Conservative Management of Invasive Placenta Using Combined Prophylactic Internal Iliac Artery Balloon Occlusion and Immediate Postoperative Uterine Artery Embolization

Abstract

Combined bilateral internal iliac artery balloon occlusion and uterine artery embolization may be an effective strategy to control intraoperative blood loss and preserve the uterus in patients with invasive placenta undergoing caesarean delivery.

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

“…improved visualization on the surgical field. [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] However, other studies fail to demonstrate any benefit and criticize their use. [69][70][71][72][73] These authors claim that occlusive balloons cannot prevent catastrophic bleeding since the blood supply to the pelvis is maintained by the development of rich collaterals during pregnancy.…”

Placenta Praevia and Placenta Accreta: Diagnosis and Management

“…The main aim of this procedure is to reduce the risks of intraoperative haemorrhage during the caesarean delivery of pregnancies diagnosed antenatally with placenta accreta spectrum. Various combinations have been proposed, including intraoperative internal iliac artery and/or postoperative uterine artery embolisation 202,203 and internal iliac artery [204][205][206][207] or abdominal balloon occlusion. [208][209][210][211][212] The latter technique has been increasingly used in China.…”

Prophylactic uterine artery embolization during cesarean delivery for placenta previa complicated by placenta accreta

“…8 Consequently, blood volume recanalization after recovery induces recurrent bleeding. In a previous study, D'Souza et al 11 placed a balloon catheter in the catheterization laboratory before transporting the women to the obstetric operating room for cesarean delivery, followed by interventional embolization treatment back in the catheterization laboratory.…”

“…Gelatin sponges constitute the majority of embolic substances 11,16,17 because they are absorbed within 2 weeks and the embolized vessels can then reconnect. 21 In cases where a large number of gelatin sponges are used and arterial blood flow to the uterus remains unaffected, polyvinyl alcohol particles may also be used.…”