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CardioVascular and Interventional Radiology

, Volume 42, Issue 3, pp 365–370 | Cite as

Non-conservative Management of Placenta Accreta Spectrum in the Hybrid Operating Room: A Retrospective Cohort Study

  • César Hernán Meller
  • Ricardo D. Garcia-MonacoEmail author
  • Gustavo Izbizky
  • Marina Lamm
  • Jorge Jaunarena
  • Oscar Peralta
  • Lucas Otaño
Clinical Investigation Arterial Interventions
  • 93 Downloads
Part of the following topical collections:
  1. Arterial Interventions

Abstract

Introduction

Hysterectomy is the standard of care in placenta accreta spectrum (PAS). To reduce the risks of obstetric hemorrhage during surgery, endovascular interventions have been proposed. Our aim is to evaluate the feasibility and safety of the overall non-conservative management of PAS in the hybrid operating room (OR) to replace the classic two-step procedure (catheterization in the interventional radiology suite and transfer to conventional OR).

Materials and Methods

This is a retrospective study of series of patients with histopathologic confirmation of PAS treated in the hybrid OR at the same university hospital. We used for comparison our historical cohort managed with the standard two-step procedure.

Results

We included 110 patients, 80 in the conventional OR and 30 in the hybrid OR. There were no cases of major complications attributable to the endovascular procedures. In the two-step procedure, there were 10 (12.5%) intra-arterial catheter displacements that required repositioning in the conventional OR under mobile C-arm fluoroscopy and no cases in the hybrid OR (p = 0.04). The mean operative time was 380 + 42 min in the conventional OR and 296 + 66 min in the hybrid OR (p = .00001). There were no differences in the gestational age at delivery, postoperative length of stay, or large-volume blood transfusion. There were no maternal deaths.

Conclusions

The overall non-conservative management of PAS in the hybrid OR has shown to be feasible and safe in our series, offering potential advantages to replace the classic two-step procedure. More studies are needed to evaluate whether this strategy is cost-effective and whether it may improve maternal and perinatal outcomes.

Keywords

Hybrid operating room Obstetric hemorrhage Placenta accreta Postpartum hysterectomy Uterine artery embolization 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

For this type of study, informed consent is not required.

Consent for Publication

For this type of study, consent for publication is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • César Hernán Meller
    • 1
  • Ricardo D. Garcia-Monaco
    • 2
    Email author
  • Gustavo Izbizky
    • 1
  • Marina Lamm
    • 1
  • Jorge Jaunarena
    • 3
  • Oscar Peralta
    • 2
  • Lucas Otaño
    • 1
  1. 1.Department of Obstetrics and GynecologyHospital Italiano de Buenos AiresBuenos AiresArgentina
  2. 2.Department of RadiologyHospital Italiano de Buenos AiresBuenos AiresArgentina
  3. 3.Department of UrologyHospital Italiano de Buenos AiresBuenos AiresArgentina

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