title: Effect of prophylactic placement of internal iliac artery balloon catheters on outcomes of women with placenta accreta: an impact study.
abstract: We performed an impact study on the introduction of routine placement of internal iliac artery balloon catheters for the management of haemorrhage during caesarean section in women with placenta accreta. We identified 11 women, with prenatally diagnosed placenta accreta/increta/percreta before this change in practice, who acted as controls, and 30 women who had iliac artery balloons placed. The balloons were inflated in 27 cases. The median (IQR [range]) intra-operative blood loss was 1100 (800-2600 [500-6000]) ml in controls, compared with 1000 (600-2513 [400-15000]) ml in women with iliac artery balloons (p = 0.64). Six (54%) controls received intra-operative blood transfusion compared with 14 (47%) women with iliac artery balloons (p = 0.66). Caesarean hysterectomy was performed in 3 (27.3%) controls and 13 (43.3%) women with iliac artery balloons (p = 0.48). Balloon catheter insertion was associated with a shortened postoperative hospital stay, 6 (5-7 [4-12] days in controls vs. 5 (4-6 [3-10]) in the iliac artery balloon group (p = 0.033). General anaesthesia was used in six (54%) controls, but all women with iliac artery balloons. This study demonstrates that prophylactic balloon occlusion of the internal iliac arteries did not reduce intra-operative haemorrhage or caesarean hysterectomy in women with placenta accreta undergoing caesarean section. In addition, it has a significant impact on the choice of anaesthetic technique.
authors.affiliation: Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
authors.forename: S
authors.initials: S
authors.lastname: Feng
authors.affiliation: Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Liao
authors.affiliation: Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.|Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: H
authors.initials: H
authors.lastname: Huang
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007083:Iliac Artery; D007902:Length of Stay; D010921:Placenta Accreta / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy
keywords: anaesthesia; arterial balloon occlusion; caesarean section; haemorrhage; internal iliac arteries; placenta accreta; placenta previa; postpartum haemorrhage