title: Prophylactic abdominal aorta balloon occlusion during caesarean section: a retrospective case series.
abstract: BACKGROUND
  The management of patients with morbidly adherent placenta has been described using vascular balloon catheters placed in the iliac arteries, but rarely in the aorta. This case series presents our experience with prophylactic lower abdominal aorta balloon occlusion in 45 women.
  
  
  METHODS
  The records of patients in our centre who underwent caesarean section between May 2013 and June 2014 were retrospectively analysed for the use of prophylactic lower abdominal aorta balloon occlusion.
  
  
  RESULTS
  Forty-five cases were identified. All patients had a morbidly adherent placenta, including placenta accreta (n=22), placenta increta (n=20) and placenta percreta (n=3). A subtotal hysterectomy was performed in four cases. Eleven of the 45 patients received red blood cell transfusion of a mean of 1.7 units. Mean preoperative and postoperative haemoglobin concentrations were 10.1g/dL and 9.4g/dL, respectively. Mean estimated blood loss was 835mL [range 200-6000mL]. The incidence of complications was 4.4% (2/45), including one case of lower extremity arterial thrombosis and one case of ischaemic injury to the femoral nerve. Follow up at one year was completed in 22 patients at which time all babies were well.
  
  
  CONCLUSIONS
  Prophylactic lower abdominal aorta balloon occlusion has the potential to reduce intraoperative blood loss, transfusion and hysterectomy rate in patients with morbidly adherent placenta undergoing caesarean section. Careful patient selection is critical as the technique may be associated with potentially serious complications.
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Wei
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Qinjun
authors.initials: Q
authors.lastname: Chu
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Yingying
authors.initials: Y
authors.lastname: Du
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Na
authors.initials: N
authors.lastname: Xing
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Xiaohan
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Yinhui
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. Electronic address: zhangw571012@126.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D001012:Aorta, Abdominal; D021721:Balloon Occlusion / Q000379:methods*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D010922:Placenta Diseases / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D012189:Retrospective Studies
keywords: Aorta; Balloon; Caesarean; Placenta abnormality