Internal iliac artery balloon occlusion during cesarean hysterectomy in women with placenta previa accreta

Chen, Meng; Lv, Bin; He, Guolin; Liu, Xinghui

doi:10.1002/ijgo.12763

Cited by 31 publications

(21 citation statements)

References 20 publications

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“…[ 7 ] However, other studies have found the opposite. [ 25 ] These studies have focused on the use of BO in traditional CS, and there are no reports on the preoperative application of BO during PTUI CS. In the study by You et al, [ 5 ] a novel technique using PTUI during CS is presented that could effectively control bleeding and preserve the uterus in patients with placenta previa and PA. Prophylactic internal IIA BO and cell salvage are increasingly being performed during PTUI CS when there is a high risk of hemorrhage in our hospital.…”

Section: Discussionmentioning

confidence: 99%

Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa

Luo

Jiang

et al. 2020

Medicine

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Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS. This retrospective study included all women who were diagnosed with PPP and PA and underwent PTUI CS from October 1, 2016, to October 31, 2018. Sixty-four patients were included: 34 underwent prophylactic IIA BO (IIA group), whereas 30 were treated without prophylactic IIA BO (control group). The primary outcome was a composite measure of perioperative blood management outcomes, including the estimated blood loss (EBL), donor blood transfusion, salvaged blood returned, fresh frozen plasma (FFP), pre- and postoperative serum hemoglobin and hematocrit. In addition, the baseline conditions of mother and neonates were compared. EBL was significantly higher in the IIA group compared to the control group (2883.5 mL in the IIA group vs 1868.7 mL in the control group, P = .001). Overall, the donor blood transfusion rate was 23.5% (8/34), averaging 4.2 U, in the IIA group versus 30% (9/30), averaging 3.4 U, in the control group, which were not significantly different. The FFP transfusion rate was 47%, averaging 765.6 mL, in the IIA group versus 20%, averaging 816.7 mL, in the control group. In the IIA group, 97.1% used cell savage and had salvaged blood returned, averaging 954.9 mL. In the control group, 90% had salvaged blood returned, averaging 617.9 mL. No cases of amniotic fluid embolism were observed with leukocyte depletion filters. Prophylactic IIA BO during PTUI CS in women with PPP and PA does not lead to a statistically significant reduction in EBL. Cell salvage was associated with a reduction in the rate of donor blood transfusion during PTUI CS.

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Section: Discussionmentioning

confidence: 99%

Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa

Luo

Jiang

et al. 2020

Medicine

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“…Some authors advocate the use of IIA BO for treatment of PA, and they found preoperative prophylactic BO was associated with reduced EBL and fewer massive donor transfusions [26] . However, other studies have found the opposite [27] . These studies have focused on the use of BO in traditional CS, and there are no reports on the preoperative application of BO during PTUI CS.…”

Section: Discussionmentioning

confidence: 83%

Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa: A retrospective cohort analysis

Luo

Lin

et al. 2019

Preprint

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Background Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage (PPH) and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS. Methods This retrospective study included all women who were diagnosed with PPP and PA and underwent PTUI CS from October 1, 2016, to October 31, 2018. Sixty-four patients were included: 34 underwent prophylactic IIA BO (IIA group), while 30 were treated without prophylactic IIA BO (control group). The primary outcome was a composite measure of perioperative blood management outcomes, including the estimated blood loss (EBL), donor blood transfusion, salvaged blood returned, fresh frozen plasma (FFP), pre- and postoperative serum hemoglobin(Hb) and hematocrit (HCT). In addition, the baseline conditions of mother and neonates were compared. Results The EBL was significantly higher in the IIA group compared to the control group (2883.5 ML in the IIA group versus 1868.7 ML in the control group, P=0.001). Overall, the donor blood transfusion rate was 23.5% (8/34), averaging 4.2 U, in the IIA group versus 30% (9/30), averaging 3.4 U, in the control group, which were not significantly different. The FFP transfusion rate was 47%, averaging 765.6 ml, in the IIA group versus 20%, averaging 816.7 ml, in the control group. In the IIA group, 97.1% used cell savage and had salvaged blood returned, averaging 954.9 ml. In the control group, 90% had salvaged blood returned, averaging 617.9 ml. No cases of amniotic fluid embolism were observed with leukocyte depletion filters. Conclusion Prophylactic IIA BO during PTUI CS in women with PPP and PA does not lead to a statistically significant reduction in EBL. Cell salvage was associated with a reduction in the rate of donor blood transfusion during PTUI CS.

