Estimation of fetal radiation absorbed dose during the prophylactic use of aortic occlusion balloon for abnormally invasive placenta.

Published on Oct 1, 2021in Journal of Maternal-fetal & Neonatal Medicine1.737
· DOI :10.1080/14767058.2019.1678144
Albaro José Nieto-Calvache3
Estimated H-index: 3
(ICESI University),
L. F. Salas1
Estimated H-index: 1
+ 3 AuthorsFernando Rodríguez-Holguín2
Estimated H-index: 2
Sources
Abstract
: Purpose: Abnormally invasive placenta is an important cause of maternal morbidity, and its primary complication is massive bleeding. Strategies for preventing bleeding include arterial endovascular occlusion. One concern with the use of intra-arterial occlusion balloons is radiation exposure to the fetus, which occurs while determining balloon position. In this study, we sought to determine the radiation absorbed dose by the fetus during intra-aortic occlusion balloon placement in patients with abnormally invasive placenta. Materials and methods: We estimated the fetal absorbed dose and the entrance skin dose in the vaginal fundus and lumbar skin, respectively, using thermoluminescent dosimeter crystals, during intra-aortic balloon positioning using the mobile X-ray image intensifier system (C-arm) in digital radiography mode, directly in surgery room, without transfer to angiographic suite. We also performed a mannequin-based simulation to validate the entrance skin dose measurement technique. Results: Ten women undergoing surgical management of an abnormally invasive placenta, in whom the location of the intra-aortic occlusion balloon was verified using plain radiography with C-arm in the surgery room, were included in the study. Following maternal and fetal radiation exposure, the entrance skin dose and radiation absorbed dose by the fetus were 1.31 ± 0.96 mGy and 0.27 ± 0.28 mGy, respectively, with radiation exposure durations of <1 s. Conclusions: There were no complications with the use of REBOA, the radiation absorbed dose by the fetus, entrance skin dose, and duration of radiation exposure during intra-aortic occlusion balloon placement were lower than those reported for other vascular occlusion techniques, being this a safe procedure.
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References14
Newest
#1Albaro J Nieto (ICESI University)H-Index: 5
#2María Paula Echavarría (ICESI University)H-Index: 2
Last. María Fernanda Escobar (ICESI University)H-Index: 6
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Abstract Introduction: The management of patients with placenta accreta (PA) poses a challenge to health services. Although it may lead to devastating complications, its low incidence limits the development of expertise in all obstetric centers. We evaluate the results obtained from a multidisciplinary approach in patients with PA in a Latin American hospital. Methods: The study included patients with prenatal suspicion or intraoperative diagnosis of PA, before and after initiating a set of inte...
13 CitationsSource
#1Ramiro Manzano-Nunez (Harvard University)H-Index: 11
Last. Carlos A. Ordoñez (University of Valle)H-Index: 29
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Morbidly adherent placenta (MAP), which includes accreta, increta, and percreta, is a condition characterized by the invasion of the uterine wall by placental tissue. The condition is associated with higher odds of massive post-partum hemorrhage. Several interventions have been developed to improve hemorrhage-related outcomes in these patients; however, there is no evidence to prefer any intervention over another. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascul...
14 CitationsSource
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.
23 CitationsSource
BACKGROUNDWe describe intraoperative and postdischarge outcomes of a case series after the prophylactic use of resuscitative endovascular balloon occlusion of the aorta (REBOA) during elective cesarean delivery in pregnant women with morbidly adherent placenta (MAP). We furthermore performed a syste
39 CitationsSource
BACKGROUNDRecent evidence suggests that resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective life-saving intervention in patients with severe torso trauma. However, the deployment of REBOA in patients with isolated penetrating intrathoracic injuries remains controversial
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#1Lan Xie (Academy of Medical Sciences, United Kingdom)H-Index: 1
#2Yan Wang (Academy of Medical Sciences, United Kingdom)H-Index: 1
Last. Xiao-Lan Zhao (Academy of Medical Sciences, United Kingdom)H-Index: 1
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AbstractThis study evaluated the surgical and neonatal outcomes of 71 patients diagnosed with placenta accreta before caesarean section with or without placement of a prophylactic abdominal aorta balloon catheter. This study took place at our hospital from January 2013 to May 2015. Thirty patients had a prophylactic balloon catheter inserted (balloon group), and 41 patients did not receive the intervention (control group). The mean estimated blood loss and decrease in haemoglobin after surgery w...
