Internal IIiac Artery Occlusion Balloon Catheters to Minimize Blood Loss in Adherent Placenta: A Retrospective Cohort Study

Abstract

ABSTRACTAdherent placenta is a rare but life- and fertility-threatening condition, with a rapid increase in incidence in this decade. Cesarean hysterectomy, the traditional management, is associated with very high morbidity due to massive blood loss and adjacent organ damage. The objective was to study the effect of preoperative internal iliac artery balloon catheter placement as a means of reducing morbidity.MethodsAdherent placenta cases were identified using hospital database over a 9 years period from 2001 to 2009 at Fernandez hospital, a tertiary perinatal center with 5000 deliveries annually. Mothers who had preoperative internal iliac artery balloon placements were compared with those who did not have. Maternal morbidity was assessed in the form of intraoperative blood loss, total units of blood products transfused, mean operative time, length of postoperative hospital stay, use of adjuvant procedures (for control of hemorrhage), adjacent organ damage, cardiac arrest, and maternal mortality.ResultsForty-one subjects with a diagnosis of adherent placenta were identified out of 32,354 deliveries (incidence of 1:789) and 27 of these had peripartum hysterectomy. Six had preoperative internal iliac artery balloons placement before hysterectomy (study group) and 21 had hysterectomy alone (control group). Significant difference was found in mean amount of blood loss (p = 0.002) and in mean number of blood products given (p = 0.04). No statistically significant difference was found in mean operative time and length of postoperative hospital stay. There were four subjects who had adjacent organ damage, two had cardiac arrest, two required recombinant factor VIIa in the control group when compared with none in the study group.ConclusionPreoperative placement of internal iliac artery occlusion balloon catheters reduced morbidity by minimizing blood loss and adjacent organ damage.