title: Role of prophylactic uterine artery balloon catheters in the management of women with suspected placenta accreta.
abstract: BACKGROUND
  Placenta praevia and accreta are leading causes of major obstetric haemorrhage and peripartum hysterectomy. Detection is largely based on a high index of clinical suspicion, though the diagnostic accuracy of radiological imaging is improving. Interventional radiological techniques can reduce blood loss and the incidence of hysterectomy.
  
  
  METHODS
  We have reviewed our experience with bilateral prophylactic uterine artery balloon occlusion in the management of women with suspected placenta accreta. Thirteen women at high risk of major haemorrhage due to placenta praevia or suspected placenta accreta were retrospectively studied. Uterine artery balloons were placed prophylactically under neuraxial anaesthesia in the angiography suite followed by caesarean delivery in the obstetric operating theatre.
  
  
  RESULTS
  Intraoperative blood loss and transfusion requirements were low in our case series. There were no hysterectomies or admissions to the intensive care unit. Fetal bradycardia necessitating immediate caesarean delivery occurred in two women (15.4%).
  
  
  CONCLUSIONS
  In our case series in women with suspected placenta accreta, prophylactic use of uterine artery balloons was associated with a low requirement for blood transfusion but with possible increased risk of fetal compromise. Performing the interventional procedure at a different site from the operative room complicated management.
authors.affiliation: Department of Obstetric Anaesthesia, St. James' University Hospital, Leeds, UK. drjagga@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Sadashivaiah
authors.forename: R
authors.initials: R
authors.lastname: Wilson
authors.forename: A
authors.initials: A
authors.lastname: Thein
authors.forename: H
authors.initials: H
authors.lastname: McLure
authors.forename: C J
authors.initials: CJ
authors.lastname: Hammond
authors.forename: G
authors.initials: G
authors.lastname: Lyons
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000379:methods*; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010921:Placenta Accreta / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D055988:Uterine Artery