Role of prophylactic uterine artery balloon catheters in the management of women with suspected placenta accreta

• Published in: International journal of obstetric anesthesia Vol. 20; no. 4; pp. 282 - 287
• Main Authors: Sadashivaiah, J, Wilson, R, Thein, A, McLure, H, Hammond, C.J, Lyons, G
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.10.2011
• Subjects: Adult; Anesthesia & Perioperative Care; Balloon Occlusion - methods; Blood Transfusion; Female; Fetal bradycardia; Humans; Interventional radiology; Magnetic Resonance Imaging; Obstetric haemorrhage; Obstetrics and Gynecology; Placenta accreta; Placenta Accreta - therapy; Pregnancy; Retrospective Studies; Uterine Artery; Uterine artery balloon occlusion; Placenta accreta; Obstetric haemorrhage; Uterine artery balloon occlusion; Fetal bradycardia; Interventional radiology
• ISSN: 0959-289X; 1532-3374
• DOI: 10.1016/j.ijoa.2011.06.006

Abstract Background Placenta praevia and accreta are leading causes of major obstetric haemorrhage and peripartum hysterectomy. Detection is largely based on a high index of clinical suspicion, though the diagnostic accuracy of radiological imaging is improving. Interventional radiological techniques can reduce blood loss and the incidence of hysterectomy. Methods We have reviewed our experience with bilateral prophylactic uterine artery balloon occlusion in the management of women with suspected placenta accreta. Thirteen women at high risk of major haemorrhage due to placenta praevia or suspected placenta accreta were retrospectively studied. Uterine artery balloons were placed prophylactically under neuraxial anaesthesia in the angiography suite followed by caesarean delivery in the obstetric operating theatre. Results Intraoperative blood loss and transfusion requirements were low in our case series. There were no hysterectomies or admissions to the intensive care unit. Fetal bradycardia necessitating immediate caesarean delivery occurred in two women (15.4%). Conclusion In our case series in women with suspected placenta accreta, prophylactic use of uterine artery balloons was associated with a low requirement for blood transfusion but with possible increased risk of fetal compromise. Performing the interventional procedure at a different site from the operative room complicated management.