Intraoperative aorta balloon occlusion: fertility preservation in patients with placenta previa accreta/increta.

Abstract

OBJECTIVE:

To evaluate whether aorta balloon occlusion decreases the rate of hysterectomies and maternal morbidity during extirpative surgery of placenta previa accreta or increta.

METHODS:

We prospectively assessed 33 consecutive patients with placenta praevia and MRI diagnosis of multifocal accreta or increta. Manual removal of the placenta was performed during a scheduled caesarean delivery. In 15 patients, surgery was preceded by balloon catheterization of the abdominal aorta (Intra Abdominal Balloon Occlusion: IABO); 18 patients refusing IABO were considered as controls. We used Fisher's exact test for categorical variables and Mann-Whitney test for continuous variables.

RESULTS:

In the IABO group we observed significant decreases in incidence of hysterectomy, estimated blood loss, number of transfused units of red blood cells, postoperative stay and admission to Intensive Care Unit. No IABO-related complications were reported.

CONCLUSIONS:

During scheduled caesarean section for placenta previa multifocally accreta or increta, IABO can prevent hysterectomy in many cases and improves perioperative outcome as it gives the operator time to achieve the haemostasis via curettage and oversewing of the implantation site with acceptable blood loss.

• Authors: Pierluigi Benedetti Panici, Maurizio Anceschi, Maria Luisa Borgia, Luciano Bresadola, Gabriele Masselli, Tiziana Parasassi, Giuseppina Perrone, Fetal Maternal Risk Group, Roberto Brunelli
• Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (J Matern Fetal Neonatal Med) Vol. 25 Issue 12 Pg. 2512-6 (Dec 2012) ISSN: 1476-4954 [Electronic] England
• PMID: 22992070 (Publication Type: Controlled Clinical Trial, Journal Article)

Topics

• Adult
• Aorta, Abdominal (surgery)
• Balloon Occlusion (methods)
• Blood Transfusion (statistics & numerical data)
• Cesarean Section (statistics & numerical data)
• Female
• Fertility Preservation (methods)
• Humans
• Hysterectomy (statistics & numerical data)
• Infant, Newborn
• Intraoperative Period
• Length of Stay (statistics & numerical data)
• Placenta Accreta (epidemiology, therapy)
• Placenta Previa (epidemiology, therapy)
• Pregnancy
• Young Adult