title: The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta.
abstract: OBJECTIVE
  To report experience of prophylactic occlusion balloon catheters (POBCs) in both internal iliac arteries before caesarean section, with or without embolization, to preserve the uterus and reduce haemorrhage.
  
  
  METHODS
  Twenty-seven women diagnosed with morbidly adherent placenta (MAP) and with suspected placenta percreta underwent POBC placement before caesarean section. The balloons were inflated immediately after delivery of the baby. The patients' case notes were reviewed retrospectively for histological grading of MAP, blood loss, transfusion, requirement of uterine artery embolization (UAE), or hysterectomy, radiation dose, and infant or maternal morbidity and mortality.
  
  
  RESULTS
  MAP was confirmed histologically as percreta in 17, accreta in eight, and increta in two women. Mean blood loss was 1.92 l (range 0.5-12 l). Postpartum haemorrhage (PPH) occurred in nine patients. Eight were referred for UAE, which was successful in six. Immediate peri-partum hysterectomy was performed in one patient. Three women in total required hysterectomy, two after recurrent haemorrhage after UAE. No foetal morbidity or mortality occurred. No maternal mortality occurred. There was one case of iliac artery thrombosis, which resolved with conservative therapy.
  
  
  CONCLUSIONS
  POBC, with or without UAE, contributes to reduction of blood loss and preservation of the uterus in women with MAP.
authors.affiliation: Radiology Department, St. George's Hospital, London SW17 0QT, UK. Electronic address: mireiateixidor@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Teixidor Viñas
authors.affiliation: Obstetrics and Gynecology Department, St George's Hospital, London SW17 0QT, UK.
authors.forename: E
authors.initials: E
authors.lastname: Chandraharan
authors.affiliation: Statistic Department, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain.
authors.forename: M V
authors.initials: MV
authors.lastname: Moneta
authors.affiliation: Radiology Department, St. George's Hospital, London SW17 0QT, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Belli
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000379:methods*; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D010921:Placenta Accreta / Q000628:therapy; D010922:Placenta Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D011247:Pregnancy; D011856:Radiographic Image Enhancement / Q000379:methods; D015642:Radiology, Interventional / Q000379:methods*
chemical_list: D003287:Contrast Media