Intraoperative temporary internal iliac arterial occlusion (Polat's technique) for severe placenta accreta spectrum: A description of the technique and outcomes in 61 patients

• Published in: International journal of gynecology and obstetrics 2024-01, Vol.164 (1), p.99-107
• Main Authors: Daggez, Mine, Aslanca, Tufan, Dursun, Polat
• Format: Article
• Language: English
• Subjects: abnormally invasive placenta; Balloon Occlusion - methods; Blood Loss, Surgical - prevention & control; Bulldog clamp; cesarean hysterectomy; Cesarean Section - methods; Female; Humans; Hysterectomy - methods; Iliac Artery - surgery; maternal mortality; Placenta Accreta - surgery; placenta accreta spectrum; placenta percreta; postpartum hemorrhage; Pregnancy; Retrospective Studies
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.14968

Objective To report the results of prophylactic use of intraoperative temporary internal iliac arterial occlusion by Bulldog clamps in patients clinically diagnosed with abnormally invasive placenta. Methods This retrospective study included 61 patients diagnosed with FIGO grade 3 abnormally invasive placenta between January 2018 and March 2022. After transfundal incision and fetal delivery, bilateral temporary internal iliac arterial occlusion by Bulldog clamps was performed in all patients. The grades 3b and 3c group underwent cesarean hysterectomy whereas selected cases of grade 3a abnormally invasive placenta underwent fertility‐preserving procedures. Preoperative and postoperative findings were compared. Results Cesarean hysterectomy was performed in 50 (82%) patients and cesarean plus conservative procedures were performed in 11 (18%) patients. Intraoperative blood replacement was not performed in 83.6% of all patients. Mean blood loss was 1.37 ± 0.53 L (range 0.5–2.5) in all patients. Estimated blood loss was significantly higher in cesarean hysterectomy group. There was no statistically significant difference between two groups in terms of peroperative blood replacement, bladder, and ureteral injury. Conclusion Prophylactic bilateral temporary internal iliac arterial occlusion by Bulldog clamps should be performed in cases of grade 3 abnormally invasive placenta. Fertility‐preserving steps may be undertaken safely in selected cases with this approach. Synopsis Prophylactic temporary internal iliac arterial occlusion by Bulldog clamps should be considered in abnormally invasive placenta. Acceptable estimated blood loss is observed with this technique.