Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021, 165(4):435-440 | DOI: 10.5507/bp.2020.046

Estimating the radiation dose to the fetus during prophylactic internal iliac occlusion in patients with abnormal placentation

Marie Cernaa, Karel Humlb, Martin Kochera, Lenka Jonasovac, Tomas Vavraa, Vojtech Prasila
a Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc, Czech Republic
b Department of Obstetrics and Gynaecology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic and Department of Obstetrics and Gynaecology, Bata Hospital Zlin, Czech Republic
c Department of Medical Physics and Radiation Protection, University Hospital Olomouc, Czech Republic

Aims: To evaluate the estimated fetal radiation dose during prophylactic internal iliac arterial occlusion in patients with abnormal placenta and to estimate the risk of radiation induced cancer in child age.

Methods: Prophylactic occlusion of the internal iliac arteries during Caesarean section was performed in 42 patients with placenta praevia and/or placenta accreta spectrum. Fogarty embolectomy catheters were used for prophylactic occlusion of the internal iliac arteries. All procedures were performed in the hybrid operating room using Philips Allura Xper FD 20 X-ray system. Low dose X-ray fluoroscopy (7.5 frames per second) was used. The CODE (Conceptus dose estimation) Software was used to estimate the fetal dose and the risk of radiation induced carcinoma.

Results: Fluoroscopy times required for insertion of Fogarty catheters were 0.5-4.2 min (mean: 1.7 min, median: 1.5 min). The estimated radiation dose to the fetus was 0.26-3.36 mGy (mean: 1.49 mGy, median: 1.25 mGy). The risk of radiation induced cancer in child age was 0.01-0.04% (mean 0.02%, median 0.01%). One patient developed thrombosis of a common femoral artery.

Conclusion: Prophylactic occlusion of the internal iliac arteries is a simple and safe procedure with minimal risk of complications and with a very low estimated radiation dose to the fetus.

Keywords: placenta praevia, placenta accreta spectrum, prophylactic occlusion, internal iliac arteries, fetus radiation dose

Received: May 18, 2020; Revised: September 15, 2020; Accepted: October 2, 2020; Prepublished online: November 26, 2020; Published: November 23, 2021  Show citation

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Cerna, M., Huml, K., Kocher, M., Jonasova, L., Vavra, T., & Prasil, V. (2021). Estimating the radiation dose to the fetus during prophylactic internal iliac occlusion in patients with abnormal placentation. Biomedical papers, 165(4), 435-440. doi: 10.5507/bp.2020.046
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    References

