Preoperative infrarenal abdominal aorta balloon catheter occlusion combined with Bakri tamponade reduced maternal morbidity of placenta increta/percreta

Abstract

Background:Placenta increta/percreta is an increasingly common and life-threatening obstetric complication. It poses a management challenge to clinicians. The present study aimed to evaluate efficacy and safety of preoperative placement of infrarenal abdominal aorta balloon catheter (IAABC) alone or combined with Bakri tamponade for the management of cases with placenta increta/percreta.Methods:We retrospectively analyzed all cases with placenta increta/percreta at a tertiary referral teaching hospital in China between the year 2014 and 2017. Statistical analysis considered the individual subgroups: IAABC placed group and control group (without IAABC), and compared their maternal–fetal outcomes.Results:The study covered 86 cases with placenta increta. For cases in the IAABC placed group (n = 48), significant reductions were noted in maternal morbidity including estimated blood loss (EBL), EBL ≥ 2000 mL, blood products transfusions, postpartum hemorrhage, operative time, intensive care unit admission, and postoperative days (P < .05 for all). The overall rate of hysterectomy was much lower (4.2%vs 23.7%, P = .018), compared with those in the control group (n = 38). Furthermore, in the IAABC placed group, hysterectomy was avoided in a further 17 cases combined with Bakri tamponade. In the control group, 10 cases were successful in preserving uterus by Bakri tamponade. Four cases failed and needed reoperation (3 uterine arterial embolism, 1 hysterectomy). There were no differences in fetal outcomes between the 2 groups. Eighteen cases were diagnosed with placenta percreta. Almost all the cases (17/18) inevitably underwent caesarean hysterectomy. Only 1 case was treated with a combination of IAABC and Bakri tamponade, and successfully reserved uterus. No differences were observed in any other outcomes, except for a significant less mean operative time (P = .017) in cases with IAABC placed (n = 10), compared with those without IAABC (n = 8). Only 1 case had a femoral artery thrombosis directly related to IAABC placement and recovered after conservative treatment. There was no maternal or neonatal death in this study.Conclusion:Prophylactic insertion of IAABC alone or combined with Bakri tamponade should be safe and effective in controlling intraoperative bleeding due to placenta increta, thus hysterectomy could be avoided. It seems to be less beneficial to women with placenta percreta. Bakri tamponade can be a good choice in the management of placenta increta/percreta before more aggressive surgeries.

Placenta accreta spectrum disorder trends in the context of the universal two‐child policy in China and the risk of hysterectomy

“…A planned operative delivery for women with PAS disorders has been shown to decrease maternal morbidity . A recent study noted the advantages of a scheduled surgical approach with preoperative placement of an infra‐renal abdominal aorta balloon catheter . Taken altogether, these results show the importance of evaluating the degree of invasion before delivery.…”

“…Eligible patients were identified by searching the hospital electronic database system for admissions coded as “cesarean delivery,” “advanced maternal age,” “PPH,” “hysterectomy,” “placenta accreta,” “placenta increta,” and “placenta percreta.” The inclusion criteria for PAS disorders have been described previously . Patients with PAS disorders that were referred to the study center owing to complications occurring after surgery elsewhere were excluded.…”

Research on Application of Bakri Balloon Tamponade in Treatment of 169 Cases of Postpartum Hemorrhage

“…Bakri balloons have insigni cant effect on the patients with placental penetration. However, prior to more invasive procedures, pre-positioned Bakri balloons may be a good choice for placental implantation / penetration [16] . The Bakri balloon can play a temporary role in compressing hemostasis, and can effectively control the rapidly opened blood sinus.…”

The effect and long-term outcome of Partial Anterior Myometrial Resection and Reconstruction under tourniquet and/or prophylactic abdominal aorta balloon occlusion on the patients with placenta percreta

“…Prophylactic devascularization achieved by aortic artery balloon occlusion and/or tourniquet before dealing with the placenta can reduce the risk of intra operative blood loss and prevent the occurrence of severe postpartum hemorrhage [10][11][12][13][14][15][16][17][18]. First, the eroded defective anterior lower uterus segment and bulk of the placenta without detachment was removed together, which can reduce the homeostasis area and shorten the homeostasis time, consequently reducing the bleeding volume.…”