Safety and efficacy of preoperative abdominal Aortic balloon occlusion in placenta increta and/or percreta

Sun, Wenjuan; Duan, Shuhong; Xin, Gang; Xiao, Juan; Hong, Fanzhen; Hong, Haijie; Wu, Yuange; Xu, Yongping

doi:10.1016/j.jss.2017.10.002

Cited by 36 publications

(30 citation statements)

References 34 publications

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“…Although this technology has been applied clinically for approximately 20 years, no consensus or data are available regarding the safe dose for the foetus, and further research and statistics are needed. Sun et al [49] recommended a dose of 4.2 ± 1.9 mGy. To minimise radiation exposure, experienced interventional doctors should quickly insert the balloon into the internal iliac artery.…”

Section: Discussionmentioning

confidence: 99%

The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study

Peng

Jiang

Cheng

et al. 2020

BMC Pregnancy Childbirth

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Background: Severe obstetric haemorrhage caused by placenta accreta spectrum (PAS) results in significant maternal morbidity and mortality. The effectiveness of prophylactic balloon occlusion of the internal iliac artery in PAS patients remains controversial. Therefore, we conducted a retrospective case-control study to investigate the clinical effectiveness of this treatment. Methods: The clinical data of 104 patients with PAS complicated with placenta previa who delivered by caesarean section between January 2016 and January 2019 were collected, and the patients were divided into two groups. The study group (48 cases) underwent internal iliac artery preset balloon occlusion before caesarean section and uterine artery embolisation according to the bleeding status after surgery, while the control group (56 cases) did not undergo internal iliac artery preset balloon occlusion before caesarean section. Results: The operation and hospitalisation times in the study group were longer than those in the control group. Additionally, the hysterectomy rate in the study group was significantly higher than that in the control group. No significant differences in blood loss, blood transfusion volume, urinary system injury, postoperative ICU transfer rate, or neonatal scores were identified between the groups. Among the patients without invasive placenta (placenta increta and percreta), blood loss was lower in the study group, and the caesarean hysterectomy rate did not significantly differ between the groups. Among the patients with invasive placenta, blood loss and the caesarean hysterectomy rate did not significantly differ between the groups. The risk of hysterectomy in the study group was related to invasive placenta penetration, a large area of placental invasion, or abnormal vascular filling. One patient in the study group had a thrombus in the left lower extremity artery.

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Section: Discussionmentioning

confidence: 99%

The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study

Peng

Jiang

Cheng

et al. 2020

BMC Pregnancy Childbirth

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“…BO (abdominal aorta or IIA) is the only technique that can be employed before CS in patients who need to keep the uterus and reserve fertility. The use of endovascular interventional procedures with BO has been described in the management of obstetric hemorrhage of various causes [24][25] , but the effect of intraoperative IIA BO in women with PPP and PA is still controversial. Some authors advocate the use of IIA BO for treatment of PA, and they found preoperative prophylactic BO was associated with reduced EBL and fewer massive donor transfusions [26] .…”

Section: Discussionmentioning

confidence: 99%

Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa: A retrospective cohort analysis

Luo

Lin

et al. 2019

Preprint

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Background Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage (PPH) and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS. Methods This retrospective study included all women who were diagnosed with PPP and PA and underwent PTUI CS from October 1, 2016, to October 31, 2018. Sixty-four patients were included: 34 underwent prophylactic IIA BO (IIA group), while 30 were treated without prophylactic IIA BO (control group). The primary outcome was a composite measure of perioperative blood management outcomes, including the estimated blood loss (EBL), donor blood transfusion, salvaged blood returned, fresh frozen plasma (FFP), pre- and postoperative serum hemoglobin(Hb) and hematocrit (HCT). In addition, the baseline conditions of mother and neonates were compared. Results The EBL was significantly higher in the IIA group compared to the control group (2883.5 ML in the IIA group versus 1868.7 ML in the control group, P=0.001). Overall, the donor blood transfusion rate was 23.5% (8/34), averaging 4.2 U, in the IIA group versus 30% (9/30), averaging 3.4 U, in the control group, which were not significantly different. The FFP transfusion rate was 47%, averaging 765.6 ml, in the IIA group versus 20%, averaging 816.7 ml, in the control group. In the IIA group, 97.1% used cell savage and had salvaged blood returned, averaging 954.9 ml. In the control group, 90% had salvaged blood returned, averaging 617.9 ml. No cases of amniotic fluid embolism were observed with leukocyte depletion filters. Conclusion Prophylactic IIA BO during PTUI CS in women with PPP and PA does not lead to a statistically significant reduction in EBL. Cell salvage was associated with a reduction in the rate of donor blood transfusion during PTUI CS.

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“…[8] In recent years, abdominal aortic balloon, as a new technology, has become more and more popular in women with placenta increta or percreta. [9,10] To evaluate the efficacy and safety of this new technology, we collected relevant clinical data, together with previous articles, to make an analysis and summary. we collected data from patients with placenta increta or percreta who were treated in the Sichuan Provincial People's Hospital and make a comparison on blood loss volume blood transfusion volume and hysterectomy rates between AABO group and NO-AABO group.…”

Section: Introductionmentioning

confidence: 99%

Clinical evaluation of preoperative abdominal aortic balloon occlusion in patients with placenta increta or percreta

Yang¹,

Mei²,

Hou³

et al. 2019

Preprint

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Background Placenta increta or percreta will result in severe postpartum hemorrhage and become a research hotspot in obstetrics. Preoperative abdominal aortic balloon occlusion (AABO), as a new intravascular interventional therapy, has taken more and more attention in obstetrics. Thus, the aim of this study is to evaluate the safety and efficacy of abdominal aortic balloon occlusion. Methods Retrospective analysis of pregnant women with placenta increta or percreta delivered between January 2013 and April 2019 in the Sichuan Provincial People’s Hospital. The experimental group (AABO group) included 168 patients who underwent abdominal aortic balloon occlusion before cesarean section. The control group (NO-AABO group) was composed of 106 patients who underwent surgery without any preoperative intravascular interventional therapy. The parameters containing estimated blood loss, red cell suspension (RCS) transfusion volume, hysterectomy, surgery time, postoperative hospital days, neonatal status and complications were compared between the two groups. Results The patients with preoperative abdominal aortic balloon occlusion had significant reduction in blood loss volume, red cell suspension transfusion volume and plasma transfusion volume compared to patients without balloon. Similarly, the surgery time and hysterectomy were obviously reduced in AABO group. However, there were no differences in the Apgar scores and neonatal complications between the two groups, indicating that the abdominal aortic balloon has little adverse effect on the newborns. Conclusion AABO is a safe and effective technology for pregnant women with placenta increta or percreta to reduce blood loss volume and blood transfusion volume.

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Safety and efficacy of preoperative abdominal Aortic balloon occlusion in placenta increta and/or percreta

Cited by 36 publications

References 34 publications

The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study

The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study

Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa: A retrospective cohort analysis

Clinical evaluation of preoperative abdominal aortic balloon occlusion in patients with placenta increta or percreta

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