2018
DOI: 10.1055/s-0038-1641736
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Pilot Study of Intra-Aortic Balloon Occlusion to Limit Morbidity in Patients with Adherent Placentation Undergoing Cesarean Hysterectomy

Abstract: Objective  We study whether using an intra-aortic balloon (IAB) during cesarean hysterectomy decreases delivery morbidity in patients with suspected morbidly adherent placentation. Study Design  This is a retrospective cohort study of deliveries complicated by suspected abnormal placentation between 2009 and 2016 comparing maternal and neonatal outcomes with an IAB placed prior to cesarean hysterectomy versus no IAB. The primary outcome included quantified blood loss (QBL). Results  Thirty-five cases were re… Show more

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Cited by 15 publications
(12 citation statements)
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“…(27) The utility of routine aortic balloon placement for placenta previapercreta surgery in our settings is questionable, since predicted mean blood loss is reduced to an acceptable level (<1.5 liters) via our 5-step approach to cesarean hysterectomy. One recent North American publication in this context compared blood loss in 16 cases with an aortic balloon with 19 cases without a balloon over a 7 year period, and found no significant difference in mean blood loss (28), confirming our view. A variant of this strategy, originally described in Taiwan (29), and subsequently adopted both in Denmark (30) and in Japan(31) with favorable initial results, is bilateral placement of balloons in the common iliac arteries.…”
Section: Percutaneous Aortic Balloon Placementsupporting
confidence: 86%
“…(27) The utility of routine aortic balloon placement for placenta previapercreta surgery in our settings is questionable, since predicted mean blood loss is reduced to an acceptable level (<1.5 liters) via our 5-step approach to cesarean hysterectomy. One recent North American publication in this context compared blood loss in 16 cases with an aortic balloon with 19 cases without a balloon over a 7 year period, and found no significant difference in mean blood loss (28), confirming our view. A variant of this strategy, originally described in Taiwan (29), and subsequently adopted both in Denmark (30) and in Japan(31) with favorable initial results, is bilateral placement of balloons in the common iliac arteries.…”
Section: Percutaneous Aortic Balloon Placementsupporting
confidence: 86%
“…Ten studies used continuous inflation, seven did not describe the inflation protocol or this was unclear from the text, one used a mixture of intermittent and continuous inflation, and in one did not inflate the vascular balloons at all . However, it is noted that mean EBL among cases in studies in which continuous occlusion of the internal iliac arteries occurred was 1.94 L, which is slightly less than the 2.27 L overall in all cases in which internal iliac artery occlusion was unclear, intermittent or omitted.…”
Section: Resultsmentioning
confidence: 98%
“…Potential benefits of aortic balloon placement beyond reduced blood loss may also include a single puncture site for insertion, single balloon utilisation, lower rate of maternal and fetal complications, and the lowest maternal and fetal radiation doses as compared with balloon placement at more distal sites . Furthermore, newer techniques may allow aortic balloons to be placed under ultrasound guidance, eliminating the need for fluoroscopic guidance and avoiding fetal radiation exposure associated with fluoroscopy …”
Section: Discussionmentioning
confidence: 99%
“…In this systematic review, the pooled hysterectomy rate obtained from 8 studies reporting the use of uterine artery embolization was 15.5% (24/155) (9,14,25,29,31,32,46,70). This rate obtained from 22 studies that use prophylactic balloon occlusion of the internal iliac arteries was 76.5% (318/697) (21,22,27,28,(34)(35)(36)(37)(38)(39)47,49,54,(56)(57)(58)63,65,(67)(68)(69)71) and 12.1% (54/445) from 10 studies using prophylactic occlusion of the abdominal aorta (17,33,45,48,52,55,60,64,66,71).…”
Section: Recommendationsmentioning
confidence: 95%