title: Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhage in placenta accreta.
abstract: OBJECTIVE
  The purpose of this study was to describe the preliminary results of prophylactic temporary balloon occlusion of the internal iliac arteries for bleeding control in patients with placenta accreta during cesarean hysterectomy.
  
  
  METHODS
  From May 2006 to March 2010, 21 patients diagnosed with placenta accreta using ultrasound and/or magnetic resonance imaging were submitted to prophylactic balloon occlusion before hysterectomy. Fluoroscopy, balloon occlusion time, surgical duration, intraoperative blood loss, transfusion volume, and procedure complications were analyzed.
  
  
  RESULTS
  The mean age was 30.5 years with a mean of 3.6 previous gestations. Imaging studies revealed that all patients had placenta accreta and all were submitted to cesarean hysterectomy. One hysterectomy was due to previous diagnosis of fetal death and another due to cesarean with uterine curettage. Mean fluoroscopy time was 7.5 min, balloon occlusion time was 164 min, and surgery duration was 260 min. Estimated blood loss was 1,671.5 ml with mean reposition fluids of 3,538 ml of crystalloids, 309.5 ml of colloids, and 1.24 ml of packed red blood cells. Two patients were submitted to thromboembolectomy due to prolonged surgical time. There was no maternal or fetal mortality related to the procedure.
  
  
  CONCLUSIONS
  The results demonstrated that prophylactic balloon occlusion of internal iliac artery is a safe method and appears to reduce blood loss and transfusion requirements in patients diagnosed with placenta accreta who undergo cesarean hysterectomy. Antenatal imaging diagnosis of placenta accreta enables preoperative planning.
authors: Hospital das Clínicas, Interventional Radiology Unit, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP 05403-001, Brazil. fcarnevale@uol.com.br
authors: Francisco Cesar
authors: FC
authors: Carnevale
authors: Mario Macoto
authors: MM
authors: Kondo
authors: Wilson
authors: W
authors: de Oliveira Sousa
authors: Aline Barbosa
authors: AB
authors: Santos
authors: Joaquim Mauricio
authors: JM
authors: da Motta Leal Filho
authors: Airton Mota
authors: AM
authors: Moreira
authors: Ronaldo Hueb
authors: RH
authors: Baroni
authors: Rossana Pulcinelli Vieira
authors: RP
authors: Francisco
authors: Marcelo
authors: M
authors: Zugaib