28 CitationsSource
#1Yanli Wang (Zhengzhou University)H-Index: 8
#2Xuhua Duan (Zhengzhou University)H-Index: 7
Last. Wei Zhang (Zhengzhou University)H-Index: 17
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Abstract. Background: To compare the efficacy of temporary abdominal aortic occlusion with internal iliac artery occlusion for the management of placenta accreta. Patients and methods: 105 patients with placenta accreta were selected for treatment with temporary abdominal aortic occlusion (n = 57, group A) or bilateral iliac artery occlusion (n = 48, group B). Temporary abdominal aortic and internal iliac artery balloon occlusions were performed during caesarean sections. Data regarding the clin...
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Last. Jukka Perälä (OUH: Oulu University Hospital)H-Index: 16
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Purpose The purpose of the study was to estimate the absorbed dose (AD) to the fetus for pregnant patients with placenta accreta undergoing fluoroscopy imaging during prophylactic catheterization and uterine artery embolization. We hypothesize that after optimizing the use of the radiation, this endovascular method is safe.
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#1Gilles Kayem (French Institute of Health and Medical Research)H-Index: 32
#2Catherine Deneux-Tharaux (French Institute of Health and Medical Research)H-Index: 32
Last. Loïc SentilhesH-Index: 41
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Background No population-based study has assessed the prevalence of placenta accreta, the predictive value of prenatal diagnostic examinations, the maternal morbidity associated with its management, or its psychological effects. Moreover, the technical resources necessary for the safest delivery of women at risk have not been clearly identified. Objectives The primary objectives are to identify individual risk factors, as well as factors associated with types of management and with the healthcar...
27 CitationsSource
#1Xiao-guang Li (Peking Union Medical College Hospital)H-Index: 6
#2Zhiwei Wang (Peking Union Medical College Hospital)H-Index: 7
Last. Jinghe Lang (Peking Union Medical College Hospital)H-Index: 28
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Aim To evaluate the efficacy and safety of uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta. Materials and methods Between January 2005 and August 2011, 45 women with placenta accreta, which was discovered during delivery, were managed conservatively in Peking Union Medical College Hospital. They did not experience severe bleeding during delivery. Ten patients (mean age 31 ± 6.4 years) developed secondary postpartum haemorrhage a...
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Cited By4
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INTRODUCTION The main complication of placenta accreta spectrum (PAS) is massive bleeding. Endoarterial occlusion techniques has been incorporated into the management of this pathology. Our aim was to examine the endovascular practice patterns among PAS patients treated during a 9 year period in a low-middle income country in which an interdisciplinary group's technical skills were improved with the creation of a "PAS team". METHODOLOGY Retrospective cohort including all PAS patients treated fro...
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Abstract Placenta accreta spectrum (PAS) disorders are rare but potentially life-threatening obstetric conditions, which can result in severe postpartum haemorrhage (PPH). Traditional management necessitates peripartum hysterectomy but this carries high rates of morbidity and mortality. More recently, interventional radiology techniques have been developed in order to reduce morbidity and preserve fertility. This article summarises and compares the various reported interventional radiology techn...
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#1Philippe SoyerH-Index: 56
#2Maxime Barat (University of Paris)H-Index: 6
Last. Anthony DohanH-Index: 26
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Abnormally invasive placenta (AIP) is a potentially severe condition. To date, arterial embolization in women with postpartum hemorrhage due to AIP is the treatment option for which highest degrees of evidence are available. However, other techniques have been tested, including prophylactic catheter placement, balloon occlusion of the iliac arteries and abdominal aorta balloon occlusion. In this systematic review, we provide an overview of the currently reported interventional radiology procedur...
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