Vol 92, No 3 (2021)
Research paper
Published online: 2021-01-13

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The clinical evaluation of internal iliac arteries balloon occlusion for placenta accreta spectrum

Anna Rosner-Tenerowicz1, Tomasz Fuchs1, Michal Pomorski1, Jakub Sliwa1, Aleksandra Zimmer-Stelmach1, Mariusz Zimmer
Pubmed: 33448010
Ginekol Pol 2021;92(3):210-215.


Objectives: To evaluate the balloon occlusion of the internal iliac arteries during a caesarean section in the group of
patients with placenta accreta spectrum.
Material and methods: We analysed 29 pregnant women with placenta accreta spectrum. The study group consisted of
15 patients, who underwent a caesarean delivery with temporary bilateral internal iliac artery occlusion. In the control group,
we examined 14 women who had a standard caesarean delivery without any radiologic procedure. We compared pre- and
post-operative haemoglobin level, necessity of blood transfusion, intraoperative blood loss, intensive care requirement,
complications, duration of surgery, anaesthesia and hospital stay.
Results: The history and obstetric outcomes were similar in both groups. The study group required fewer blood transfusions
than the control group (p = 0.0176). We administered less packed red blood cells and fresh frozen plasma. Complications
were more frequent in the control group (p = 0.0014). Complications related to occlusion of the internal iliac arteries did
not occur. The intensive care unit transfer was more frequent in the control group (p = 0.0329). The duration of surgery
and hospital stay did not differ between groups. The anaesthesia time was longer in a study group, which related to the
radiologic procedure.
Conclusions: Caesarean delivery for placenta accreta spectrum with bilateral balloon occlusion of the internal iliac arteries
requires fewer transfusions. It contributes to a decrease in the complication rate and maternal morbidity.

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  1. Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am. 2015; 42(2): 381–402.
  2. Committee on Obstetric Practice. Committee opinion no. 529: placenta accreta. Obstet Gynecol. 2012; 120(1): 207–211.
  3. Silver RM, Landon MB, Rouse DJ, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006; 107(6): 1226–1232.
  4. Cho JY, Lee YH, Moon MH, et al. Difference in migration of placenta according to the location and type of placenta previa. J Clin Ultrasound. 2008; 36(2): 79–84.
  5. Rahimi-Sharbaf F, Jamal A, Mesdaghinia E, et al. Ultrasound detection of placenta accreta in the first trimester of pregnancy. Iran J Reprod Med. 2014; 12(6): 421–426.
  6. Ballas J, Pretorius D, Hull AD, et al. Identifying sonographic markers for placenta accreta in the first trimester. J Ultrasound Med. 2012; 31(11): 1835–1841.
  7. Warshak CR, Eskander R, Hull AD, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol. 2006; 108(3 Pt 1): 573–581.
  8. Shih JC, Palacios Jaraquemada JM, Su YN, et al. Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray-scale and color Doppler techniques. Ultrasound Obstet Gynecol. 2009; 33(2): 193–203.
  9. Esakoff TF, Sparks TN, Kaimal AJ, et al. Diagnosis and morbidity of placenta accreta. Ultrasound Obstet Gynecol. 2011; 37(3): 324–327.
  10. Jauniaux E, Collins SL, Jurkovic D, et al. Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness. Am J Obstet Gynecol. 2016; 215(6): 712–721.
  11. Windrim R, Kingdom J, Jang HJ, et al. Contrast enhanced ultrasound (CEUS) in the prenatal evaluation of suspected invasive placenta percreta. J Obstet Gynaecol Can. 2016; 38(10): 975–978.
  12. Budorick NE, Figueroa R, Vizcarra M, et al. Another look at ultrasound and magnetic resonance imaging for diagnosis of placenta accreta. J Matern Fetal Neonatal Med. 2017; 30(20): 2422–2427.
  13. D'Antonio F, Iacovella C, Palacios-Jaraquemada J, et al. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2014; 44(1): 8–16.
  14. Hudon L, Belfort MA, Broome DR. Diagnosis and management of placenta percreta: a review. Obstet Gynecol Surv. 1998; 53(8): 509–517.
  15. Shellhaas CS, Gilbert S, Landon MB, et al. Eunice Kennedy Shriver National Institutes of Health and Human Development Maternal-Fetal Medicine Units Network. The frequency and complication rates of hysterectomy accompanying cesarean delivery. Obstet Gynecol. 2009; 114(2 Pt 1): 224–229.
  16. Cheng HC, Pelecanos A, Sekar R. Review of peripartum hysterectomy rates at a tertiary Australian hospital. Aust N Z J Obstet Gynaecol. 2016; 56(6): 614–618.
  17. Dilauro MD, Dason S, Athreya S. Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: literature review and analysis. Clin Radiol. 2012; 67(6): 515–520.
  18. Tan YL, Suharjono H, Lau NLJ, et al. Prophylactic bilateral internal iliac artery balloon occlusion in the management of placenta accreta: A 36-month review. Med J Malaysia. 2016; 71(3): 111–116.
  19. Tan CH, Tay KH, Sheah K, et al. Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta. AJR Am J Roentgenol. 2007; 189(5): 1158–1163.
  20. Heinze S, Filsinger B, Kastenholz G, et al. Intraoperative Intermittent Blocking of the Common Iliac Arteries in Cases of Placenta Percreta without the Use of Fluoroscopy. Rofo. 2016; 188(12): 1151–1155.
  21. Al-Hadethi S, Fernando S, Hughes S, et al. Does temproray bilateral balloon occlusion of the common iliac arteries reduce the need for intra-operative blood transfusion in cases of placenta accretism? J Med Imaging Radiat Oncol. 2017; 61(3): 311–316.
  22. Wang YL, Duan XH, Han XW, et al. Comparison of temporary abdominal aortic occlusion with internal iliac artery occlusion for patients with placenta accreta - a non-randomised prospective study. Vasa. 2017; 46(1): 53–57.
  23. Cui SH, Zhi YX, Zhang K, et al. [Application of temporary balloon occlusion of the abdominal aorta in the treatment of complete placenta previa complicated with placenta accreta]. Zhonghua Fu Chan Ke Za Zhi. 2016; 51(9): 672–677.
  24. Wu Q, Liu Z, Zhao X, et al. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta. Cardiovasc Intervent Radiol. 2016; 39(11): 1573–1579.
  25. Papillon-Smith J, Singh SS, Ziegler C. Internal Iliac Artery Rupture Caused by Endovascular Balloons in a Woman with Placenta Percreta. J Obstet Gynaecol Can. 2016; 38(11): 1024–1027.
  26. Salim R, Chulski A, Romano S, et al. Precesarean Prophylactic Balloon Catheters for Suspected Placenta Accreta: A Randomized Controlled Trial. Obstet Gynecol. 2015; 126(5): 1022–1028.
  27. Bishop S, Butler K, Monaghan S, et al. Multiple complications following the use of prophylactic internal iliac artery balloon catheterisation in a patient with placenta percreta. Int J Obstet Anesth. 2011; 20(1): 70–73.
  28. Pomorski M, Fuchs T, Rosner-Tenerowicz A, et al. Standardized ultrasonographic approach for the assessment of risk factors of incomplete healing of the cesarean section scar in the uterus. Eur J Obstet Gynecol Reprod Biol. 2016; 205: 141–145.