Perioperative Prophylactic Internal Iliac Artery Balloon Occlusion (Iiabo) in Placental Implantation Abnormalities

Abstract

BackgroundPlacental implantation abnormalities remain among the major causes of massive postpartum hemorrhage and maternal mortality worldwide. To avoid a hysterectomy, prophylactic management with perioperative internal iliac artery balloon occlusion (IIABO) could minimize blood loss and facilitate surgical performance through reductions in the rate of uterine perfusion. We aimed to evaluate the safety and efficacy of IIABO in patients with placental implantation abnormalities.ResultsThe study group consisted of 13 patients, including three patients with placenta previa totalis, seven patients with placenta increta, and three patients with placenta percreta. Prophylactic IIABO was performed in all patients. The median estimated blood loss was 700 ml ± 598.8 ml, the median number of red blood cell transfusion units was 0 ± 0.75, and only two patients required uterine artery embolization. The uterus was preserved in eight patients (61.5%), with an average intra-hospitalary stay of 6 ± 3.2 days. The average fetal radiation dose was 4.67 mGy. No complications were attributed to IIABO placement.ConclusionsThe prophylactic use of IIABO in placental implantation abnormalities is an effective and safe method of controlling perioperative bleeding during cesarean section and hysterectomy. Indications should be strictly controlled, and interdisciplinary planning and management are mandatory.