Prophylactic endovascular internal iliac balloon placement during cesarean hysterectomy for placenta accreta spectrum

• Published in: American journal of obstetrics & gynecology MFM 2022-09, Vol.4 (5), p.100657-100657, Article 100657
• Main Authors: Overton, Eve, Booker, Whitney A., Mourad, Mirella, Moroz, Leslie, Nhan Chang, Chia-Ling, Breslin, Noelle, Syeda, Sbaa, Laifer-Narin, Sherelle, Cimic, Adela, Chung, Doreen E., Weiner, David M., Smiley, Richard, Sheikh, Maria, Mobley, David G., Wright, Jason D., Gockley, Allison, Melamed, Alexander, St. Clair, Caryn, Hou, June, D'Alton, Mary, Khoury Collado, Fady
• Format: Article
• Language: English
• Subjects: obstetrical hemorrhage; placenta accreta spectrum; placenta increta; placenta percreta
• ISSN: 2589-9333; 2589-9333
• DOI: 10.1016/j.ajogmf.2022.100657

The utility of prophylactic endovascular internal iliac balloon placement in the surgical management of placenta accreta spectrum is debated. In this study, we review outcomes of surgical management of placenta accreta spectrum with and without prophylactic endovascular internal iliac balloon catheter use at a single institution. This is a retrospective cohort study of consecutive viable singleton pregnancies with a confirmed pathologic diagnosis of placenta accreta spectrum undergoing scheduled delivery from October 2018 through November 2020. In the T1 period (October 2018–August 2019), prophylactic endovascular internal iliac balloon catheters were placed in the operating room before the start of surgery. Balloons were inflated after neonatal delivery and deflated after hysterectomy completion. In the T2 period (September 2019–November 2020), endovascular catheters were not used. In both time periods, all surgeries were performed by a dedicated multidisciplinary team using a standardized surgical approach. The outcomes compared included the estimated blood loss, anesthesia duration, operating room time, surgical duration, and a composite of surgical complications. Comparisons were made using the Wilcoxon rank-sum test and the Fisher exact test. A total of 30 patients were included in the study (T1=10; T2=20). The proportion of patients with placenta increta or percreta was 80% in both groups, as defined by surgical pathology. The median estimated blood loss was 875 mL in T1 and 1000 mL in T2 (P=.84). The proportion of patients requiring any packed red blood cell transfusion was 60% in T1 and 40% in T2 (P=.44). The proportion of patients requiring >4 units of packed red blood cells was 20% in T1 and 5% in T2 (P=.25). Surgical complications were observed in 1 patient in each group. Median operative anesthesia duration was 497 minutes in T1 and 296 minutes in T2 (P