Prophylactic Placement of Internal Iliac Balloons in Patients with Abnormal Placental Implantation: Maternal and Foetal Outcomes

Nicholson, Patrick; O’Connor, Owen J.; Buckley, John; Spence, Liam D.; Greene, Richard A.; Tuite, David

doi:10.1007/s00270-018-1983-3

Cited by 14 publications

(11 citation statements)

References 16 publications

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“…Low mortality values have been reported in carefully selected patients [ 22 , 23 ], while another study has shown the opposite [ 24 ]. Nicholson et al [ 6 ] reported that patients with PBAO had decreased rates of hysterectomy compared to the historic controls, which is inconsistent with our findings. However, in that study, only two and one patients had a diagnosis of placenta increta and percreta, respectively, of 22 patients with MAP who underwent PBAO.…”

Section: Discussioncontrasting

confidence: 99%

“…Although the impact of MAP on pregnancy outcomes has been well-described, to the best of our knowledge, no prospective randomized trial and few studies overall have examined the management of pregnancies complicated by this disorder. Recent studies showed that PBAO reduced the rate of blood loss and transfusion requirement in patients with MAP [ 6 , 9 , 10 ]. Nicholson et al reported that patients with PBAO had a decreased rate of hysterectomy compared to those without it.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal placement site of the balloon catheter can be a critical factor affecting outcomes and side effect incidence [ 13 ]. In most studies, the anterior division of the internal iliac artery was used as the side of ballooning for vessel occlusion, but positions as proximal as the abdominal aorta and as distal as those within the anterior division of the internal iliac arteries have been employed [ 1 , 2 , 6 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. We used the proximal part of the internal iliac artery just after the common iliac artery bifurcation; this approach reduces the intervention time, collateral blood flow rate, and fetal radiation exposure degree more than occlusion of the anterior division of the internal iliac artery [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous data have shown that the success rates of surgical ligation of the uterine or internal iliac arteries varied widely from 40% to 100% [ 19 ]. Although the number of cases is limited, the success rate of PBAO is 100% in most studies [ 1 , 6 , 13 , 14 , 17 ]. Obstetric hemorrhage related to MAP tends to occur during delivery or the postpartum period [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…The theory is that the reduction of the rate of uterine perfusion allows for better control in hysterectomy performance, with decreased rates of bleeding and surgical complications. Patrick et al [ 6 ] reported that this approach is safe for both mother and baby. Conversely, some studies reported equivocal results and highlighted the potentially serious complications associated with PBAO [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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