Preoperative Prophylactic Balloon-Assisted Occlusion of the Internal Iliac Arteries in the Management of Placenta Increta/Percreta

Abstract

Background and Objectives: Preoperative prophylactic balloon-assisted occlusion (PBAO) of the internal iliac arteries minimizes blood loss and facilitates surgery performance, through reductions in the rate of uterine perfusion, which allow for better control in hysterectomy performance, with decreased rates of bleeding and surgical complications. We aimed to investigate the maternal and fetal outcomes associated with PBAO use in women with placenta increta or percreta. Material and Methods: The records of 42 consecutive patients with a diagnosis of placenta increta or percreta were retrospectively reviewed. Of 42 patients, 17 patients (40.5%) with placenta increta or percreta underwent cesarean delivery after prophylactic balloon catheter placement in the bilateral internal iliac artery (balloon group). The blood loss volume, transfusion volume, postoperative hemoglobin changes, rates of hysterectomy and hospitalization, and infant Apgar score in this group were compared to those of 25 similar women who underwent cesarean delivery without balloon placement (surgical group). Results: The mean intraoperative blood loss volume in the balloon group (2319 ± 1191 mL, range 1000–4500 mL) was significantly lower than that in the surgical group (4435 ± 1376 mL, range 1500–10,500 mL) (p = 0.037). The mean blood unit volume transfused in the balloon group (2060 ± 1154 mL, range 1200–8000 mL) was significantly lower than that in the surgical group (3840 ± 1464 mL, range 1800–15,200 mL) (p = 0.043). There was no significant difference in the postoperative hemoglobin change, hysterectomy rates, length of hospitalization, or infant Apgar score between the groups. Conclusion: PBAO of the internal iliac artery prior to cesarean delivery in patients with placenta increta or percreta is a safe and minimally invasive technique that reduces the rate of intraoperative blood loss and transfusion requirements.

Maternal and Perinatal Outcomes in Placenta Previa: A Comprehensive Review of Evidence

“…Effective blood loss control forms a cornerstone of obstetric management in complex pregnancies, with interventions such as balloon catheters for angiographic embolization of pelvic vessels and aortic balloon occlusion preceding cesarean hysterectomy (C-HYST) deployed to mitigate hemorrhage [ 19 ]. C-HYST may become unavoidable in instances of complete placenta previa coupled with a history of cesarean deliveries, underscoring the necessity for tailored management plans based on individual patient circumstances [ 19 ]. Figure 1 shows maternal complications associated with placenta previa.…”

Placenta Accreta: A Case Report on the Role of Interventional Radiology

“…PBAO consists of placing occlusion balloons (OBs) in the internal iliac arteries before the planned cesarean and inflating them immediately after the delivery to reduce post-partum bleeding. It has been proven to reduce the rate of blood loss in patients with placenta accreta spectrum (PAS) and decrease the rate of hysterectomy compared to those without it [5,6].…”

Perioperative Prophylactic Internal Iliac Artery Balloon Occlusion (Iiabo) in Placental Implantation Abnormalities

“…This implies that hemostasis relies heavily on surgical techniques such as the placement of hemostatic sutures, the use of intrauterine balloon tamponade, and the ligation of the uterine artery. If these conservative surgical approaches fail to control bleeding, the last resource is life-saving hysterectomy [2,3].…”