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Prophylactic occlusion balloon placement in internal iliac arteries for the prevention of postpartum haemorrhage due to morbidly adherent placenta: short term outcomes

  • VASCULAR AND INTERVENTIONAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

To evaluate outcomes of uterine conserving surgery with occlusion balloon technique. A critical review of the complications was performed.

Materials and methods

Between 2010 and 2016, pregnant women, with a prenatal diagnosis of morbidly adherent placenta (MAP), were treated with occlusion balloon catheters in both internal iliac arteries. Parameters such as need for hysterectomy, incidence of PPH, grade of MAP, estimated blood loss during delivery (EBL) and transfusion requirements, mean recovery time and duration of the balloon inflation, were collected and reviewed. Complications requiring further management were analysed.

Results

Thirty-seven women with MAP underwent prophylactic occlusion balloon placement (POBC). Mean recovery was 4.48 days (range 2–10). Catheters were successfully positioned and balloons inflated in obstetric theatre following caesarean delivery in 100% of the cases. The uterus was conserved in every case. The MAP grades were 20 percreta, 3 increta and 14 accreta. The EBL was not statistically different between the different grades of placentation. There was a statistically significant association in the number of patients requiring blood transfusions and the degree of placental invasion (p = 0. 0119). PPH occurred in 5 patients (13.5%) and arterial thrombosis in 4 patients (11%). The EBL during delivery was significantly higher (2811 mL) in patients with complications (p = 0.0102). Furthermore, the group of patients that had complications required statistically significant more blood transfusions compared to those without complications (p = 0.0001). No maternal mortality or foetal morbidity occurred.

Conclusion

The utilisation of Prophylactic occlusion balloon catheters allows uterine conserving surgery to be performed safely with few maternal complications.

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Acknowledgements

We would like to acknowledge the whole Interventional Radiology and Obstetric teams of St George’s for their contribution in the management of these patients.

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Authors and Affiliations

  1. Diagnostic and Interventional Radiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì 8, Milan, 20142, Italy

    Salvatore Alessio Angileri, Anna Maria Ierardi & Gianpaolo Carrafiello

  2. Radiology Department, St. George’s Hospital, Blackshaw Road, London, SW17 0QT, UK

    Leto Mailli & Anna-Maria Belli

  3. Interventional Radiology Unit, Careggi Academic and Regional Hospital of Florence, Largo Brambilla 3, Florence, 50134, Italy

    Claudio Raspanti

Authors
  1. Salvatore Alessio Angileri
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  2. Leto Mailli
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  4. Anna Maria Ierardi
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  5. Gianpaolo Carrafiello
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  6. Anna-Maria Belli
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Corresponding author

Correspondence to Gianpaolo Carrafiello.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Angileri, S.A., Mailli, L., Raspanti, C. et al. Prophylactic occlusion balloon placement in internal iliac arteries for the prevention of postpartum haemorrhage due to morbidly adherent placenta: short term outcomes. Radiol med 122, 798–806 (2017). https://doi.org/10.1007/s11547-017-0777-z

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  • DOI: https://doi.org/10.1007/s11547-017-0777-z

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