Prophylactic Internal Iliac Artery Balloon Occlusion (IIABO) in Placental Implantation Abnormalities

Author(s): Ruben López Benítez, Tomás Reyes del Castillo, Philipe S Breiding, Markus Hodel, Thiago VM Lima, Levent Kara, Magdalena Schmidt, Justus E Roos

Purpose: We aimed to evaluate the safety and efficacy of prophylactic internal iliac artery balloon occlusion (IIABO) in patients with placental implantation abnormalities.

Methods: The study consisted in a retrospective comparative analysis of 18 patients with placental implantation abnormalities, including four patients with placenta previa, eleven cases with placenta percreta and 3 cases with placenta percreta. 14 cases that underwent IIABO were allocated in the IIABO group, and 4 cases without endovascular intervention were classified as control group. The assayed variables were: estimated blood loss, number of red blood cell transfusions and length of the hospital stay for mother and child, intervention time, balloon inflation time, surgical time and fetal absorbed dose.

Results: The median estimated blood loss was similar in both groups (650ml ± 581ml vs 700 ± 475ml), the median number of red blood cell transfusion was slightly higher or the control group (0U ± 0.7U vs 0U ± 2U), three patients from the IIABO group required uterine artery embolization. The uterus was preserved in nine patients (64%) of the experimental group while three patients (75%) from the control group received an emergency hysterectomy. Average intra-hospitalary stay was significantly longer in the control group, especially for the child (6days vs 26.5 days). The average fetal radiation dose was 6.87 mGy. No complications were attributed to IIABO placement.

Conclusion: The prophylactic use of IIABO in placental implantation abnormalities is an effective and safe method of controlling perioperative rate of bleeding during cesarean section and hysterectomy. Indications should be strictly controlled, and interdisciplinary planning and management are mandatory.