Intraoperative infrarenal aortic balloon occlusion in pregnancies with placenta accreta, increta, and percreta

Abstract

Intraoperative infrarenal aortic balloon occlusion in pregnancies with placenta accreta, increta, and percreta Z.R. Zheng1, X. Xie1, Y. Hou1, P. Xie2, X. Yu2, L. Xie1 1Department of Obstetrics and Gynecology, 2Department of Interventional Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu (China) Summary Objective: The objective of this study was to evaluate the efficacy of intraoperative aortic balloon occlusion (IABO) during cesarean section for placenta accreta, increta or percreta. Materials and Methods: This was a retrospective case-control study of patients with surgically or pathologically confirmed placenta accreta, increta or percreta who were examined from 2013 to 2017. One hundred and two patients (60%) had aortic balloon catheters placed before cesarean section (balloon group), and the other patients did not undergo balloon placement (control group). Clinical records from 170 subjects were reviewed. Results: Forty-nine patients were diagnosed as having placenta accreta (28.8%), 98 patients had placenta increta (57.6%), and 23 patients had placenta percreta (13.6%). Considering all subjects, the patients in the balloon group had a significantly reduced median estimated blood loss (p < 0.01), rate of transfusion (p = 0.02), amount of packed red blood cells (PRBCs) (p = 0.02), and decrease in hemoglobin levels (p = 0.03). Nine (8.8%) patients had catheterization-related complications, including eight cases of arterial or venous thrombosis. When the data were analyzed separately according to the different forms of abnormal invasive placenta, no difference in these surgical outcomes was observed between the two groups for women with placenta accreta or placenta percreta; however, for women with placenta increta who underwent IABO, the authors observed significant reductions in the estimated blood loss (p < 0.01), the amount of transfused PRBCs (p = 0.01), the extent to which hemoglobin levels decreased after surgery (p = 0.01), and the incidence of cesarean hysterectomy (p = 0.04). Conclusions: Although IABO was efficacious in both reducing intraoperative hemorrhage and blood transfusion, and in preventing hysterectomy during cesarean section for placenta increta, it should only be used on the basis of an accurate antenatal diagnosis, as it has a high risk of thrombosis and a high cost; immediate cesarean hysterectomy still seems to be the optimal management for placenta percreta. Key words: Aorta occlusion; Abnormal invasive placenta; Balloon catheter; Caesarean section; Placenta accreta.