title: Conservative Management of Invasive Placenta Using Combined Prophylactic Internal Iliac Artery Balloon Occlusion and Immediate Postoperative Uterine Artery Embolization.
abstract: OBJECTIVE
  The objective of the study was to evaluate the efficacy and safety of combined prophylactic intraoperative internal iliac artery balloon occlusion and postoperative uterine artery embolization in the conservative management (uterine preservation) of women with invasive placenta undergoing scheduled caesarean delivery.
  
  
  METHODS
  Ten women (mean age 35 years) with invasive placenta choosing caesarean delivery without hysterectomy had preoperative insertion of internal iliac artery occlusion balloons, intraoperative inflation of the balloons, and immediate postoperative uterine artery embolization with absorbable gelatin sponge. A retrospective review was performed with institutional review board approval. Outcome measures were intraoperative blood loss, transfusion requirement, hysterectomy rate, endovascular complications, surgical complications, and postoperative morbidity.
  
  
  RESULTS
  All women had placenta increta or percreta, and concomitant complete placenta previa. Mean gestational age at delivery was 36 weeks. In 6 women the placenta was left undisturbed in the uterus, 2 had partial removal of the placenta, and 2 had piecemeal removal of the whole placenta. Mean estimated blood loss during caesarean delivery was 1.2 L. Only 2 patients (20%) required blood transfusion. There were no intraoperative surgical complications, endovascular complications, maternal deaths, or perinatal deaths. Three women developed postpartum complications necessitating postpartum hysterectomy; the hysterectomy rate was therefore 30% and uterine preservation was successful in 70%.
  
  
  CONCLUSIONS
  Combined bilateral internal iliac artery balloon occlusion and uterine artery embolization may be an effective strategy to control intraoperative blood loss and preserve the uterus in patients with invasive placenta undergoing caesarean delivery.
authors: Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada; University of Minnesota, Minneapolis, Minnesota, USA.
authors: Donna L
authors: DL
authors: D'Souza
authors: Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: John C
authors: JC
authors: Kingdom
authors: Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Hagai
authors: H
authors: Amsalem
authors: Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: John R
authors: JR
authors: Beecroft
authors: Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Rory C
authors: RC
authors: Windrim
authors: Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada. Electronic address: john.kachura@uhn.ca.
authors: John R
authors: JR
authors: Kachura
mesh_terms: D000328:Adult; D021721:Balloon Occlusion; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001810:Blood Volume; D002585:Cesarean Section; D005260:Female; D059247:Fertility Preservation; D005471:Fluoroscopy; D006801:Humans; D007044:Hysterectomy; D007083:Iliac Artery; D007430:Intraoperative Care; D059351:Organ Sparing Treatments; D010921:Placenta Accreta / Q000628:therapy*; D010923:Placenta Previa / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D011300:Preoperative Care; D065286:Prophylactic Surgical Procedures; D015642:Radiology, Interventional; D012189:Retrospective Studies; D055357:Uterine Artery Embolization