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      Endovascular interventional modalities for haemorrhage control in abnormal placental implantation deliveries: a systematic review and meta-analysis

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      European Radiology
      Springer Nature

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          A catalogue of reporting guidelines for health research.

          Growing evidence demonstrates widespread deficiencies in the reporting of health research studies. The EQUATOR Network is an international initiative that aims to enhance the reliability and value of the published health research literature. EQUATOR provides resources, education and training to facilitate good research reporting and assists in the development, dissemination and implementation of robust reporting guidelines. This paper presents a collection of tools and guidelines available on the EQUATOR website (http://www.equator-network.org) that have been developed to increase the accuracy and transparency of health research reporting.
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            Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta.

            The objective of the study was to compare outcomes of women with placenta accreta who underwent cesarean hysterectomy with and without prophylactic intravascular balloon catheters. Case-control study of women at risk for placenta accreta identified using hospital databases and billing records from January 1995 to January 2006. Subjects with preoperative intravascular balloon catheter (BC) placement plus hysterectomy were compared with those that had hysterectomy alone. Sixty-nine subjects had cesarean hysterectomy performed for placenta accreta; 19 subjects had balloon catheters plus hysterectomy and 50 subjects had hysterectomy alone. No significant differences were noted in estimated blood loss (P = .79), transfused blood products (P = .60), operative time (P = .85), and postoperative hospital days (P = .85). There were no significant differences in secondary outcomes between groups. Three of the 19 BC subjects (15.8%) had complications from catheter placement; 2 required stent placement and/or arterial bypass. Prophylactic intravascular balloon catheters did not benefit women with placenta accreta undergoing cesarean hysterectomy.
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              Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta.

              Placenta accreta/percreta is a leading cause of third trimester hemorrhage and postpartum maternal death. The current treatment for third trimester hemorrhage due to placenta accreta/percreta is cesarean hysterectomy, which may be complicated by large volume blood loss. To determine what role, if any, prophylactic temporary balloon occlusion and transcatheter embolization of the anterior division of the internal iliac arteries plays in the management of patients with placenta accreta/percreta. The records of 28 consecutive patients with a diagnosis of placenta accreta/percreta were retrospectively reviewed. Patients were divided into two groups. Six patients underwent prophylactic temporary balloon occlusion, followed by cesarean section, transcatheter embolization of the anterior division of the internal iliac arteries and cesarean hysterectomy (n = 5) or uterine curettage (n = 1). Twenty-two patients underwent cesarean hysterectomy without endovascular intervention. The following parameters were compared in the two groups: patient age, gravidity, parity, gestational age at delivery, days in the intensive care unit after delivery, total hospital days, volume of transfused blood products, volume of fluid replacement intraoperatively, operating room time, estimated blood loss, and postoperative morbidity and mortality. Patients in the embolization group had more frequent episodes of third trimester bleeding requiring admission and bedrest prior to delivery (16.7 days vs. 2.9 days), resulting in significantly more hospitalization time in the embolization group (23 days vs. 8.8 days) and delivery at an earlier gestational age than in those in the surgical group (32.5 weeks). There was no statistical difference in mean estimated blood loss, volume of replaced blood products, fluid replacement needs, operating room time or postoperative recovery time. Our findings do not support the contention that in patients with placenta accreta/percreta, prophylactic temporary balloon occlusion and embolization prior to hysterectomy diminishes intraoperative blood loss.
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                Author and article information

                Journal
                European Radiology
                Eur Radiol
                Springer Nature
                0938-7994
                1432-1084
                July 2018
                February 5 2018
                July 2018
                : 28
                : 7
                : 2713-2726
                Article
                10.1007/s00330-017-5222-0
                29404775
                4fb20bd7-5a02-4564-9915-907bad90cf9f
                © 2018

                http://www.springer.com/tdm

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