The Effect of Prophylactic Intravascular Balloon Catheterization on Surgical Outcomes in Morbid Adherent Placenta [18O]

Abstract

INTRODUCTION: The target was to determine the effect of using internal iliac artery balloon catheterization (IIABC) in morbidly adherent placenta previa on surgical outcomes during cesarean section. METHODS: A retrospective comparative study was conducted from January 2013 till Oct 2016. From 67 women with morbidly adherent placenta during this time period- 33 underwent IIBAC before cesarean section (study group) and 34 underwent cesarean section without (control group). The outcomes measured were intra-operative blood loss, units of blood transfusion, loss in hemoglobin and hematocrit, total operative time, hemostatic medications and surgical procedures used, and the duration of hospital stay. RESULTS: The demographics were comparable, with no difference in maternal age (P=1), nationality (P=.86), BMI (P=.8), parity (P=.26), gestation (P=.31), pre-op hemoglobin (P=.736) and maternal co-morbidities like anemia (P=.7), diabetes (P=.5) and hypertension (P=.08). No significant difference was noted in the mean intra-operative blood loss (3115±1745 vs. 3447±2352, P=.515), transfusion ≥-6 units (30.3% vs. 41.17%, P=.357), duration of hospital stay (6.18±3.32 vs. 5.61±3.48, P=.495), loss in hemoglobin (2.158±1.758 vs. 1.68±1.69, P=.26) and the use of medications and surgical procedures. The use of general anesthesia was more in the study group (P=.049), with no difference in the neonatal factors. CONCLUSION: The use of IIABC as a means to reduce the intra-operative maternal morbidity is questionable, since the evidence proving the benefit is limited. In this case series, there were no statistical difference in the hemorrhagic outcome between women in whom it was used.