Skip to main content
Log in

Prophylactic balloon occlusion of internal iliac arteries, common iliac arteries and infrarenal abdominal aorta in pregnancies complicated by placenta accreta: a retrospective cohort study

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the efficacy of prophylactic balloon occlusion (PBO), and to compare haemostatic effects and perioperative outcomes of PBO of the internal iliac arteries (IIA), common iliac arteries (CIA) and infrarenal abdominal aorta (IAA) in patients with placenta accreta.

Methods

One hundred and ninety-nine patients with placenta accreta were retrospectively reviewed. One hundred and twelve cases who underwent PBO were allocated into PBO group, and 87 cases without endovascular intervention were classified as the control group. According to different methods, 112 patients in the PBO group were divided into IIA (n = 37), CIA (n = 42) and IAA (n = 33) subgroups.

Results

Patients in the PBO group had decreased estimated blood loss (EBL) and blood transfusion volume (BTV), as well as improved other perioperative outcomes. PBO (vs controls) could independently predict less EBL. As to comparison among subgroups, patients had decreased EBL and BTV, as well as improved other perioperative outcomes in CIA and IAA subgroups compared to the IIA subgroup. Further validation by multivariate analysis revealed that PBO of IIA (vs others) could independently predict more EBL.

Conclusions

PBO reduces intraoperative blood loss and improves other perioperative outcomes in patients with placenta accreta, and PBO of the CIA and IAA is more effective compared to PBO of IIA.

Key Points

• PBO of IIA, CIA and IAA is effective in placenta accreta.

• PBO of CIA and IAA is more effective.

• PBO could independently predict less EBL.

• Accreta depth was an independent risk factor for EBL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

BTV:

Blood transfusion volume

CIA:

Common iliac arteries

DAP:

Dose area product

EBL:

Estimated blood loss

IAA:

Infrarenal abdominal aorta

IIA:

Internal iliac arteries

PBO:

Prophylactic balloon occlusion

References

  1. Jauniaux E, Bhide A (2017) Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 217:27–36

    Article  Google Scholar 

  2. Publications Committee SfM-FM, Belfort MA (2010) Placenta accreta. Am J Obstet Gynecol 203:430–439

    Article  Google Scholar 

  3. Wortman AC, Alexander JM (2013) Placenta accreta, increta, and percreta. Obstet Gynecol Clin N Am 40:137–154

    Article  Google Scholar 

  4. Zhang GJ, Song YH, Jin YZ (2012) The current situation in treatment of placenta accreta. Matern Child Health Care China 27:1430–1431

    Google Scholar 

  5. Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367:1066–1074

    Article  Google Scholar 

  6. Clausen C, Lonn L, Langhoff-Roos J (2014) Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand 93:138–143

    Article  Google Scholar 

  7. Tan YL, Suharjono H, Lau NL, Voon HY (2016) Prophylactic bilateral internal iliac artery balloon occlusion in the management of placenta accreta: A 36-month review. Med J Malaysia 71:111–116

    CAS  PubMed  Google Scholar 

  8. Dilauro MD, Dason S, Athreya S (2012) Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: literature review and analysis. Clin Radiol 67:515–520

    Article  CAS  Google Scholar 

  9. Al-Hadethi S, Fernando S, Hughes S, Thakorlal A, Seruga A, Scurry B (2017) Does temproray bilateral balloon occlusion of the common iliac arteries reduce the need for intra-operative blood transfusion in cases of placenta accretism? J Med Imaging Radiat Oncol 61:311–316

    Article  Google Scholar 

  10. Zeng C, Yang M, Ding Y et al (2017) Preoperative infrarenal abdominal aorta balloon catheter occlusion combined with Bakri tamponade reduced maternal morbidity of placenta increta/percreta. Medicine (Baltimore) 96:e8114

    Article  Google Scholar 

  11. Minas V, Gul N, Shaw E, Mwenenchanya S (2015) Prophylactic balloon occlusion of the common iliac arteries for the management of suspected placenta accreta/percreta: conclusions from a short case series. Arch Gynecol Obstet 291:461–465

    Article  Google Scholar 

  12. Feng S, Liao Z, Huang H (2017) Effect of prophylactic placement of internal iliac artery balloon catheters on outcomes of women with placenta accreta: an impact study. Anaesthesia 72:853–858

    Article  CAS  Google Scholar 

  13. Panici PB, Anceschi M, Borgia ML et al (2012) Intraoperative aorta balloon occlusion: fertility preservation in patients with placenta previa accreta/increta. J Matern Fetal Neonatal Med 25:2512–2516

    Article  Google Scholar 

  14. Tan CH, Tay KH, Sheah K et al (2007) Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta. AJR Am J Roentgenol 189:1158–1163

    Article  Google Scholar 

  15. Salim R, Chulski A, Romano S, Garmi G, Rudin M, Shalev E (2015) Precesarean prophylactic balloon catheters for suspected placenta accreta: a randomized controlled trial. Obstet Gynecol 126:1022–1028

    Article  CAS  Google Scholar 

  16. Cali G, Forlani F, Giambanco L et al (2014) Prophylactic use of intravascular balloon catheters in women with placenta accreta, increta and percreta. Eur J Obstet Gynecol Reprod Biol 179:36–41

    Article  Google Scholar 

  17. Raba G, Szczupak K, Stabiszewski P, Skibinski W (2015) Vascular changes responsible for the reduced effectiveness of obliteration ofuterine arteries in women with advanced cervical cancer. Wideochir Inne Tech Maloinwazyjne 10:229–232

    PubMed  PubMed Central  Google Scholar 

  18. Chou MM, Kung HF, Hwang JI, Chen WC, Tseng JJ (2015) Temporary prophylactic intravascular balloon occlusion of the common iliac arteries before cesarean hysterectomy for controlling operative blood loss in abnormal placentation. Taiwan J Obstet Gynecol 54:493–498

    Article  Google Scholar 

  19. Xie L, Wang Y, Luo FY, Man YC, Zhao XL (2017) Prophylactic use of an infrarenal abdominal aorta balloon catheter in pregnancies complicated by placenta accreta. J Obstet Gynaecol 37:557–561

    Article  Google Scholar 

  20. Broekman EA, Versteeg H, Vos LD, Dijksterhuis MG, Papatsonis DN (2015) Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa. Int J Gynaecol Obstet 128:118–121

    Article  Google Scholar 

Download references

Funding

This study has received funding by Scientific Research Project of the Health and Family Planning Commission of Zhejiang Province (2014KYA247) and Scientific Research Project of Zhejiang Provincial Education Department (Y201534762), China. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yu Zou.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Yu Zou.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

Electronic supplementary material

ESM 1

(DOCX 2120 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, K., Zou, Y., Sun, J. et al. Prophylactic balloon occlusion of internal iliac arteries, common iliac arteries and infrarenal abdominal aorta in pregnancies complicated by placenta accreta: a retrospective cohort study. Eur Radiol 28, 4959–4967 (2018). https://doi.org/10.1007/s00330-018-5527-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-018-5527-7

Keywords

Navigation