Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: literature review and analysis.
OBJECTIVE
To review the literature on the use of prophylactic balloon occlusion alone and in conjunction with arterial embolization of the internal iliac arteries in women with placenta accreta.


METHODS
The PubMed, MEDLINE, CINAHL, EMBASE, and Cochrane Library databases were searched for keywords related to this technique and its use in the avoidance of caesarean hysterectomy. The relevant published articles were selected and then searched for further references.


RESULTS
The literature search found 15 case reports and five studies for a total of 20 articles. The use of balloon catheters to prevent post-partum haemorrhage in women with placenta accreta is controversial with some investigators reporting reduced blood loss and transfusion requirements while others reporting no benefit. This procedure does not appear to reduce operative time or hospital stay. Some groups have described catheter-related complications, such as maternal thromboembolic events and the need for stent placement and/or arterial bypass. Thus far, there is no reported maternal or foetal mortality related to this procedure.


CONCLUSIONS
Current evidence is based upon case reports and small retrospective studies. Larger studies or randomized controlled trials are essential in order to demonstrate the safety and efficacy of bilateral iliac balloon occlusion. The creation of a data registry would also facilitate the reporting of this technique.
McMaster University, Michael G. DeGroote School of Medicine, Canada.
M D
MD
Dilauro
S
S
Dason
S
S
Athreya
D000328:Adult; D021721:Balloon Occlusion / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D007083:Iliac Artery; D010921:Placenta Accreta / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D016896:Treatment Outcome