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“…Previous randomized, controlled trials included 13 patients who were diagnosed with placenta accreta in the intervention group and 14 cases in the control group found that there were no significant differences in calculated blood loss (4950 verus 4709 mL) and PRBC units transfused (5.2 verus 4.1 U) between the intervention and control groups [ 25 , 26 ]. Chen et al compared 83 patients with placenta previa and accreta who underwent cesarean hysterectomy in the balloon group and 31 patients in the control group, they found PBOIIA had no significant effects on reducing EBL (3000 vs 3700 mL) and improving maternal outcomes [ 27 ]. These findings suggested that PBOIIA had no benefit in patients with placenta accreta.…”

Section: Discussionmentioning

confidence: 99%

Effect of prophylactic balloon occlusion of internal iliac artery in pregnancies complicated by placenta previa and accreta

Chen

Tian

et al. 2021

BMC Pregnancy Childbirth

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Background Placenta previa and accreta are serious obstetric conditions that are associated with a high risk of intraoperative massive hemorrhage, the prophylactic intravascular balloon occlusion technique is increasingly used in managing uncontrolled hemorrhage in cesarean section (CS). We aim to examine the clinical effectiveness of prophylactic balloon occlusion of the internal iliac artery (PBOIIA) during CS in improving maternal outcomes for patients with placenta previa and accreta. Methods A total of 420 women with placenta previa and accreta who underwent CS from January 2014 to December 2018 were included retrospectively. Patients were divided into balloon group in which patients had PBOIIA (n = 248) and the control group in which patients did not have PBOIIA (n = 172). Meanwhile, we performed a subgroup analysis in whether taking parallel transverse uterine incision (PTUI) surgery. Information on conditions of patients and newborns, perioperative blood indicators, surgical outcomes were collected. Results Median estimated blood loss (mEBL) was 2200 mL in the balloon group and 2150 mL in the control group respectively, there was no significant difference between two-groups comparison (P > 0.05), and the rate of patients with hysterectomy was also has no difference between the two groups (36.3% verus 35.5%, P > 0.05), while there is a significant difference between two groups in the amount of PRBCs transfused [3 (0–31.5) verus 3 (0–39), P <0.05], moreover, the proportion of PRBCS> 8 units in the balloon group is significantly lower than that in control group (11.29% verus 23.26%, P <0.05).. However, the total hospitalization costs (45,624.4 ± 11,061.9 verus 37,523.1 ± 14,662.2, CYN) and surgery costs (19,910.6 ± 2622.6 verus 11,850.5 ± 3146.1, CYN) in balloon group were significantly higher than those in control group (P < 0.05). Subgroup analysis showed PTUI surgery had no significant differences in EBL (P >0.05), but it could significantly decrease hysterectomy rates (P <0.05). Conclusions PBOIIA has no significant effect on reducing intraoperative EBL and hysterectomy rate in patients with placenta previa and accreta. and although it could reduce the intraoperative PRBCs in patients with massive hemorrhage, it significantly increases the financial cost for patients. Therefore, PBOIIA should not be routinely recommended to patients with placenta previa and accreta.

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Internal iliac artery balloon occlusion during cesarean hysterectomy in women with placenta previa accreta

Cited by 31 publications

References 20 publications

Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa

Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa

Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa: A retrospective cohort analysis

Effect of prophylactic balloon occlusion of internal iliac artery in pregnancies complicated by placenta previa and accreta

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