The use of pre‐caesarean prophylactic intra‐arterial balloon catheters for suspected placenta accreta

Abstract

IntroductionThe incidence of placenta accreta (PA) has markedly increased in the United States, from 1/30 000 in 1950 to 1/731 deliveries in 2011. Although placenta praevia after prior caesarean sections (CS) is the most important risk factor for PA, other risk factors make up 1–5% of PA occurrences. At our referral hospital, we use the pre‐caesarean prophylactic balloon catheter with or without post‐surgery embolisation in a hybrid room. Here, we evaluate the role of prior CS and placenta praevia on the outcome of this procedure.Materials and MethodsThis retrospective cohort analysis included 61 women during the years 2004–2016 with sonographic suspicion of PA who underwent balloon catheterisation prior to CS.ResultsEleven women had no previous CS (18%). Mean previous CS rate was 1.85. Six women (9.8%) had previous dilatation and curettage (D&C); 36.4% of women with no previous CS had previous D&C compared with 4% of women with previous CS (P = 0.008). Placenta praevia was sonographically diagnosed in 55 women (90.2%). There was a higher rate of caesarean hysterectomy in women with previous CS than in those without (32% vs 0%, P = 0.052) but no significant difference in blood product requirements (45.5% vs 66%, P = 0.303). There was no significant difference in hysterectomy rate, blood transfusion or surgery duration between women with and without placenta praevia (P = 0.648, 0.594, 0.995, respectively).ConclusionPrevious CS rather than placenta praevia is a strong indicator of hysterectomy in cases of PA. Different risk factors for PA do not affect blood transfusion rates or surgery duration.

The value of a simple sonographic screening test for placenta accreta spectrum prediction: A case–control study

“…Delays in diagnosing PAS can significantly impact maternal morbidity and mortality 13 . Given the importance of early detection of placenta accreta, women with risk factors for PAS should be treated by a multidisciplinary medical team.…”

“…Diagnosis and identification of PAS before delivery reduce the complication and mortality rate by affording the opportunity to prepare, including surgical planning, through multispecialty consultations, such as with radiologists and experienced surgeons 13 . Prenatal ultrasound with grayscale and colour Doppler imaging is currently a promising diagnostic tool for PAS 14,15 .…”

“…12 Diagnosis and identification of PAS before delivery reduce the complication and mortality rate by affording the opportunity to prepare, including surgical planning, through multispecialty consultations, such as with radiologists and experienced surgeons. 13 Prenatal ultrasound with grayscale and colour Doppler imaging is currently a promising diagnostic tool for PAS. 14,15 Welldocumented ultrasonographic signs of PAS in the second and third trimesters include loss of clear zone, myometrial thinning, placental lacunae, placental bed hypervascularity and bladder wall interruption.…”