalidade fetal, baixa necessidade de hemotransfusão, e nenhuma morte materna. Portanto, pode ser considerada uma estratégia terapêutica importante e eficaz para a diminuição da morbimortalidade materna, especialmente em gestantes com implantação placentária anômala. Além disso, a possibilidade de preservação uterina com o uso do método traz excelente contribuição na terapêutica nesse grupo de pacientes. Entretanto, são necessários ensaios clínicos randomizados para avaliar a eficácia do uso rotineiro da técnica.

Palavras-chave

útero, cateterismo, hemorragia pós-parto, placenta acreta

Abstract

Abstract: Background: Placenta accreta is an important factor in maternal morbidity and mortality and is responsible for approximately 64% of emergency hysterectomy cases and about 2/3 of cases of puerperal bleeding.

Objectives: To describe a series of cases of prophylactic uterine catheterization performed to prevent significant postpartum bleeding or during caesarean delivery in pregnant women with a previous diagnosis of accretion.

Methods: A retrospective analysis was conducted of medical records of cases of uterine artery catheterization performed during elective or emergency caesarean sections of patients at high risk of postpartum bleeding.

Results: The catheterization of uterine arteries procedure was performed in fourteen patients. Mean duration of surgery and hospital stay were 214.64 minutes (± 42.16) and 7 days, respectively. All patients underwent obstetric hysterectomy. No patient required embolization. There was no bleeding or need to revisit any patient and there were no complications related to puncture. There was one fetal death and no maternal deaths.

Conclusions: In this study, prophylactic uterine artery catheterization with temporary occlusion of blood flow proved to be a safe technique with low fetal mortality, no maternal mortality, and a low rate of blood transfusion and can be considered an important and effective therapeutic strategy for reduction of maternal morbidity and mortality, especially in pregnant women with anomalous placental attachment. Furthermore, the possibility of uterine preservation with the use of this method is an excellent contribution to therapeutic management of this group of patients. However, randomized clinical trials are needed to evaluate the effectiveness of routine use of the technique.
 

Keywords

uterus, catheterization, postpartum hemorrhage, placenta accreta

References

Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev. 2014;13(2):CD003249. PMid:24523225.

World Health Organization – WHO. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO; 2012.

Angstmann T, Gard G, Harrington T, Ward E, Thomson A, Giles W. Surgical management of placenta accreta: a cohort series and suggested approach. Am J Obstet Gynecol. 2010;202(1):38.e1-9. http://dx.doi.org/10.1016/j.ajog.2009.08.037. PMid:19922901.

Bodner LJ, Nosher JL, Gribbin C, Siegel RL, Beale S, Scorza W. Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta. Cardiovasc Intervent Radiol. 2006;29(3):354-61. http://dx.doi.org/10.1007/s00270-005-0023-2. PMid:16502171.

Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):1458-61. http://dx.doi.org/10.1016/j.ajog.2004.12.074. PMid:15902137.

Kirby JM, Kachura JR, Rajan DK, et al. Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol. 2009;20(8):1036-45. http://dx.doi.org/10.1016/j.jvir.2009.04.070. PMid:19647182.

Tantbirojn P, Crum CP, Parast MM. Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta. 2008;29(7):639-45. http://dx.doi.org/10.1016/j.placenta.2008.04.008. PMid:18514815.

Khong TY. The pathology of placenta accreta, a worldwide epidemic. J Clin Pathol. 2008;61(12):1243-6. http://dx.doi.org/10.1136/jcp.2008.055202. PMid:18641410.

Melcer Y, Jauniaux E, Maymon S, et al. Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa. Am J Obstet Gynecol. 2018;218(4):443.e1-8. http://dx.doi.org/10.1016/j.ajog.2018.01.017. PMid:29353034.

Shamshirsaz AA, Fox KA, Erfani H, et al. Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta. Obstet Gynecol. 2018;131(2):234-41. http://dx.doi.org/10.1097/AOG.0000000000002442. PMid:29324609.

Maldjian C, Adam R, Pelosi M, Pelosi M 3rd, Rudelli RD, Maldjian J. MRI appearance of placenta percreta and placenta accrete. Magn Reson Imaging. 1999;17(7):965-71. http://dx.doi.org/10.1016/S0730-725X(99)00035-1. PMid:10463645.

Duzyj C, Han C, Mhatr M, et al. 555: focal placenta accreta not requiring hysterectomy has alternate risk factors and morbidity. Am J Obstet Gynecol. 2018;210(1):273-4. http://dx.doi.org/10.1016/j.ajog.2013.10.588.

Mushtaq S, Kurdi W, Al-Shammari M. Prophylactic catheters placement and intraoperative internal iliac artery embolization in a patient with placenta accreta. J Obstet Gynaecol. 2007;27(8):853-5. http://dx.doi.org/10.1080/01443610701748658. PMid:18097915.

Thon S, McLintic A, Wagner Y. Prophylactic endovascular placement of internal iliac occlusion balloon catheters in parturients with placenta accreta: a retrospective case series. Int J Obstet Anesth. 2011;20(1):64-70. http://dx.doi.org/10.1016/j.ijoa.2010.08.006. PMid:21112764.

Lee HY, Shin JH, Kim J, et al. Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution. Radiology. 2012;264(3):903-9. http://dx.doi.org/10.1148/radiol.12111383. PMid:22829685.

Ojala K, Perälä J, Kariniemi J, Ranta P, Raudaskoski T, Tekay A. Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage*. Acta Obstet Gynecol Scand. 2005;84(11):1075-80. PMid:16232175.

Badawy SZ, Etman A, Singh M, Murphy K, Mayelli T, Philadelphia M. Uterine artery embolization: the role in obstetrics and gynecology. Clin Imaging. 2001;25(4):288-95. http://dx.doi.org/10.1016/S0899-7071(01)00307-2. PMid:11566093.

Omar HR, Sprenker C, Alvey E, et al. The value of occlusive balloons in the management of abnormal placentation: A retrospective study. J Obstet Gynaecol. 2016;36(3):333-6. http://dx.doi.org/10.3109/01443615.2015.1052962. PMid:26492439.

Shrivastava V, Nageotte M, Major C, Haydon M, Wing D. Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta. Am J Obstet Gynecol. 2007;197(4):402.e1-5. http://dx.doi.org/10.1016/j.ajog.2007.08.001. PMid:17904978.

Kidney DD, Nguyen AM, Ahdoot D, Bickmore D, Deutsch LS, Majors C. Prophylactic perioperative hypogastric artery balloon occlusion in abnormal placentation. AJR Am J Roentgenol. 2001;176(6):1521-4. http://dx.doi.org/10.2214/ajr.176.6.1761521. PMid:11373225.

Mitty HA, Sterling KM, Alvarez M, Gendler R. Obstetric hemorrhage: prophylactic and emergency arterial catheterization and embolotherapy. Radiology. 1993;188(1):183-7. http://dx.doi.org/10.1148/radiology.188.1.8511294. PMid:8511294.

Hansch E, Chitkara U, McAlpine J, El-Sayed Y, Dake MD, Razavi MK. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience. Am J Obstet Gynecol. 1999;180(6 Pt 1):1454-60. http://dx.doi.org/10.1016/S0002-9378(99)70036-0. PMid:10368488.
 

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