Safety and efficacy of preoperative abdominal Aortic balloon occlusion in placenta increta and/or percreta

J Surg Res. 2018 Feb;222:75-84. doi: 10.1016/j.jss.2017.10.002. Epub 2017 Nov 1.

Abstract

Background: With the increase of cesarean deliveries globally, the incidence of placenta adhesive disorder has been on the rise greatly which is associated closely with maternal and infant morbidity and mortality. We sought to investigate the safety and efficacy of preoperative transfemoral balloon occlusion of abdominal aorta in cesarean section of women with placenta increta or percreta.

Methods: We conducted a retrospective study of 31 patients with placenta increta or percreta diagnosed by ultrasound and/or magnetic resonance imaging. The observation group included 19 patients who received transfemoral abdominal aorta balloon occlusion for preoperative prophylaxis, while the other 12 patients in the control group did not receive any preoperative interventional managements. Clinical outcomes were compared between the two groups.

Results: Patients in observation group had significantly less estimated blood loss during surgery than those in control group (1.2 L versus 3.15 L, P = 0.006). The average transfusion volume of the observation group was significantly lower than the control group (0.8 L versus 1.95 L, P = 0.017). Seventy-nine percent (15 of 19) patients in the observation group and 50% (6 of 12) in the control group had their uterus successfully retained (P = 0.093). No peripheral tissues including bladder, ureter, and bowel were injured in all patients. Neonatal weight and Apgar scores of 1 min and 5 min had no statistical difference (P = 0.513 and P = 1, respectively) between the two groups. The mean radiation exposure time of fetus in the observation group was 22.68 ± 8.07 s and mean radiation exposure dose was 4.20 ± 1.49 mGy. Both operation time and postoperative hospital stay had no statistical difference between the two groups (2 versus 2.75 h, P = 0.063; 7.0 versus 6.5 d, P = 0.846). No patients had long-term complications after 6-8 wk follow-up.

Conclusions: Application of preoperative transfemoral abdominal aorta balloon occlusion during cesarean section is a safe and effective strategy for patients with placenta increta and/or percreta. It could reduce intraoperative blood loss and enhance the possibility of uterus preservation and ensure the safety of life from severe complications.

Keywords: Abdominal aorta balloon occlusion; Cesarean section; Placenta increta; Placenta percreta; Postpartum hemorrhage.

MeSH terms

  • Adult
  • Aorta, Abdominal*
  • Balloon Occlusion*
  • Female
  • Fertility Preservation
  • Humans
  • Organ Sparing Treatments*
  • Placenta Accreta*
  • Postpartum Hemorrhage / etiology
  • Postpartum Hemorrhage / prevention & control*
  • Pregnancy
  • Retrospective Studies