癒着胎盤による産科危機的出血に対するIVRサポート 〜神戸大学の取り組み〜

抄録

Postpartum hemorrhage remains a leading cause of maternal mortality, even in countries like Japan with advanced medical care. The incidence of placenta accreta spectrum disorders (PAS) is particularly increasing, primarily due to the rising rates of cesarean sections and assisted reproductive technologies. There is currently no standardized strategy for IVR support in PAS, despite attempts to mitigate blood loss through techniques such as arterial balloon occlusion, transcatheter arterial embolization (TAE), or a combination of these interventions.
At Kobe University Hospital, in collaboration with the Department of Obstetrics and Gynecology, the strategy involves conducting Internal Iliac Artery Balloon Occlusion (IIABO) for hem-orrhage control during cesarean section in pregnant women diagnosed with PAS. These pro-cedures are performed in a hybrid operating room, and TAE or Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) are utilized as needed in combination with IIABO.
To contribute effectively as a team member, an IVR physician requires a com-prehensive understanding of PAS and the ability to perform the necessary procedures promptly and accurately. Unlike IVR procedures performed in the angiography room, IVR during ce-sarean section necessitates specific technical tips and awareness of potential pitfalls. The aim of this article is to share these valuable insights through case studies.