Prophylactic preoperative balloon occlusion of hypogastric arteries in abnormal placentation; 5 years experience

Purpose

The purpose is to describe and evaluate the technique of prophylactic balloon occlusion of the anterior division of the internal iliac arteries (hypogastric arteries) in abnormal placentation.

Materials and methods

It is a retrospective study; the records of 44 patients with a diagnosis of placenta previa/accreta/percreta were retrospectively reviewed. Patients were divided into two groups. Thirty-two patients underwent prophylactic temporary balloon occlusion, followed by cesarean section. A review of cases was done over a period of 5 years. All cases after previous arrangement with the interventional radiologist and after admission, patient in the balloon occlusion group underwent the procedure of hypogastric artery balloon occlusion under fluoroscopy using minimal radiation exposure. Intra-operatively, the balloon was inflated as needed. Twelve patients underwent cesarean section without endovascular intervention. The following parameters were compared in the two groups: patient age, gravidity, parity, gestational age at delivery, pregnancy outcome, and days in the intensive care unit after delivery, total hospital days, volume of transfused blood products, operating room time, estimated blood loss, and postoperative morbidity and mortality.

Results

Patients in the balloon occlusion group had significantly less in estimated blood loss than the non balloon occlusion group. There was no statistical difference in mean volume of replaced blood products, operating room time or postoperative recovery time.

Conclusion

Our results support that in patients with placenta accreta/percreta, pre-operative prophylactic temporary balloon occlusion diminishes intra-operative blood loss. We conclude that balloon occlusion of the hypogastric arteries is safe and effective in an attempt to minimize blood loss in patients with abnormal placentation.