RESUMEN
Background: The placenta accreta spectrum is a complex disorder characterized by abnormal invasion of the placenta into the uterine wall, posing a significant risk of life-threatening haemorrhage for patients. Its incidence is on the rise, largely attributed to the increasing rates of caesarean sections. Management of this spectrum involves a multidisciplinary approach, although standardized protocols are not yet established. While caesarean hysterectomy remains the standard Gold, several adjunctive treatments have emerged in recent years to mitigate bleeding risk and associated morbidity. Among these, prophylactic occlusion balloons placed in the internal iliac arteries have shown promise. The aim of our study is to demonstrate the effect of prophylactic occlusion balloons in both uterine iliac arteries in the management of placental accreta spectrum disorders. Methods: A retrospective monocentric cohort study was conducted in the Department "C" of Gynaecology and Obstetrics at the Maternity Center of Tunis. The study spanned three years, from January 2nd, 2020, to December 31st, 2022. The study population consisted of two groups: Control Group (CG) comprised patients who underwent caesarean hysterectomy without internal-iliac prophylactic occlusion balloons, and Occlusion balloons of both internal iliac arteries Group (OBIIAG) included patients who underwent caesarean hysterectomy with internal-iliac prophylactic occlusion balloons. Results: A total of 38 patients were included in the study, all of whom exhibited similar epidemiological characteristics and comparable personal and obstetric histories. The most prevalent risk factor among the patients was a history of caesarean section (92%). On average, patients were diagnosed at 30 weeks of gestation, with third-trimester bleeding being the most common presentation (71% of cases). The median gestational age at delivery was between 36 and 37 weeks. We observed a significant difference in blood loss between the two groups (2888 ml in the control group and 1828 ml in the group with internal-iliac prophylactic occlusion balloons, p < 0.05). Implementation of this technique resulted in a reduced need for massive transfusions (p < 0.01) and shorter operating times (126 min for the control group and 92 min for the group with internal-iliac prophylactic occlusion balloons; p = 0.04). There were no significant differences in morbidity between the two groups. Conclusion: The intra-iliac prophylactic occlusion balloons can help reduce the risk of hemorrhage and the morbidities that come with the placenta accreta spectrum disorder.
RESUMEN
INTRODUCTION: in pregnant women, the symptoms of COVID-19 join those of the general population in most cases. However, like any population at risk, more serious symptoms can appear such as pneumonia or ARDS. In our study, we propose to define the clinical, biological and therapeutic characteristics as well as the management of a series of pregnant women suffering from COVID-19. METHODS: this is a prospective and descriptive study which brought together 11 pregnant patients affected by the Coronavirus SARS-CoV-2 in the gynecology-obstetrics department of Mohamed Tlatli hospital, Nabeul, Tunisia between 12th September and 11th November 2020. RESULTS: the average age is 31.18 years. Six patients were followed for a chronic disease. Gestational diabetes was the most common comorbidity. Contact with a suspected or confirmed case of COVID-19 was identified in 6 patients. The average incubation period of the virus was 5.89 days. Average term of pregnancy was 33.36 weeks with amenorrhea. The preferred route of delivery was cesarean section. The most frequently reported symptoms were fever in all patients, dry cough, dyspnea and headache in nine patients. Two patients were subsequently treated in medical intensive care for a picture of acute respiratory distress syndrome (ARDS). Both patients were put on high flow nasal oxygen therapy: Optiflow without the need for mechanical ventilation. In the remaining 9 cases, symptomatic treatment and antibiotic therapy were sufficient and the patients returned to their homes. We have had no mother-to-child transmission and no death. Breastfeeding does not seem to influence this transmission. CONCLUSION: the most frequently reported symptoms were fever in all patients, followed by dry cough, dyspnea and headache. There was no mother-to-child transmission, nor transmission during breastfeeding. In general, symptomatic and antibiotic treatment was sufficient. We are currently facing the second wave of the virus. Our efforts will have to be based on a better clinical knowledge of this new coronavirus and adapt a management function accordingly.
