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

Cher Heng Tan1, Kiang Hiong Tay1, Kenneth Sheah1, Kenneth Kwek2, Kenneth Wong3, Hak Koon Tan4 and Bien Soo Tan1

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.


Figure 1
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  		Fig. 1A —31-year-old woman with placenta percreta. Preoperative fluoroscopic image obtained after bilateral occlusion balloon catheter insertion shows balloon catheters in contralateral proximal internal iliac arteries. Test inflation of catheter balloons was performed preoperatively to determine volume of contrast material required for optimal balloon inflation. Right internal iliac artery balloon has been inflated. Note fetal head (arrow).

 

Figure 2
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  		Fig. 1B —31-year-old woman with placenta percreta. Fluoroscopic image after cesarean delivery shows bilateral inflated internal iliac artery balloons. Bilateral ureteric stents were placed during surgery. The patient's placenta was retained, and she underwent subsequent uterine artery embolization.

 

Figure 3
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  		Fig. 1C —31-year-old woman with placenta percreta. Fluoroscopic image before embolization shows marked placental hypervascularity.

 

Figure 4
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  		Fig. 1D —31-year-old woman with placenta percreta. Fluoroscopic image after embolization with absorbable gelatin sponge particles shows near-complete devascularization of placenta.

 

Figure 5
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  		Fig. 2A —29-year-old woman with one previous birth by cesarean section. All images are transabdominal sonograms obtained in longitudinal plane. Third trimester sonogram shows placenta previa major with invasion of hypoechoic myometrium (black arrow). Note fetal head (white arrow).

 

Figure 6
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  		Fig. 2B —29-year-old woman with one previous birth by cesarean section. All images are transabdominal sonograms obtained in longitudinal plane. Color Doppler sonogram of the placenta shows markedly increased retroplacental flow.

 

Figure 7
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  		Fig. 2C —29-year-old woman with one previous birth by cesarean section. All images are transabdominal sonograms obtained in longitudinal plane. Color and spectral Doppler images over same region as B reveal low resistance and high-velocity flow in keeping with placenta percreta. Patient subsequently underwent transfundal cesarean delivery. Diagnosis of placenta percreta was confirmed at surgery.

 

Figure 8
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  		Fig. 2D —29-year-old woman with one previous birth by cesarean section. All images are transabdominal sonograms obtained in longitudinal plane. Placenta was retained and sonogram shows complete involution by 4 months postpartum with only small amount of fluid present in endometrial cavity.

 

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