title: Intraoperative aorta balloon occlusion: fertility preservation in patients with placenta previa accreta/increta.
abstract: OBJECTIVE
  To evaluate whether aorta balloon occlusion decreases the rate of hysterectomies and maternal morbidity during extirpative surgery of placenta previa accreta or increta.
  
  
  METHODS
  We prospectively assessed 33 consecutive patients with placenta praevia and MRI diagnosis of multifocal accreta or increta. Manual removal of the placenta was performed during a scheduled caesarean delivery. In 15 patients, surgery was preceded by balloon catheterization of the abdominal aorta (Intra Abdominal Balloon Occlusion: IABO); 18 patients refusing IABO were considered as controls. We used Fisher's exact test for categorical variables and Mann-Whitney test for continuous variables.
  
  
  RESULTS
  In the IABO group we observed significant decreases in incidence of hysterectomy, estimated blood loss, number of transfused units of red blood cells, postoperative stay and admission to Intensive Care Unit. No IABO-related complications were reported.
  
  
  CONCLUSIONS
  During scheduled caesarean section for placenta previa multifocally accreta or increta, IABO can prevent hysterectomy in many cases and improves perioperative outcome as it gives the operator time to achieve the haemostasis via curettage and oversewing of the implantation site with acceptable blood loss.
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Universita Sapienza, Roma, Italy.
authors.forename: Pierluigi Benedetti
authors.initials: PB
authors.lastname: Panici
authors.forename: Maurizio
authors.initials: M
authors.lastname: Anceschi
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Borgia
authors.forename: Luciano
authors.initials: L
authors.lastname: Bresadola
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masselli
authors.forename: Tiziana
authors.initials: T
authors.lastname: Parasassi
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Perrone
authors.forename: Roberto
authors.initials: R
authors.lastname: Brunelli
mesh_terms: D000328:Adult; D001012:Aorta, Abdominal / Q000601:surgery*; D021721:Balloon Occlusion / Q000379:methods*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007231:Infant, Newborn; D007432:Intraoperative Period; D007902:Length of Stay / Q000706:statistics & numerical data; D010921:Placenta Accreta / Q000453:epidemiology / Q000628:therapy*; D010923:Placenta Previa / Q000453:epidemiology / Q000628:therapy*; D011247:Pregnancy; D055815:Young Adult