Perioperative Internal Iliac Artery Balloon Occlusion in Patients with Abnormal Placental Invasion

Does temproray bilateral balloon occlusion of the common iliac arteries reduce the need for intra‐operative blood transfusion in cases of placenta accretism?

“…12 Although temporary bilateral balloon occlusion of the iliac arteries reduces blood supply to the pelvic organs and may reduce life threatening blood loss during surgery, there is a substantial network of collateral vessels in the female pelvis, which in many cases may potentially limit the efficacy of this procedure. 13 Furthermore, studies to date have had conflicting reports whether prophylactic temporary occlusion of the iliac arteries helps to reduce the rate of caesarean hysterectomy, reduce intra-operative time or hospital stay. 14 It is estimated that the average blood loss at delivery in women with placenta accrete is up to 3000-5000 mL with a transfusion average of 7.9 units.…”

Introductory Chapter: Is It Time to Reconsider the Importance of Cesarean Section?

“…Based on recent studies, cesarean section is associated with increased risk of severe maternal complications such as: perioperative hemorrhage (requiring blood transfusion or obstetric hysterectomy), uterine rupture, bladder injury, thromboembolic events, intra-abdominal hematomas, wound infection, anesthetic complications, and prolonged hospitalization [4]. Especially in repeated cesarean sections, there is increased risk for abnormal placental invasion as well as for severe perioperative complications [5][6][7].…”

Perioperative Utilization of Internal Iliac Artery Balloons, Does it really help in Case of Abnormal Placental Invasion?

“…The proper positioning of the balloon catheters and the effective vascular occlusion are angiographically confirmed [6][7][8][9][10]. Subsequently, patient is taken directly to the operating theatre for caesarean section [6][7][8][9][10].…”

“…The technique of internal iliac artery balloons in patients with abnormal placental invasion, was first described in 1997 by Dubois [7]. On the day of delivery, balloon catheters are placed in both internal iliac arteries using Seldinger technique, via the transcutaneous common femoral artery approach and under fluoroscopic guidance [6][7][8][9][10]. The proper positioning of the balloon catheters and the effective vascular occlusion are angiographically confirmed [6][7][8][9][10].…”

“…On the day of delivery, balloon catheters are placed in both internal iliac arteries using Seldinger technique, via the transcutaneous common femoral artery approach and under fluoroscopic guidance [6][7][8][9][10]. The proper positioning of the balloon catheters and the effective vascular occlusion are angiographically confirmed [6][7][8][9][10]. Subsequently, patient is taken directly to the operating theatre for caesarean section [6][7][8][9][10].…”