Experience of Managing Suspected Placenta Accreta Spectrum with or without Internal Iliac Artery Balloon Occlusion in Two Lithuanian University Hospitals

Abstract

Background and objectives: Placenta previa and placenta accreta spectrum are considered major causes of massive postpartum hemorrhage. Objective: To determine whether the placement of an occlusion balloon catheter in the internal iliac artery could reduce bleeding and other related complications during cesarean delivery in patients with placenta previa and placenta accreta spectrum. Materials and Methods: A retrospective analysis was conducted at two tertiary obstetric units of Lithuania. From January 2016 to November 2019 patients with placenta previa and antenatally suspected invasive placenta were included in the intervention group and underwent cesarean delivery with endovascular procedure. From January 2014 to December 2015 patients with placenta previa and suspected placenta accreta spectrum were included in the non-intervention group. The primary outcomes were reduction in intraoperative blood loss and transfusion volumes in the intervention group. Secondary outcomes were the incidence of hysterectomy and maternal complications. Results: Nineteen patients underwent cesarean delivery with preoperative endovascular procedure, and 47 women underwent elective cesarean delivery. The median intraoperative blood loss (1000 (400–4500) mL vs. 1000 (400–5000) mL; p = 0.616) and the need for red blood cell transfusion during operation (26% vs. 23%; p = 0.517) did not differ significantly between the patients groups. Seven patients in the intervention group and two patients in the non-intervention group underwent perioperative hysterectomy (p = 0.002). None of the patients had complications related to the endovascular procedure. Conclusion: The use of intermittent balloon occlusion catheter in patients with placenta pathology is a safe method but does not significantly reduce intraoperative blood loss during cesarean delivery.

Placenta Accreta Spectrum Outcomes Using Tourniquet and Forceps for Vascular Control

“…Internal iliac artery occlusion or similar interventions can reduce bleeding, but side effects include iliac or femoral artery thrombosis or rupture, as well as ischemic nerve injury. Considering the need for multidisciplinary cooperation, these may become a limitation of such occlusion treatment methods ( 11 ). Because most PAS patients undergo cesarean sections, improvements in surgical methods and the reduction of bleeding remain important.…”

Unexpected Dramatic Evolution of Placenta Increta: Case Report and Literature Review

“…Managing postpartum hemorrhage in cases of morbid placental adherence requires a coordinated approach involving obstetricians, anesthesiologists, and urologists if there exists an invasion of the urinary bladder. When considering options for preserving the uterus through medical or conservative surgical therapy, such as uterine artery embolization, it is essential to take this differential diagnosis into account before proceeding with a second surgery [36,37]. In our case, although uterine artery embolization could have been a potential option to control vaginal bleeding, the size of the mass led us to conclude that surgical removal was necessary.…”

Efficacy and safety of prophylactic balloon occlusion in the management of placenta accreta spectrum disorder: a retrospective cohort study

“…Indeed, PAS patients with multiple CS and severe PAS grade often presented with pelvic adherences, a thin and hypervascular lower uterine segment, extensive collateral circulation, and greater extent of placental invasion, as well as excessive invasion to bladder, cervix, and parametrium [31,32]. Therefore, massive bleeding is more likely to occur in these PAS patients, increasing the surgical difficulties and urologic injuries [30,33,34]. Even with the support of PBO, it remains challenging to avoid massive hemorrhage and bladder injuries, and prejudge the chances of preserving the uterus.…”

“…PBO-related complications are the most important features need to focus on, including initial vessel injury, arterial thrombosis, puncture point haematoma, ischaemic necrosis of the lower limbs, and rarely arterial rupture [36]. Thrombosis is one of the most common complications of PBO, with a reported incidence ranging from 5-15% [34,35]. A systematic review reported that the overall incidence of PBO-related complications was 5%, while one study did not show any serious PBOrelated complications occurred in the balloon group [15,17].…”