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

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.

【摘要】
背景：胎盘植入（placenta accreta）是引发孕产妇发病与死亡的重要危险因素，约占急诊子宫切除术病例的64%，同时约占产后出血病例的2/3。
研究目的：描述针对既往确诊胎盘植入的孕妇，为预防严重产后出血或在剖宫产术中实施的预防性子宫导管置入术的病例系列。
方法：对产后出血高风险患者在择期或急诊剖宫产术中实施的子宫动脉导管置入术病例的病历资料进行回顾性分析。
结果：共纳入14例接受子宫动脉导管置入术的患者。手术时长与住院时长的平均值分别为214.64分钟（标准差±42.16）与7天。所有患者均接受了产科子宫切除术，无患者需行栓塞治疗；未出现再出血或需再次诊疗的病例，亦无穿刺相关并发症。本研究中仅1例发生胎儿死亡，无孕产妇死亡病例。
结论：本研究证实，临时阻断血流的预防性子宫动脉导管置入术是一项安全技术，具有胎儿死亡率低、无孕产妇死亡且输血率低的特点，可作为降低孕产妇发病率与死亡率的重要有效治疗策略，尤其适用于胎盘附着异常的孕妇。此外，采用该技术可实现子宫保留，为此类患者的治疗管理提供了极佳的辅助方案。不过，仍需开展随机对照临床试验以评估该技术常规应用的有效性。