Vascular balloon occlusion and planned caesarean hysterectomy for morbidly adherent placenta: A systematic review

Abstract

Background Morbidly adherent placenta is potentially life‐threatening, often requiring technically difficult surgery and large blood loss. Use of intravascular balloon occlusion with or without hysterectomy to reduce blood loss is increasing despite associated morbidity and lack of evidence of efficacy. Aims To evaluate if prophylactic use of vascular balloon occlusion at the time of planned caesarean hysterectomy for antenatally diagnosed morbidly adherent placenta reduces blood loss and transfusion requirements, and determine rate of associated complications. Materials and Methods A systematic review of PubMed and Medline covering January 1997 to December 2018 was conducted. Key words included placenta accreta, increta, percreta, and morbidly adherent placenta, balloon, interventional radiology, embolization, and caesarean hysterectomy. Results Nineteen studies were included. Only three studies had appropriate controls: two with balloon placement in the internal iliac arteries and one in the common iliac arteries. One showed no difference in blood loss or transfusion requirements, the second showed a reduction in cases of percreta only and the third reported reduction in blood loss. Only few studies reported objective measures of blood loss. Blood loss and transfusion were still high (2.26 L and 3.79 units, respectively) despite use of vascular balloons. Balloon catheter use was associated with a 7.5% rate of complications; 4.5% were minor and 3.0% major. Conclusions There is a large body of poor data evaluating efficacy of prophylactic vascular balloon occlusion in cases of planned caesarean hysterectomy for known morbidly adherent placenta. Limited relevant data provide only scant evidence that these techniques are beneficial in reducing blood loss, despite associated significant complications.

Evaluation Of Patients With Previous C/S + Plasenta Previa Totalis İn 2017

“…Other procedures, such as vascular balloon occlusion, hypogastric artery ligation, and uterine tamponade, have been used in some patients 22,23 . One study with extensive patient participation in which balloon occlusion was performed indicated that the need for hysterectomy decreased with increasing obstetric experience in this subject 24 .…”

Effectiveness of Intra-Aortic Ballooning Occlusion for Bleeding Control in Gravida Patients with Placenta Accreta

“…The previous studies reported the efficacy of using an occlusive balloon during surgical management of MAP in reducing blood loss, with the highest efficacy in the aortic balloon [7]. We report the use of an intraoperative aortic balloon occlusion (IABO) procedure for bleeding control in Gravida Patients with Placenta Accreta in our center.…”