Abstract：
OBJECTIVE: To report the results of prophylactic use of intraoperative temporary internal iliac arterial occlusion by Bulldog clamps in patients clinically diagnosed with abnormally invasive placenta.
METHODS: This retrospective study included 61 patients diagnosed with FIGO grade 3 abnormally invasive placenta between January 2018 and March 2022. After transfundal incision and fetal delivery, bilateral temporary internal iliac arterial occlusion by Bulldog clamps was performed in all patients. The grades 3b and 3c group underwent cesarean hysterectomy whereas selected cases of grade 3a abnormally invasive placenta underwent fertility-preserving procedures. Preoperative and postoperative findings were compared.
RESULTS: Cesarean hysterectomy was performed in 50 (82%) patients and cesarean plus conservative procedures were performed in 11 (18%) patients. Intraoperative blood replacement was not performed in 83.6% of all patients. Mean blood loss was 1.37 ± 0.53 L (range 0.5-2.5) in all patients. Estimated blood loss was significantly higher in cesarean hysterectomy group. There was no statistically significant difference between two groups in terms of peroperative blood replacement, bladder, and ureteral injury.
CONCLUSIONS: Prophylactic bilateral temporary internal iliac arterial occlusion by Bulldog clamps should be performed in cases of grade 3 abnormally invasive placenta. Fertility-preserving steps may be undertaken safely in selected cases with this approach.
METHODS: This retrospective study included 61 patients diagnosed with FIGO grade 3 abnormally invasive placenta between January 2018 and March 2022. After transfundal incision and fetal delivery, bilateral temporary internal iliac arterial occlusion by Bulldog clamps was performed in all patients. The grades 3b and 3c group underwent cesarean hysterectomy whereas selected cases of grade 3a abnormally invasive placenta underwent fertility-preserving procedures. Preoperative and postoperative findings were compared.
RESULTS: Cesarean hysterectomy was performed in 50 (82%) patients and cesarean plus conservative procedures were performed in 11 (18%) patients. Intraoperative blood replacement was not performed in 83.6% of all patients. Mean blood loss was 1.37 ± 0.53 L (range 0.5-2.5) in all patients. Estimated blood loss was significantly higher in cesarean hysterectomy group. There was no statistically significant difference between two groups in terms of peroperative blood replacement, bladder, and ureteral injury.
CONCLUSIONS: Prophylactic bilateral temporary internal iliac arterial occlusion by Bulldog clamps should be performed in cases of grade 3 abnormally invasive placenta. Fertility-preserving steps may be undertaken safely in selected cases with this approach.
摘要：
目的：报告在临床诊断为异常侵入性胎盘的患者中预防性使用Bulldog钳夹术中暂时性髂内动脉闭塞的结果。
方法：这项回顾性研究包括2018年1月至2022年3月期间诊断为FIGO3级异常侵入性胎盘的61例患者。经底切口和胎儿分娩后，所有患者均通过Bulldog钳进行双侧暂时性髂内动脉闭塞。3b级和3c级组接受了剖宫产子宫切除术，而部分3a级异常侵入性胎盘病例接受了保留生育能力的手术。比较术前和术后结果。
结果：50例（82%）患者行剖宫产子宫切除术，11例（18%）患者行剖宫产加保守手术。83.6%的患者未进行术中血液置换。所有患者的平均失血量为1.37±0.53L（范围0.5-2.5）。剖宫产子宫切除术组的估计失血量明显较高。两组在围手术期血液置换方面的差异无统计学意义。膀胱,和输尿管损伤。
结论：对于3级异常侵入性胎盘，应通过Bulldog钳进行预防性双侧暂时性髂内动脉闭塞。在某些情况下，可以使用这种方法安全地采取保持生育力的步骤。
方法：这项回顾性研究包括2018年1月至2022年3月期间诊断为FIGO3级异常侵入性胎盘的61例患者。经底切口和胎儿分娩后，所有患者均通过Bulldog钳进行双侧暂时性髂内动脉闭塞。3b级和3c级组接受了剖宫产子宫切除术，而部分3a级异常侵入性胎盘病例接受了保留生育能力的手术。比较术前和术后结果。
结果：50例（82%）患者行剖宫产子宫切除术，11例（18%）患者行剖宫产加保守手术。83.6%的患者未进行术中血液置换。所有患者的平均失血量为1.37±0.53L（范围0.5-2.5）。剖宫产子宫切除术组的估计失血量明显较高。两组在围手术期血液置换方面的差异无统计学意义。膀胱,和输尿管损伤。
结论：对于3级异常侵入性胎盘，应通过Bulldog钳进行预防性双侧暂时性髂内动脉闭塞。在某些情况下，可以使用这种方法安全地采取保持生育力的步骤。
