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J Matern Fetal Neonatal Med. 2019 Oct 21:1-6. doi: 10.1080/14767058.2019.1678144. [Epub ahead of print]

Estimation of fetal radiation absorbed dose during the prophylactic use of aortic occlusion balloon for abnormally invasive placenta.

Author information

1
Abnormally Invasive Placenta Clinic, High Complexity Obstetric Unit, Fundación Valle Del Lili , Cali , Colombia.
2
Health Science Faculty, Universidad ICESI , Cali , Colombia.
3
Department of Medical Physics and Radiation Protection, Fundación Valle de Lili , Cali , Colombia.
4
Department of Physics, Universidad Del Cauca , Popayán , Colombia.
5
Department of Trauma Surgery, Fundación Valle Del Lili , Cali , Colombia.

Abstract

Purpose: Abnormally invasive placenta is an important cause of maternal morbidity, and its primary complication is massive bleeding. Strategies for preventing bleeding include arterial endovascular occlusion. One concern with the use of intra-arterial occlusion balloons is radiation exposure to the fetus, which occurs while determining balloon position. In this study, we sought to determine the radiation absorbed dose by the fetus during intra-aortic occlusion balloon placement in patients with abnormally invasive placenta. Materials and methods: We estimated the fetal absorbed dose and the entrance skin dose in the vaginal fundus and lumbar skin, respectively, using thermoluminescent dosimeter crystals, during intra-aortic balloon positioning using the mobile X-ray image intensifier system (C-arm) in digital radiography mode, directly in surgery room, without transfer to angiographic suite. We also performed a mannequin-based simulation to validate the entrance skin dose measurement technique. Results: Ten women undergoing surgical management of an abnormally invasive placenta, in whom the location of the intra-aortic occlusion balloon was verified using plain radiography with C-arm in the surgery room, were included in the study. Following maternal and fetal radiation exposure, the entrance skin dose and radiation absorbed dose by the fetus were 1.31 ± 0.96 mGy and 0.27 ± 0.28 mGy, respectively, with radiation exposure durations of <1 s. Conclusions: There were no complications with the use of REBOA, the radiation absorbed dose by the fetus, entrance skin dose, and duration of radiation exposure during intra-aortic occlusion balloon placement were lower than those reported for other vascular occlusion techniques, being this a safe procedure.

KEYWORDS:

Radiation; placenta accreta; radiation dosage; radiation tolerance; uterine hemorrhage

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