The clinical evaluation of IIA balloon occlusion in caesarean delivery for patients with PAS: a retrospective study

Abstract

Objective The aim of this study is the clinical evaluation of IIA balloon occlusion in the caesarean delivery in patients with a diagnosis of placenta accreta spectrum. Background High incidence of cesarean section leads to the increasing incidence of placenta accreta spectrum (PAS), which contributes to serious consequences such as severe obstetric postpartum hemorrhage or even maternal mortality. Methods Fifty-eight patients with a diagnosis of PAS were retrospectively reviewed. The balloon group consisted of 23 patients, who underwent a caesarean delivery with internal iliac artery occlusion. 35 patients were in the control group, who had a standard caesarean delivery. The primary outcomes were estimated blood loss (EBL). The secondary outcomes were cesarean hysterectomy, blood transferring volume, operating time, intraoperative hemostatic approaches, surgical complications, balloon catheter–related complications, length of maternal stay, cost of hospitalization, and neonatal outcomes. Results No difference was observed in estimated blood loss (EBL), blood transferring percentages and volume, additional measures to secure hemostasis, surgical complications, hospital stay postoperatively and newborn outcomes. More than 40% of the balloon group underwent hysterectomy because of uncontrollable postpartum bleeding (10 [43.48%] vs. 11 [31.43%], P=0.350). Complications related to occlusion of IIA did not occur. The duration of the surgery of the balloon group was significantly longer than that of the control group (123.52 min±74.76 versus 89.17±48.68, P=0.038), and the total hospitalization cost was also significantly higher than that of the control group (45116.67±9358.67 yuan versus 30615.41±11587.44 yuan, P=0.000). Conclusion It does not permit to draw final conclusions for us on the effectiveness of the balloons IIA given the heterogeneity of selection of cases undergoing the procedures in the retrospective design. However, it is possible that IIA balloon occlusion may contribute to limiting intraoperative blood loss in more severe cases, particularly those undergoing peripartum hysterectomy.

Comparison of Placenta Previa and Placenta Accreta Spectrum Disorder Following Previous Cesarean Section between Women with a Short and Normal Interpregnancy Interval

“…The authors concluded that temporal, perioperative, and prophylactic positioning of balloon vascular catheters is an active method for managing severe hemorrhage caused by placenta accreta spectrum disorder as it reduced intraoperative blood loss, lessened perioperative hemostatic measures, intraoperative red cell transfusions, and reduced hysterectomies [ 29 ]. Similarly, Hong et al did a clinical evaluation of the efficacy of IIA balloon occlusion during cesarean sections in patients with a diagnosis of placenta accreta spectrum disorders [ 30 ]. Although the complications related to occlusion of IIA balloon did not occur, Hong et al revealed that more than 40% participants that received balloon occlusion underwent hysterectomy because of uncontrollable postpartum bleeding [ 30 ].…”

“…Similarly, Hong et al did a clinical evaluation of the efficacy of IIA balloon occlusion during cesarean sections in patients with a diagnosis of placenta accreta spectrum disorders [ 30 ]. Although the complications related to occlusion of IIA balloon did not occur, Hong et al revealed that more than 40% participants that received balloon occlusion underwent hysterectomy because of uncontrollable postpartum bleeding [ 30 ].…”

Ligation or Occlusion of the Internal Iliac Arteries for the Treatment of Placenta Accreta Spectrum: Why Is This Technique Still Performed?

“…The technique described for IIA surgical ligation 15 and arterial balloons 21 emphasizes that only the IIA anterior division is occluded. The primary goal of maintaining flow in the posterior division of the IIA is to avoid gluteal necrosis 22 .…”

“…The utilization of radiology and the participation of vascular interventional specialists increases the costs associated with the management of PAS disorder 21,35 . Furthermore, many PAS referral centers lack these resources 17 …”

“…The utilization of radiology and the participation of vascular interventional specialists increases the costs associated with the management of PAS disorder. 21,35 Furthermore, many PAS referral centers lack these resources. 17 Some previous authors have reported that IIA ligation is inexpensive and available in both low-and middle-income countries.…”