Perioperative prophylactic internal iliac artery balloon occlusion in the prevention of postpartum hemorrhage in placenta previa: a randomized controlled trial

Yu, Simon Chun Ho; Cheng, Yvonne Kwun Yue; Tse, Wing Ting; Sahota, Daljit Singh; Chung, Man-Kin; Wong, Simon S.; Chan, Oi Ka; Leung, Tak Yeung

doi:10.1016/j.ajog.2020.01.024

Cited by 40 publications

(31 citation statements)

References 61 publications

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“…One large systematic review and meta-analysis showed that endovascular intervention was associated with reduced blood loss only for patients who underwent prophylactic balloon occlusion of the abdominal aorta [ 12 ]. Other studies did not show any benefit of balloon occlusion, including two randomized controlled trials on OBCs [ 17 , 18 , 19 ]. Salim et al [ 18 ] examined patients with suspected placenta accreta who did or did not undergo balloon occlusion and found no changes between the groups.…”

Section: Discussionmentioning

confidence: 99%

“…This could be due to the small number of cases in our IG or the short period from the perioperative internal iliac artery balloon insertion to displacement. Yu et al [ 19 ] recently published data from a trial involving women with placenta previa: the trial involved 16 women who underwent prophylactic endovascular internal iliac artery procedures and 20 who were assigned to the control group; there was no reduction in the rate of perioperative hemorrhage or transfusion in the intervention group. Our study results also did not show any significant benefit of perioperative balloon occlusion in terms of EBL, need for blood transfusion, incidence of hysterectomy, and postoperative duration of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…However, the incidence is increasing with the increasing rate of cesarean deliveries [2,3]. PP is a severe pregnancy complication that leads to life-threatening postpartum hemorrhage (PPH) [4], damages the surrounding organs, and endangers the lives of pregnant women [5]. The fetus may experience preterm delivery, or may have low birth weight or congenital defects [6,7].…”

Section: Introductionmentioning

confidence: 99%

Effect of types of placenta previa on maternal and neonatal outcomes: a 10-year retrospective cohort study

Zhang

Wang

et al. 2021

Arch Gynecol Obstet

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Purpose: Through this study, we aimed to evaluate the effects of different types of placenta previa (PP) on maternal and neonatal outcomes.Methods: This study was conducted in The Third A liated Hospital of Guangzhou Medical University and Tongji Hospital between January 2009 and 2019. PP was traditionally classi ed into four types, namely low-lying placenta, marginal, partial, and complete PP. Previous studies have classi ed PP into two types, namely low-lying placenta and PP. Based on our clinical experience, we proposed the classi cation of PP into three types, for the rst time, which included low-lying placenta, "marpartial" (marginal and partial) PP, and complete PP. Multivariate logistic regression analysis was performed to determine the effects of different types of PP on maternal and neonatal outcomes.Results: In total, 4490 singleton pregnancies were complicated with PP. In the four-classi cation method, compared with women with low-lying placenta, women with complete PP had a risk of placenta accrete spectrum disorders, postpartum hemorrhage (PPH), hemorrhagic shock, severe PPH, blood transfusion, hysterectomy, puerperal infection, preterm labor, NICU admission, and low birth weight. There was no difference in maternal and neonatal outcomes between marginal and partial PP, except for increased chances of preterm labor and low birth weight in partial PP. In the two-classi cation method, PP was the risk factor for most of the adverse maternal and neonatal outcomes, compared with low-lying placenta. Conclusion:Complete PP and low-lying placenta were associated with the highest and lowest risks of adverse pregnancy outcomes, respectively, whereas clinically similar outcomes were observed between marginal and partial PP. The three-classi cation of PP may be practical from the clinical perspective.

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“…This implies that hemostasis relies heavily on surgical techniques such as the placement of hemostatic sutures, the use of intrauterine balloon tamponade, and the ligation of the uterine artery. If these conservative surgical approaches fail to control bleeding, the last resource is life-saving hysterectomy [2,3].…”

Section: Introductionmentioning

confidence: 99%

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

López-Benítez

Castillo

Hodel

et al. 2021

Preprint

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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.

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Perioperative prophylactic internal iliac artery balloon occlusion in the prevention of postpartum hemorrhage in placenta previa: a randomized controlled trial

Cited by 40 publications

References 61 publications

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

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

Effect of types of placenta previa on maternal and neonatal outcomes: a 10-year retrospective cohort study

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

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