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      Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage

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          Abstract

          Background

          Severe postpartum hemorrhage occurs in 1/1000 women giving birth. This condition is often dramatic and may be life threatening. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has in recent years been introduced as a novel treatment for hemorrhagic shock. We present a series of fluoroscopy-free REBOA for controlling life threatening postpartum hemorrhage.

          Methods

          In 2008 an ‘aortic occlusion kit’ was assembled and used in three Norwegian university hospitals. The on-call interventional radiologist (IR) was to be contacted with a response time < 30 minutes in case of life threatening PPH. Demographics and characteristics were noted from the medical records.

          Results

          This retrospective study includes 36 patients treated with fluoroscopy-free REBOA for controlling severe postpartum hemorrhage in the years 2008–2015. The REBOA success rate was 100% and no patients died from REBOA related complications. Uterine artery embolization was performed in 17 (47%) patients and a hysterectomy in 16 (44%) patients. A short (11cm) introducer length was strongly associated with iliac artery thrombus formation ( ρ = 0.50, P = 0.002). In addition, there was a strong negative correlation between uterine artery embolization and hysterectomy ( ρ = -0.50, P = 0.002).

          Conclusions

          Our Norwegian experience indicates the clinical safety and feasibility of REBOA in life threatening PPH. Also, REBOA can be used in an emergency situation without the use of fluoroscopy with a high degree of technical success. It is important that safety implementation of REBOA is established, especially through limited aortic balloon occlusion time and a thorough balloon deflation regime.

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          Most cited references 26

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          The global burden of injuries.

          The traditional view of injuries as "accidents", or random events, has resulted in the historical neglect of this area of public health. However, the most recent estimates show that injuries are among the leading causes of death and disability in the world. They affect all populations, regardless of age, sex, income, or geographic region. In 1998, about 5.8 million people (97.9 per 100,000 population) died of injuries worldwide, and injuries caused 16% of the global burden of disease. Road traffic injuries are the 10th leading cause of death and the 9th leading cause of the burden of disease; self-inflicted injuries, falls, and interpersonal violence follow closely. Injuries affect mostly young people, often causing long-term disability. Decreasing the burden of injuries is among the main challenges for public health in the next century--injuries are preventable, and many effective strategies are available. Public health officials must gain a better understanding of the magnitude and characteristics of the problem, contribute to the development and evaluation of injury prevention programs, and develop the best possible prehospital and hospital care and rehabilitation for injured persons.
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            Epidemiology of postpartum haemorrhage: a systematic review.

            Postpartum haemorrhage (PPH) is an important cause of maternal mortality. We conducted a systematic review of the prevalence of PPH with the objective of evaluating its magnitude both globally and in different regions and settings: global figures, as well as regional, country and provincial variations, are likely to exist but are currently unknown. We used prespecified criteria to select databases, recorded the database characteristics and assessed their methodological quality. After establishing PPH (>or=500 mL blood loss) and severe PPH (SSPH) (>or=1000 mL blood loss) as main outcomes, we found 120 datasets (involving a total of 3,815,034 women) that reported PPH and 70 datasets (505,379 women) that reported SPPH in the primary analysis. The prevalence of PPH and SPPH is approximately 6% and 1.86% of all deliveries, respectively, with a wide variation across regions of the world. The figures we obtained give a rough estimate of the prevalence of PPH and suggest the existence of some variations. For a reliable picture of PPH worldwide - its magnitude, distribution and consequences - a global survey tackling this condition is necessary.
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              Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock.

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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                29 March 2017
                2017
                : 12
                : 3
                Affiliations
                [1 ]Dept of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway
                [2 ]Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
                [3 ]Dept of Radiology and Nuclear Medicine, Oslo University Hospital Ullevaal, Oslo, Norway
                [4 ]Dept of Radiology and Nuclear Medicine, Stavanger University Hospital, Stavanger, Norway
                Azienda Ospedaliero Universitaria Careggi, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: KHS E. Sovik.

                • Formal analysis: AJ.

                • Investigation: KHS AJ.

                • Methodology: KHS E. Sovik.

                • Project administration: KHS.

                • Resources: AJ YH E. Skomedal.

                • Supervision: KHS.

                • Validation: KHS.

                • Visualization: KHS E. Sovik AJ.

                • Writing – original draft: KHS.

                • Writing – review & editing: KHS E. Sovik AJ.

                Article
                PONE-D-16-32954
                10.1371/journal.pone.0174520
                5371310
                28355242
                © 2017 Stensaeth et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 0, Tables: 2, Pages: 8
                Product
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                Severe Blood Loss
                Postpartum Hemorrhage
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Hemorrhage
                Severe Blood Loss
                Postpartum Hemorrhage
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Hemorrhage
                Severe Blood Loss
                Postpartum Hemorrhage
                Medicine and Health Sciences
                Vascular Medicine
                Hemorrhage
                Severe Blood Loss
                Postpartum Hemorrhage
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Postpartum Hemorrhage
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Postpartum Hemorrhage
                Biology and Life Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
                Arteries
                Medicine and Health Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
                Arteries
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Hemorrhage
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Hemorrhage
                Medicine and Health Sciences
                Vascular Medicine
                Hemorrhage
                Biology and Life Sciences
                Biotechnology
                Medical Devices and Equipment
                Catheters
                Medicine and Health Sciences
                Medical Devices and Equipment
                Catheters
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Reproductive System Procedures
                Hysterectomy
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Surgical Excision
                Hysterectomy
                Biology and Life Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
                Aorta
                Medicine and Health Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
                Aorta
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                Severe Blood Loss
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Hemorrhage
                Severe Blood Loss
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Hemorrhage
                Severe Blood Loss
                Medicine and Health Sciences
                Vascular Medicine
                Hemorrhage
                Severe Blood Loss
                Custom metadata
                All relevant data are within the paper.

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