Use of temporary aortic balloon occlusion of the abdominal aorta was useful during cesarean hysterectomy for placenta accreta

We describe the use of an abdominal aortic occlusion balloon catheter to control excessive blood loss at cesarean hysterectomy for placenta accreta. Prophylactic abdominal aortic occlusion balloon catheter was placed in the angiography suite under local anesthesia before surgery. The 38-year-old parturient was anesthetized with propofol, sevoflurane, ketamine, remifentanil and fentanyl under close monitoring and appropriate respiratory management. The occlusion balloon was inflated after the infant had been delivered, and bleeding at the placenta required cesarean hysterectomy. There was a sudden and dramatic reduction in blood loss, and hysterectomy was performed uneventfully. An aortic occlusion was sustained for 25 min. Intraoperative blood loss was 1,800 g, and 300 g of autologous blood and 4 units of red cell concentrates were transfused. The postoperative course was uneventful. The present case suggests that prophylactic insertion of an aortic occlusion balloon catheter seems to be a safe and an effective method in controlling anticipated bleeding for caesarean hysterectomy in a parturient with placenta accreta.