    1. Hayes E, Ayida G, Crocker A. The morbidly adherent placenta: diagnosis and management options. Curr Opin Obstet Gynecol 2011;23(6):448-53. Go to original source...
    2. Takayama T, Minakami H, Koike T, Watanabe T, Sato I. Risks associated with cesarean sections in women with placenta previa. J Obstet Gynaecol Res 1997;23(4):375-9. Go to original source...
    3. Warshak CR, Ramos GA, Eskander R, Benirschke k, Saenz CC, Kelly TF, Moore TR, Resnik R. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol 2010;115(1):65-9. Go to original source... Go to PubMed...
    4. Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG 2009;116(5):648-54. Go to original source... Go to PubMed...
    5. Berg CJ, Atrash HK, Koonin LM, Tucker M. Pregnancy-related mortality in the United States, 1987-1990. Obstet Gynecol 1996;88(2):161-7. Go to original source... Go to PubMed...
    6. Committee Opinion No. 723: Guidelines for Diagnostic Imaging during Pregnancy and Lactation. Obstet Gynecol 2017;130(4):e210-6. Go to original source... Go to PubMed...
    7. Carnevale FC, Kondo MM, de Oliveira Sousa W, Santos AB, da Motta leal Flho JM, Moreira AM, Baroni RH, Francicso RP, Zugaib M. Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhage in placenta accreta. Cardiovasc Intervent Radiol 2011;34(4):758-64. Go to original source... Go to PubMed...
    8. Li K, Zou Y, Sun j, Wen H. Prophylactic balloon occlusion of internal iliac arteries, common iliac arteries and infrarenal abdominal aorta in pregnancies complicated by placenta accreta: a retrospective cohort study. Eur Radiol 2018;28(12):4959-67. Go to original source...
    9. Nicholson PJ, O“Connor O, Buckley J, Spence LD, Greene RA, Tuite DJ. Prophylactic Placement of Internal Iliac Balloons in Patients with Abnormal Placental Implantation: Maternal and Foetal Outcomes. Cardiovasc Intervent Radiol 2018;41(10):1488-93. Go to original source... Go to PubMed...
    10. Shahin Y, Panq CL. Endovascular interventional modalities for haemorrhage control in abnormal placental implantation deliveries: a systematic review and meta-analysis. Eur Radiol 2018;28(7):2713-26. Go to original source...
    11. Picel AC, Wolford B, Cochran RL, Ramos GA, Roberts AC. Prophylactic Internal Iliac Artery Occlusion Balloon Placement to Reduce Operative Blood Loss in Patients with Invasive Placenta. J Vasc Interv Radiol 2018;29(2):219-24. Go to original source... Go to PubMed...
    12. Kai K, Hamada T, Yuge A, Kiyose H, Nishida Y, Nasu K, Narahara H. Estimating the Radiation Dose to the Fetus in Prophylactic Internal Iliac Artery Balloon Occlusion: Three Cases. Case Rep Obstet Gynecol 2015;170343. Go to original source...
    13. Semeraro V, Susac A, Morasca A, D“Antonio F, Belli AM. Foetal Radiation Dose during Prophylactic Occlusion Balloon Placement for Morbidly Adherent Placenta. Cardiovasc Intervent Radiol 2015;38(6):1487-93. Go to original source... Go to PubMed...
    14. Wakeford R, Little MP. Childhood cancer after low-level intrauterine exposure to radiation. J Radiol Prot 2002;22(3A):A123-7. Go to original source... Go to PubMed...
    15. Doll R, Wakeford R. Risk of childhood cancer from fetal irradiation. Br J Radiol 1997;70:130-9. Go to original source...
    16. ICRP Publication 103. The 2007 Recommendations of the International Commission on Radiological Protection. Annals of the ICRP 2007;34 nos2-4. ISSN 0146-6453.
    17. Ohlson L. Effects of the pregnant uterus on the abdominal aorta and its branches. Acta Radiol Diagn (Stockh) 1978;19(2):369-76. Go to original source... Go to PubMed...
    18. Cho JH, Kim JY, Kang Jo, Park PE, Kim JH, Lim JA, Kim HK, Woo NS. A Study to Compare the Radiation Absorbed Dose of the C-arm Fluoroscopic Modes. Korean J Pain 2011;24(4):199-204. Go to original source...
    19. Brown PH, Thomas RD, Silberberg PJ, Johnson LM. Optimization of a fluoroscopy to reduce radiation exposure in pediatric imaging. Pediatr Radiol 2000;30:229-35. Go to original source... Go to PubMed...
    20. Cohen MD. Optimizing the use of pulsed fluoroscopy to reduce radiation exposure to children. J Am Coll Radiol 2008;5:205-9. Go to original source... Go to PubMed...
    21. Andrews RT, Brown PH. Uterine arterial embolization: factors influencing patient radiation exposure. Radiology 2000;217(3):713-22. Go to original source... Go to PubMed...
    22. Shih JC, Liu KL, Shyu MK. Temporary balloon occlusion of the common iliac artery: new approach to bleeding control during cesarean hysterectomy for placenta percreta. Am J Obstet Gynecol 2005;193(5):1756-8. Go to original source...
    23. Broekman EA, Versteeg H, Vos LD, Dijksterhuis MG, Papatsonis DN. Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa. Int J Gynaecol Obstet 2015;128(2):118-21. Go to original source... Go to PubMed...
    24. Valentin J. Effects of in utero irradiation. Ann ICRP 2000;30(1):9-12. Go to original source...
    25. Bishop S, Butler K, Monaghan S, Chan K, Murphy G, Edozien L. Multiple complications following the use of prophylactic internal iliac artery balloon catheterisation in a patient with placenta percreta. Int J Obstet Anesth 2011;20(1):70-3. Go to original source... Go to PubMed...
    26. Bodner LJ, Nosher JL, Gribbin C, Siegel RL, Beale S, Scorza W. Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta. Cardiovasc Intervent Radiol 2006;29(3):354-61. Go to original source... Go to PubMed...
    27. Salazar GM, Petrozza JC, Walker TG. Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies. Tech Vasc Interv Radiol 2009;12(2):139-47. Go to original source... Go to PubMed...
    28. Luo F, Wu Z, Mei J, Yue J, Yu X, Xie L. Thrombosis after aortic balloon occlusion during cesarean delivery for abnormally invasive placenta. Int J Obstet Anesth 2018;33:32-9. Go to original source... Go to PubMed...
    29. Ribeiro MAF, Feng CYD, Nguyen ATM, Roriques VC, Bechara GEK, de Moura RR, Brenner M. The complications associated with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). World J Emerg Surg 2018;11:13-20. Go to original source...
    30. Tsurukiri J, Akamine I, Sato T, Sakurai M, Okumura E, Moriya M, Yamanaka H, Ohta S. Resuscitative endovascular balloon occlusion of the aorta for uncontrolled haemorrahgic shock as an adjunct to haemostatic procedures in the acute care setting. Scand J Trauma Resusc Emerg Med 2016;24:13. Go to original source... Go to PubMed...
    31. Russo RM, Neff LP, Lamb CM, Cannon JW, Galante JM, Clement NF, Grayson JK, Williams TK. Partial Resuscitative Endovascular Balloon Occlusion of the Aorta in swine model of hemorrhagic shock. J Am Coll Sur 2016;223(2):359-68. Go to original source...
    32. Nieta-Calvache AJ, Salas LF, Duran EJ, Benavides SL, Ordonez-Delgado CA, Rodriquez-Holguin F. Estimation of fetal radiation absorbed dose during the prophylactic use of aortic occlusion balloon for abnormally invasive placenta. J Matern Fetal Neonatal Med 2019;21:1-6.
    33. Chen K, Zhang G, Li F, Liu J, Xie K, Zhu E, Li W, Zhang M, Gen Ch, Wang A. Application of ultrasoudn-guided balloon occluision in cesarean section in 130 cases of sinister placenta previa. J Intervent Med 2020;3:41-44. Go to original source...
    34. Bodner LJ, Nosher JL, Gribbin C, Siegel RL, Beale S, Scorza W. Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta. Cardiovasc Intervent Radiol 2006;29(3):354-61. Go to original source... Go to PubMed...
    35. Levine AB, Kuhlman K, Bonn J. Placenta accreta: comparison of cases managed with and without pelvic artery balloon catheters. J Matern Fetal Med 1999;8(4):173-6. Go to original source... Go to PubMed...
    36. Yi KW, Oh M, Seo T, So KA, PAEK YC, Kim HJ. Prophylactic Hypogastric Artery Ballooning in a Patient with Complete Placenta Previa and Increta. J Korean Med Sci 2010;25(4):651-5. Go to original source...

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