title: Does temproray bilateral balloon occlusion of the common iliac arteries reduce the need for intra-operative blood transfusion in cases of placenta accretism?
abstract: BACKGROUND
  Bilateral balloon occlusion has been employed as a prophylactic measure in cases of placenta accretism prior to caesarean section with the aim of reducing blood loss and its associated morbidity/mortality. There is however no clear consensus on its efficacy in the current literature. The objective of this study was to assess the efficacy of bilateral balloon occlusion of the common iliac arteries (CIA) in reducing intra-operative morbidity in cases of placenta accretism.
  
  
  METHODS
  The databases of the pathology department and radiology interventional suite were reviewed over a nine year period. Fifty-two cases of confirmed placental accretism who underwent caesarean section with or without hysterectomy were identified and divided into two groups. Twenty-five cases had temporary occlusion of the common iliac arteries (CIA) during delivery and these were considered the study group. The reminder 27 cases did not have temporary occlusion of the CIA and were considered the control group. The two groups were compared based on gravidity, age group, post-operative haemoglobin, drop in haemoglobin, estimated blood loss (EBL), transfusion requirement and the histopathological sub-types of placenta accretism.
  
  
  RESULTS
  There was no statistically difference between the study and the control groups regarding EBL, post-operative haemoglobin drop, transfusion requirement or in the placenta accretism histopathological subtype. Two cases in the study group had acute thromboembolic complications. Both groups had a single patient requiring a massive intra-operative transfusion.
  
  
  CONCLUSIONS
  Our study was not able to detect a significant difference in blood loss or blood product requirement between patients who underwent CIA balloon in the setting of caesarean section for placenta accreta. This remains a challenging scenario requiring a multidisciplinary approach.
authors.affiliation: Department of Diagnostic Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Sinan
authors.initials: S
authors.lastname: Al-Hadethi
authors.affiliation: Department of Diagnostic Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Shane
authors.initials: S
authors.lastname: Fernando
authors.affiliation: Department of Diagnostic Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Hughes
authors.affiliation: Department of Diagnostic Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Ajay
authors.initials: A
authors.lastname: Thakorlal
authors.affiliation: Department of Diagnostic Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Seruga
authors.affiliation: Pathology North, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Scurry
mesh_terms: D000328:Adult; D000792:Angiography; D021721:Balloon Occlusion / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007083:Iliac Artery; D009517:New South Wales; D010921:Placenta Accreta / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
keywords: angiography; obstetrics