Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta.

Qinghua Wu,Zhimin Chen,Qinjun Chu,Yanli Wang,Cai Liu,Zhuan Liu,Xianlan Zhao,Xiaojuan Wang

doi:10.1007/s00270-016-1418-y

Abstract

PurposeTo explore the efficacy and safety of prophylactic temporary balloon occlusion of the infrarenal abdominal aorta during caesarean for the management of patients with placenta praevia accreta.MethodsTwo hundred and sixty-eight cases of placenta praevia accreta from January 2012 to June 2015 were retrospectively reviewed. Group A included two hundred and thirty patients who underwent prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section. Group B included thirty-eight patients who underwent caesarean without endovascular intervention. The parameters including operating room time, estimated blood loss, blood transfusion volume, PT (prothrombin time) during operation, days in the intensive care unit, and total hospital days were compared between the two groups.ResultsThe operating room time, estimated blood loss, PT, the incidence of hysterectomy, blood transfusion volume, postpartum haemorrhage, and days in intensive care unit were lower in group A than in group B, with statistical significance (P < 0.05). There was no significant difference in the Apgar scores of the neonates and the incidences of thrombosis in lower limbs between the two groups (P > 0.05). No patient in the group with prophylactic temporary balloon occlusion of the infrarenal abdominal aorta was performed hysterectomy, while three patients in group B were performed hysterectomy because of uncontrollable haemorrhage.ConclusionsThe results indicate that prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section is safe and effective to control intraoperative blood loss and greatly decreases the risk of hysterectomy in patients with placenta praevia accreta.

Highlights

Placental disorders such as placenta previa, placenta accreta, and vasa previa are all associated with vaginal bleeding in the second half of pregnancy, which are important causes of serious foetal and maternal morbidity and mortality
The operating room time, estimated blood loss, prothrombin time (PT), the incidence of hysterectomy, blood transfusion volume, postpartum haemorrhage, and days in intensive care unit were lower in group A than in group B, with statistical significance (P \ 0.05)
The results indicate that prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section is safe and effective to control intraoperative blood loss and greatly decreases the risk of hysterectomy in patients with placenta praevia accreta

Summary

Introduction

Placental disorders such as placenta previa, placenta accreta, and vasa previa are all associated with vaginal bleeding in the second half of pregnancy, which are important causes of serious foetal and maternal morbidity and mortality. It is widely accepted that the most important risk factor for placenta accreta is the increasing rate of caesarean section, the coexisting placenta praevia [2], which may be caused by abnormal decidualization of a scarred area or lack of decidua in the lower uterine segment near the cervix [3]. Placenta praevia accreta is a major cause of caesarean hysterectomy with potential risk of maternal mortality and morbidity, which is among the greatest treatment challenges in modern obstetrics

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