Effect of Prophylactic Placement of Internal Iliac Artery Balloon Catheters on Outcomes of Women With Placenta Accreta: An Impact Study

Feng, Shiquan; Liao, Z.; Huang, Han

doi:10.1097/01.aoa.0000529990.02540.46

Cited by 5 publications

(9 citation statements)

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“…Recently, Yao FAN and Soo BuemCho 's two randomized controlled studies also agree with this view [15,17] . However, randomized controlled studies [10,18] and several case control studies [11,12,19] did not nd any bene t. Our ndings accord with the previous randomized controlled trial conducted by Meng Chen et [18] .…”

Section: Discussionsupporting

confidence: 88%

“…The arterial occlusion balloon was introduced and used in pernicious placenta previa, recently, and the role of intraoperative internal iliac artery(IIA) balloon occlusion to improve hemorrhagic outcomes in women with placenta accreta has been evaluated in many studies, most of which showed some bene t [5][6][7][8][9] , but others failed to demonstrate any [10][11][12] . In this retrospective study, we aimed to evaluate the clinical e cacy of IIA balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta.…”

Section: Introductionmentioning

confidence: 99%

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The Clinical Evaluation of IIA Balloon Occlusion for Pernicious Placenta Previa Patients with Placenta Accreta: A Retrospective Study

Luan

Chen

et al. 2021

Preprint

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Objective: This study aimed to evaluate the clinical efficacy of internal iliac artery(IIA) balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta. Background: Pernicious placenta previa is frequently reported to be complicated with placenta accreta, which contributes to serious consequences such as severe obstetric postpartum hemorrhage or even maternal mortality. Methods: Fifty-eight pernicious placenta previa patients complicated with placenta accreta were retrospectively reviewed. The ballon group consisted of 23 patients, who underwent a caesarean delivery with internal iliac artery occlusion. 35 patients were in the control group, who had a standard caesarean delivery. The primary outcomes were estimated blood loss (EBL), cesarean hysterectomy, and blood transferring volume. The secondary outcomes were operating time, intraoperative hemostatic approaches, surgical complications, balloon catheter–related complications, length of maternal stay, cost of hospitalization, and neonatal outcomes.Results: No difference was observed in estimated blood loss (EBL), blood transferring percentages and volume, additional measures to secure hemostasis , surgical complications, hospital stay postoperatively and newborn outcomes. More than 40% of the balloon group underwent hysterectomy because of uncontrollable postpartum bleeding (10[43.48%] vs. 11[31.43%],P=0.350).Complications related to occlusion of IIA did not occur.The duration of the surgery of the balloon group was significantly longer than that of the control group(123.52 min±74.76 versus 89.17±48.68,P=0.038), and the total hospitalization cost was also significantly higher than that of the control group(45116.67±9358.67 yuan versus 30615.41±11587.44yuan,P=0.000).Conclusion: IIA balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta did not reduce the hysterectomy rate during cesarean section, nor did it reduce blood loss and blood transfusion, but it prolonged the duration of the surgery and increased the total cost.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

The Clinical Evaluation of IIA Balloon Occlusion for Pernicious Placenta Previa Patients with Placenta Accreta: A Retrospective Study

Luan

Chen

et al. 2021

Preprint

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“…In this systematic review, the pooled hysterectomy rate obtained from 8 studies reporting the use of uterine artery embolization was 15.5% (24/155) (9,14,25,29,31,32,46,70). This rate obtained from 22 studies that use prophylactic balloon occlusion of the internal iliac arteries was 76.5% (318/697) (21,22,27,28,(34)(35)(36)(37)(38)(39)47,49,54,(56)(57)(58)63,65,(67)(68)(69)71) and 12.1% (54/445) from 10 studies using prophylactic occlusion of the abdominal aorta (17,33,45,48,52,55,60,64,66,71).…”

Section: Recommendationsmentioning

confidence: 95%

“…Some researchers have claimed a potential for prophylactic balloon catheters in the internal iliac arteries (22,27,36,37,40,42,49,55,57,58,63,(100)(101)(102)(103)(104)(105)(106)(107)(108)(109)(110). Cali et al reported the results based on a historical comparison of two groups of women with AIP (36).…”

Section: Prophylactic Placement Of Balloon Catheters In the Iliacmentioning

confidence: 99%

“…Several studies reported no benefit with the use of prophylactic balloon catheters in the internal iliac arteries with amounts of EBL, up to 16,000 mL using prophylactic balloon occlusion of the internal iliac arteries (21,23,34,43) or no benefit by comparison with historical control group (49). Bodner et al found unfavorable results with the use of balloon-assisted occlusion of the internal iliac artery in 28 women with AIP using an historical comparison, with a rate of hysterectomy of 83% (5/6) in woman who underwent prophylactic occlusion compared to 100% (22/22) in women without occlusion (103).…”

