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Perioperative Endovascular Internal Iliac Artery Occlusion Balloon Placement in Management of Placenta Accreta

¹ Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608.
² Department of Maternal and Fetal Medicine, KK Women's and Children's Hospital, Singapore.
³ Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore.
⁴ Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.

OBJECTIVE. The purpose of our study was to evaluate the efficacy of the perioperative placement of occlusion balloons within the internal iliac arteries in reducing intraoperative blood loss and transfusion requirements during cesarean delivery for women with placenta accreta or its variants.

MATERIALS AND METHODS. Over a 30-month period, 11 patients with placenta accreta or its variants underwent cesarean delivery after bilateral internal iliac artery occlusion balloon placement (study group). The intraoperative blood loss and transfusion volumes, immediate postoperative change in hemoglobin levels, duration of surgery, and length of ICU stay and hospitalization of this study group were compared with 14 similar patients who underwent cesarean delivery without occlusion balloon placement over a 36-month period (control group).

RESULTS. The mean intraoperative blood loss in the study group (2,011 mL; range, 400–5,000 mL) was 39.4% less than in the control group (3,316 mL; range, 1,000–4,000 mL) (p = 0.042). The mean volume of blood transfused was 52.1% less in the study group (1,058 mL; range, 0–3,600 mL) than in the control group (2,211 mL; range, 1,190–3,980 mL) (p = 0.005). There was no significant difference in the immediate postoperative change in hemoglobin levels (p = 0.44), length of hospitalization (p = 0.203), or ICU admission (p = 0.614). The duration of the surgery was significantly less in the study group (p = 0.046).

CONCLUSION. Perioperative internal iliac artery occlusion balloon placement is a safe and minimally invasive technique that reduces intraoperative blood loss and transfusion requirements in patients with placenta accreta and its variants undergoing cesarean delivery.

Keywords: balloon occlusion • cesarean delivery • internal iliac artery • placenta accreta

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