Prophylactic bilateral internal iliac artery balloon occlusion in the management of placenta accreta: A 36-month review
- Author:
Yiap Loong Tan
;
Haris Suharjono
;
Nina Lee Jing Lau
;
Hian Yan Voon
- Publication Type:Journal Article
- Keywords:
Internal Iliac artery occlusion;
balloon occlusion;
placenta accrete;
morbidly adherent placenta;
postpartum haemorrhage;
caesarean hysterectomy
- MeSH:
Placenta Accreta
- From:
The Medical Journal of Malaysia
2016;71(3):111-116
- CountryMalaysia
- Language:English
-
Abstract:
Background: The contemporary obstetrician is increasingly
put to the test by rising numbers of pregnancies with
morbidly adherent placenta. This study illustrates our
experience with prophylactic bilateral internal iliac artery
occlusion as part of its management.
Methods: Between January 2011 to January 2014, 13
consecutive patients received the intervention prior to
scheduled caesarean delivery for placenta accreta. All cases
were diagnosed by ultrasonography, color Doppler imaging
and supplemented with MRI where necessary. The Wanda
balloonTM catheter (Boston Scientific, Natick, MA, U.S.A)
were placed in the proximal segment of the internal iliac
arteries preceding surgery. This was followed by a midline
laparotomy and classical caesarean section, avoiding the
placenta. Both internal iliac balloons were inflated just
before the delivery of fetus and deflated once haemostasis
was secured. Primary outcomes measured were
perioperative blood loss, blood transfusion requirement and
the need for ICU admission.
Results: The mean and median intraoperative blood loss
were 1076mls±707 and 800mls (300-2500) respectively while
mean perioperative blood loss was 1261mls±946. Just over
half of the patients in our series required blood and/or blood
products transfusion. Two patients (15.4%) required ICU
admission.
Conclusion: Our study suggests that preoperative
prophylactic balloon occlusion of bilateral internal iliac
arteries reduces both blood loss and transfusion
requirement in patients with placenta accreta, scheduled to
undergo elective caesarean hysterectomy. It is an adjunct to
be considered in the management of a modern day obstetric
problem, although the authors are cautious about
generalizing its benefit without larger, randomized trials.
- Full text:P020160808594847485333.pdf
