title: The efficacy of pre-delivery prophylactic trans-catheter arterial balloon occlusion of bilateral internal iliac artery in patients with suspected placental adhesion.
abstract: OBJECTIVE
  Prophylactic trans-catheter arterial balloon occlusion (PTABO) before cesarean section of placenta previa totalis has been introduced to prevent massive hemorrhage. The purpose of this study is to evaluate the clinical usefulness of PTABO in cases of suspected placental adhesion and to examine antepartal risk factors and perinatal outcomes in women with placental adhesion.
  
  
  METHODS
  Between January 2012 and December 2015, 77 patients who had undergone ultrasonography for evaluation of placenta previa were enrolled in this study. Seventeen of these patients with suspected placental adhesion by ultrasonography and Pelvic MRI underwent PTABO before cesarean section and another 59 patients underwent cesarean section without PTABO. Antepartal risk factors and peripartum maternal and neonatal outcomes were compared between patients with PTABO and those without PTABO.
  
  
  RESULTS
  More advanced maternal age, longer in gestational weeks at delivery, and more common previous cesarean section history were observed in the PTABO group. Placenta adhesion, abnormal Doppler findings, and frequency of transfusion were more common in the PTABO group. However there was no significant difference in estimated blood loss, hospital days, and neonatal outcome. It had occurred 3 cases of hysterectomy and 1 case of uterine artery embolization after cesarean section in the PTABO group.
  
  
  CONCLUSIONS
  Close surveillance of antepartum risk factors for placental adhesion using ultrasonography and pelvic magnetic resonance imaging is important to prevention of massive hemorrhage during cesarean section. PTABO before cesarean section might result in reduced blood loss and requirement for transfusion during the operation.
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Yoon Jin
authors.initials: YJ
authors.lastname: Cho
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Yong Taek
authors.initials: YT
authors.lastname: Oh
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Suk Young
authors.identifier: 0000-0003-3600-9691
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Ju Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Jung
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Seung Joo
authors.initials: SJ
authors.lastname: Chon
authors.affiliation: Department of Interventional Radiology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Jeong Ho
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Interventional Radiology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Sung Su
authors.initials: SS
authors.lastname: Byun
keywords: Placenta adhesion; Placenta previa; Postpartum hemorrhage; Trans-catheter arterial balloon occlusion; Uterine artery embolization