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Prophylactic Placement of Internal Iliac Balloons in Patients with Abnormal Placental Implantation: Maternal and Foetal Outcomes

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Abstract

Purpose

To report on outcomes following the use of prophylactic internal iliac artery occlusion balloons in patients with abnormal placental implantation.

Methods

A retrospective analysis was undertaken of patients with abnormal placental implantation who underwent prophylactic iliac balloon placement prior to delivery in a University Maternity Hospital. Various clinical and technical factors were analysed, including technical success of balloon placement, blood loss and number of blood units transfused, duration of surgery, length of stay, hysterectomy rates, complications related to the balloon insertion, foetal pH and infant Apgar scores.

Results

Twenty-two patients with placenta accreta or a variant thereof underwent caesarean section after first undergoing prophylactic placement of bilateral internal artery balloons. Average follow-up duration was 2.08 years. The average gestational age was 37 weeks 6 days, and the mean gravidity was 2.8. The mean number of previous caesarean sections was 2.4, while the mean maternal age was 35 years. The mean intraoperative blood loss was 1.4 L, and the mean number of blood units transfused was 2. Mean duration of surgery was 90 min, mean total length of hospital stay 7.5 days, while the mean duration of ICU/HDU stay was 1.2 days. The balloons were inflated in 60% of cases and two patients (2/22–9%) underwent subsequent hysterectomy. There were no major maternal complications due to the procedure.

Conclusion

Prophylactic placement of arterial balloons prior to caesarean section in patients with placenta accreta is well tolerated and leads to satisfactory maternal and foetal outcomes with minimal complications.

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Acknowledgements

Staff of anaesthesia, obstetrics and interventional radiology involved in the care of these patients.

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Authors and Affiliations

  1. Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland

    Patrick J. Nicholson, Owen O’Connor, John Buckley, Liam D. Spence & David J. Tuite

  2. National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland

    Richard A. Greene

Authors
  1. Patrick J. Nicholson
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  2. Owen O’Connor
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  3. John Buckley
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  4. Liam D. Spence
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  5. Richard A. Greene
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  6. David J. Tuite
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Contributions

DT, RG, LS, JB, O’OC, PN: conception and planning, collecting and analysing data, writing up of the work.

Corresponding author

Correspondence to Patrick J. Nicholson.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

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. The procedures of the study received ethics approval from the local institutional ethics committee (Cork University Maternity Hospital, confirmation received 10/03/2013 Ref: CUMH).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Nicholson, P.J., O’Connor, O., Buckley, J. et al. Prophylactic Placement of Internal Iliac Balloons in Patients with Abnormal Placental Implantation: Maternal and Foetal Outcomes. Cardiovasc Intervent Radiol 41, 1488–1493 (2018). https://doi.org/10.1007/s00270-018-1983-3

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  • DOI: https://doi.org/10.1007/s00270-018-1983-3

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