Effect of Internal Iliac Arterial Balloon Occlusion on Estimated Blood Loss in Morbidly Adherent Placenta [29B

Abstract

INTRODUCTION: The role of prophylactic placement of internal iliac arterial balloon occlusion prior to cesarean hysterectomy for anticipated morbidly adherent placenta (MAP) is a subject of debate. We aimed to compare estimated blood loss (EBL) in patients with suspected MAP and received internal iliac balloon occlusion to those who did not. METHODS: This is a retrospective cohort of patients at a single tertiary center with suspected MAP between January 2007 and June 2018. The intervention group received internal iliac arterial occlusion balloon occlusion prior to cesarean hysterectomy while the control group did not. The primary outcome was EBL. RESULTS: There were 24 cases of suspected MAP. Balloon occlusion was placed in 17 (71%) cases, while 7 (29%) cases did not have balloon occlusion. Cases with balloon occlusion were more likely to have gynecology oncology (94.1% vs 42.9%, p=0.01) and more likely to receive cell saver (88.2% vs 42.9%, p=0.04). There was a non-significant trend towards lower EBL in women who received balloon occlusion (1200 [800, 2000] vs 3000 [1200, 3190], p=0.34). Transfusion outcomes did not differ between groups. Women who did have balloon occlusion were less likely to be admitted to the intensive care unit (ICU) after delivery (11.8% vs 57.1%, p=0.04). There were no complications observed from balloon occlusion. Neonatal outcomes did not differ between groups. CONCLUSION: There was a non-significant trend seen towards lower EBL in women with MAP and prophylactic internal iliac arterial balloon occlusion compared to those who did not.