Placenta accreta: Comparison of cases managed with and without pelvic artery balloon catheters

Multiple complications following the use of prophylactic internal iliac artery balloon catheterisation in a patient with placenta percreta

“…7 Bilateral ligation of the internal iliac arteries (IIAs) or placement of IIABOCs under fluoroscopic guidance have been used to reduce intraoperative blood loss. 12,13 Randomised controlled trials are lacking and would be difficult to achieve due to the variability of abnormal placentation and its presentation. Neither IIA ligation or balloon occlusion arrest blood flow to the uterus but decrease pulse pressure distal to the occlusion site.…”

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

“…A large number of studies, mostly retrospective, have evaluated the role of prophylactic placement of balloon occlusion catheters to mitigate bleeding at the time of cesarean hysterectomy for PAS disorders, with varied results . These devices are usually inserted by specialist interventional radiologists into the aorta, common iliac, internal iliac, or uterine arteries under fluoroscopic guidance and are inflated when hemorrhage is encountered.…”

“…Many authors have advocated their use, claiming a decrease in blood loss and transfusion requirements, and improved visualization on the surgical field . However, other studies fail to demonstrate any benefit and criticize their use . These authors claim that occlusive balloons cannot prevent catastrophic bleeding since the blood supply to the pelvis is maintained by the development of rich collaterals during pregnancy .…”

“…These authors claim that occlusive balloons cannot prevent catastrophic bleeding since the blood supply to the pelvis is maintained by the development of rich collaterals during pregnancy . In fact, they postulate that the empiric inflation of these balloons in a relatively dry setting may actually exacerbate bleeding from such collaterals . Finally, reports of vessel rupture and thromboembolic catheter‐related complications have called into question these balloons’ risk–benefit ratio …”

Placental disordersaaIncludes placenta previa, placenta accreta, and vasa previa. For normal or abnormal third stage, including postpartum hemorrhage, retained placenta, and uterine inversion, see chapter 9.

“…Another potential adjunctive strategy that may be considered is the cell saver. Although multiple other strategies (e.g., ureteral stents, preoperative placement of pelvic artery catheters for potential postpartum embolization and/or balloon inflation) have been utilized, these strategies have not been shown in either prospective trials or retrospective studies to have clear benefits that outweigh risks (22,(29)(30)(31).…”