Balloon-Assisted Occlusion of the Internal Iliac Arteries in Patients with Placenta Accreta/Percreta
Placenta accreta/percreta is a leading cause of third trimester hemorrhage and postpartum maternal death. The current treatment for third trimester hemorrhage due to placenta accreta/percreta is cesarean hysterectomy, which may be complicated by large volume blood loss.
To determine what role, if any, prophylactic temporary balloon occlusion and transcatheter embolization of the anterior division of the internal iliac arteries plays in the management of patients with placenta accreta/percreta.
The records of 28 consecutive patients with a diagnosis of placenta accreta/percreta were retrospectively reviewed. Patients were divided into two groups. Six patients underwent prophylactic temporary balloon occlusion, followed by cesarean section, transcatheter embolization of the anterior division of the internal iliac arteries and cesarean hysterectomy (n = 5) or uterine curettage (n = 1). Twenty-two patients underwent cesarean hysterectomy without endovascular intervention. The following parameters were compared in the two groups: patient age, gravidity, parity, gestational age at delivery, days in the intensive care unit after delivery, total hospital days, volume of transfused blood products, volume of fluid replacement intraoperatively, operating room time, estimated blood loss, and postoperative morbidity and mortality.
Patients in the embolization group had more frequent episodes of third trimester bleeding requiring admission and bedrest prior to delivery (16.7 days vs. 2.9 days), resulting in significantly more hospitalization time in the embolization group (23 days vs. 8.8 days) and delivery at an earlier gestational age than in those in the surgical group (32.5 weeks). There was no statistical difference in mean estimated blood loss, volume of replaced blood products, fluid replacement needs, operating room time or postoperative recovery time.
Our findings do not support the contention that in patients with placenta accreta/percreta, prophylactic temporary balloon occlusion and embolization prior to hysterectomy diminishes intraoperative blood loss.
KeywordsAngiographic embolization Placenta accrete Placenta percreta
- 1.Guy GP, Peisner DB, Timor-Tritsch IE (1990) Ultrasonographic evaluation of uteroplacental blood flow patterns of abnormally located and adherent placentas. J Obstet Gynecol 163:723–727Google Scholar
- 4.American College of Obstetricians and Gynecologists (1998) Postpartum hemorrhage. ACOG Educational Bulletin 243. ACOG, Washington, DCGoogle Scholar
- 8.Miller DA, Chollet JA, Goodwin TM (1997) Clinical risk factors for placenta previa–placenta accreta. Am J Obstet 177:210–214Google Scholar
- 11.Chait A, Moltz A, Nelson JH Jr (1968) The collateral arterial circulation in the pelvis: An angiographic study. AJR Am J Roentgenol 102:393–400Google Scholar
- 13.Heaton DK (1979) Transcatheter arterial embolization for control of persistent massive puerperal hemorrhage after bilateral surgical hypogastric artery ligation. AJR Am J Roentgenol 133:152–154Google Scholar
- 18.Levine AJ, Kuhlman K, Bonn J (1999) Placenta accreta: Comparison of cases managed with and without pelvic artery balloon catheters. J Maternal Fetal Med 8:173–176Google Scholar
- 19.Vendantham S, Goodwin SC, McLucas B, et al. (1997) Uterine artery embolization: An underused method of controlling pelvic hemorrhage. Am J Obstet Gynecol 176:938–948Google Scholar
- 24.Wagner LK, Lester RG, Saldana LR (1997) Exposure of the pregnant patient to diagnostic radiations: A guide to medical management, 2nd ed. Medical Physics Publishing, Madison, WI, p 88Google Scholar