Section: Prophylactic Placement Of Balloon Catheters In the Iliacmentioning

confidence: 99%

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The role of interventional radiology in the management of abnormally invasive placenta: a systematic review of current evidences

Soyer¹,

Barat²,

Loffroy³

et al. 2020

Quant Imaging Med Surg

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Abnormally invasive placenta (AIP) is a potentially severe condition. To date, arterial embolization in women with postpartum hemorrhage due to AIP is the treatment option for which highest degrees of evidence are available. However, other techniques have been tested, including prophylactic catheter placement, balloon occlusion of the iliac arteries and abdominal aorta balloon occlusion. In this systematic review, we provide an overview of the currently reported interventional radiology procedures that are used for the treatment of postpartum hemorrhage due to AIP and suggest recommendations based on current evidences. Owing to a high rate of adverse events, prophylactic occlusion of internal iliac arteries should be used with caution and applied when the endpoint is hysterectomy. On the opposite, when a conservative management is considered to preserve future fertility, uterine artery embolization should be the preferred option as it is associated with a hysterectomy rate of 15.5% compared to 76.5% with prophylactic balloon occlusion of the internal iliac arteries and does not result in fetal irradiation. Limited data are available regarding the application of systematic prophylactic embolization and no comparative studies with arterial embolization are available.

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Role of interventional radiology in pregnancy complicated by placenta accreta spectrum disorder: systematic review and meta‐analysis

D’Antonio

Iacovelli

Liberati

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To evaluate the potential benefit of interventional radiology (IR) in improving the outcome of women undergoing surgery for a placenta accreta spectrum (PAS) disorder.Methods MEDLINE, EMBASE and CINAHL databases were searched for studies comparing outcomes of women with a prenatal diagnosis of PAS who underwent an IR procedure before surgery vs those who did not, using a robust collection of terms relating to PAS. The primary outcome was intraoperative estimated blood loss (EBL). Secondary outcomes were the number of transfused units of packed red blood cells (PRBC), fresh frozen plasma (FFP), platelets and cryoprecipitate, operation time, length of hospital stay, EBL ≥ 2.5 L, PRBC transfused ≥ 5 units, surgical complications, bladder or ureteral injury, relaparotomy, infection, disseminated intravascular coagulation, and complications related to endovascular catheter placement. Only studies reporting on the incidence of, or the mean difference in, the observed outcomes in women affected by a PAS disorder who had vs those who did not have an IR procedure before surgery were considered for inclusion. All outcomes were explored in the overall population of women with a prenatally diagnosed PAS disorder and in those undergoing hysterectomy.tool. The GRADE methodology was used to assess the quality of the body of retrieved evidence.Results Fifteen studies (958 women with PAS) were included. In women who underwent IR before surgery, compared with those who did not, mean EBL (mean difference (MD), −1.02 L; 95% CI, −1.60 to −0.43 L; P < 0.001) and the risk of EBL ≥ 2.5 L (odds ratio (OR), 0.18; 95% CI, 0.04-0.78; P = 0.02) were significantly lower. There was no significant difference between the two groups in the other outcomes explored. On subgroup analysis of pregnancies complicated by PAS undergoing hysterectomy, EBL (MD, −0.68 L; 95% CI, −1.24 to −0.12 L; P = 0.02) and the number of transfused FFP units (MD, −1.66; 95% CI, −2.71 to −0.61; P = 0.02) were significantly lower in women who had an endovascular IR procedure compared with controls. Furthermore, women undergoing IR had a significantly lower risk of EBL ≥ 2.5 L (OR, 0.10; 95% CI,; P = 0.004). Overall, complications related to the placement of an endovascular catheter occurred in 5. 3% (95% CI,; I 2 , 65.3%) of pregnancies undergoing IR. Overall quality of evidence, as assessed by GRADE, was very low. ConclusionsThe current available data provide encouraging evidence that IR procedures may be associated with lower EBL and need for transfusion in pregnancies undergoing surgery for a PAS disorder. However, given the overall very low quality of the evidence, further large studies are needed in order to confirm the beneficial role of IR in improving the outcome of these women. Copyright

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Effect of Prophylactic Placement of Internal Iliac Artery Balloon Catheters on Outcomes of Women With Placenta Accreta: An Impact Study

Cited by 5 publications

References 0 publications

The Clinical Evaluation of IIA Balloon Occlusion for Pernicious Placenta Previa Patients with Placenta Accreta: A Retrospective Study

The Clinical Evaluation of IIA Balloon Occlusion for Pernicious Placenta Previa Patients with Placenta Accreta: A Retrospective Study

The role of interventional radiology in the management of abnormally invasive placenta: a systematic review of current evidences

Role of interventional radiology in pregnancy complicated by placenta accreta spectrum disorder: systematic review and meta‐analysis

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