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.
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
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
Publications Committee SfM-FM, Belfort MA (2010) Placenta accreta. Am J Obstet Gynecol 203:430–439
Wortman AC, Alexander JM (2013) Placenta accreta, increta, and percreta. Obstet Gynecol Clin N Am 40:137–154
Zhang GJ, Song YH, Jin YZ (2012) The current situation in treatment of placenta accreta. Matern Child Health Care China 27:1430–1431
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
Clausen C, Lonn L, Langhoff-Roos J (2014) Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand 93:138–143
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Corresponding author
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
About this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-018-5527-7