The anaesthetic management of caesarean section in the interventional radiology suite

Interventional radiology has been used in the last decade for the management of major obstetric haemorrhage particularly when the placenta is pathologically adherent (accreta) or for postpartum haemorrhage when a bleeding vessel is suspected. This review describes the radiological, obstetric and anaesthetic interventions which are often carried out in the radiology suite.

The incidence of placenta accreta is increasing as the caesarean section rate rises. Pre-delivery diagnosis has been facilitated by the use of ultrasound and magnetic resonance imaging. The use of interventional radiology for elective caesarean sections with suspected placenta accreta is mainly restricted to larger centres and the evidence base for its use is currently weak. The actual location of the surgery remains controversial. Some centres with expertise perform the caesarean section in the radiology suite with obstetric, anaesthetic and neonatal teams in attendance. Robust communication is essential, especially when working in sites remote to the usual place of care.

This review describes the management of patients who are amenable to prophylactic or emergency radiological intervention for obstetric haemorrhage in the radiology suite. Controversy surrounds the optimum place for surgery and the most suitable mode of anaesthesia in these patients.