title: Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa.
abstract: OBJECTIVE
  To evaluate the effectiveness of temporary balloon occlusion of the internal iliac artery before uterine incision to prevent massive obstetric hemorrhage during cesarean delivery among patients with anterior placenta previa.
  
  
  METHODS
  In a retrospective cohort study conducted at Amphia Hospital Breda (Breda, Netherlands), data were analyzed from women with anterior placenta previa who delivered by cesarean between January 1, 2001, and September 30, 2012. Cases with and without balloon occlusion of the internal iliac artery were included. The primary outcomes were the amount of blood loss during cesarean delivery, drop of hemoglobin level, and blood loss of more than 1000 mL.
  
  
  RESULTS
  Of 68 eligible women, 42 (62%) had temporary balloon occlusion and 26 (38%) had no balloon occlusion. Median blood loss was 800 mL (interquartile range [IQR] 488-1113) in the balloon group and 1000 mL (IQR 694-1307) in the no balloon group (P=0.06). Blood loss of 1000 mL or more was recorded in 16 (38%) women in the balloon group and 18 (69%) in the no balloon group (P=0.01).
  
  
  CONCLUSIONS
  Temporary balloon occlusion of the internal iliac artery before uterine incision during cesarean delivery could potentially reduce blood loss among patients with anterior placenta previa. Large, randomized controlled trials are needed to confirm the results.
authors.affiliation: Department of Obstetrics and Gynecology, Amphia Hospital Breda, Breda, Netherlands. Electronic address: evelienbroekman@gmail.com.
authors.forename: Evelien A
authors.initials: EA
authors.lastname: Broekman
authors.affiliation: Department of Medical and Clinical Psychology and Statistics, Tilburg University, Tilburg, Netherlands.
authors.forename: Henneke
authors.initials: H
authors.lastname: Versteeg
authors.affiliation: Department of Radiology, Amphia Hospital Breda, Breda, Netherlands.
authors.forename: Louwerens D
authors.initials: LD
authors.lastname: Vos
authors.affiliation: Department of Obstetrics and Gynecology, Amphia Hospital Breda, Breda, Netherlands.
authors.forename: Marja G
authors.initials: MG
authors.lastname: Dijksterhuis
authors.affiliation: Department of Obstetrics and Gynecology, Amphia Hospital Breda, Breda, Netherlands.
authors.forename: Dimitri N
authors.initials: DN
authors.lastname: Papatsonis
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002585:Cesarean Section / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007083:Iliac Artery; D010923:Placenta Previa / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000517:prevention & control*
keywords: Anterior placenta previa; Blood loss; Cesarean delivery; Hemorrhage; Temporary balloon occlusion