Internal iliac balloon ‘catheter’ with ligation or ‘only ligation’ for morbidly adherent placenta

Abstract

Morbidly adherent placenta can lead to catastrophic obstetric hemorrhage accounting for between 1/3rd and ½ of emergency peripartum hysterectomies. When recognized antenatally, a multidisciplinary team approach with careful peripartum planning, can reduce complications. We compared 2 patients with morbidly adherent placenta who underwent obstetric hysterectomy with IIA ligation only and the other with IIA balloon catheter with ligation. The intra & postoperative course was compared and has been described. IIA ligation is a valuable procedure to control intractable obstetric haemorrhage. It is cost effective, doesn't require any prior extensive setup, safe and simple in practiced hands & can be of immense help in immediate control of bleeding. Balloon catheters prophylactically in the internal iliac arteries before delivery can be done to allow obstruction of blood flow to the uterus when necessary. With balloon catheter occlusion, the balloons are in place and need only to be inflated, utilizing less than a minute's time; this can be crucial in a moment of massive hemorrhage.