Iliac artery rupture related to balloon insertion for placenta accreta causing maternal hemorrhage and neonatal compromise

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

“…In fact, they postulate that the empiric inflation of these balloons in a relatively dry setting may actually exacerbate bleeding from such collaterals . Finally, reports of vessel rupture and thromboembolic catheter‐related complications have called into question these balloons’ risk–benefit ratio …”

FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management,

“…There are also very limited data on the use of these adjuvant techniques . Preventive devascularization can be achieved by surgical or interventional radiology procedures also used in the management of severe postpartum hemorrhage, such as stepwise uterine surgical devascularization, bilateral uterine or hypogastric artery surgical ligation, iliac artery embolization, or balloon occlusion.…”

“…The value of prophylactic placement of balloon catheters in the iliac arteries in cases of PAS disorders is even more controversial, mainly owing to the higher risks of complications than with embolization. In particular, there are two case reports, one of a popliteal and one of an external iliac arterial thrombus, a case of iliac artery rupture, and a case of ischemic nerve injury attributable to iliac artery thrombosis complicating common iliac balloon catheterization at cesarean hysterectomy.…”

Delayed bleeding after prophylactic bilateral internal iliac artery balloon occlusion in elective caesarean hysterectomy for the management of placenta accreta

“…et al). 15,16 Although this complication is a technique-related complication, it's significantly compromising patient safety by causing a massive haemorrhage perioperatively. Perioperative massive haemorrhage also occurred after removing the pre-set balloon immediately after caesarean section resulting in a significant blood loss and requiring emergent embolization and hysterectomy based on the fact that 66% of haemorrhage occur within 2 hours after delivery and 33% of haemorrhage occur more than 4 hours after delivery.…”