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CC-BY-NC-ND 4.0 · AJP Rep 2018; 08(02): e57-e63
DOI: 10.1055/s-0038-1641736
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pilot Study of Intra-Aortic Balloon Occlusion to Limit Morbidity in Patients with Adherent Placentation Undergoing Cesarean Hysterectomy

Elizabeth Blumenthal
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, Orange County
,
Rashmi Rao
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Aisling Murphy
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Jeffrey Gornbein
3   Department of Biomathematics, University of California, Los Angeles, California
,
Richard Hong
4   Department of Anesthesia, University of California, Los Angeles, California
,
John M. Moriarty
5   Department of Interventional Radiology; University of California, Los Angeles, California
,
Daniel A. Kahn
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Carla Janzen
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
› Author Affiliations
Further Information

Publication History

29 March 2017

23 February 2018

Publication Date:
11 April 2018 (online)

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Abstract

Objective We study whether using an intra-aortic balloon (IAB) during cesarean hysterectomy decreases delivery morbidity in patients with suspected morbidly adherent placentation.

Study Design This is a retrospective cohort study of deliveries complicated by suspected abnormal placentation between 2009 and 2016 comparing maternal and neonatal outcomes with an IAB placed prior to cesarean hysterectomy versus no IAB. The primary outcome included quantified blood loss (QBL).

Results Thirty-five cases were reviewed, 16 with IAB and 19 without IAB. No difference was seen in median QBL between the two groups (1,351 vs. 1,397 mL; p = 0.90). There were no significant differences in overall surgical complications (19% IAB, 21% no IAB; p = 0.86), bladder complications (12 vs. 21%; p = 0.66), intensive care unit admissions (12 vs. 26%; p = 0.41), surgical duration (2.9 vs. 2.8 hour; p = 0.83), or blood transfusions (median 2 vs. 2; p = 0.27) between the two groups. There was one groin hematoma at the balloon site that was managed conservatively. There were no complications involving thrombosis or limb ischemia in the IAB group.

Conclusion While we did not detect statistically significant differences, larger studies may be warranted given the potential for extreme morbidity in these cases. This study highlights the potential use of an IAB in the management of these cases.

Keywords

placenta accreta - intra-aortic balloon - abnormal placentation - placenta percreta - cesarean hysterectomy