Prophylactic Arterial Balloon Placement in Moms with Placenta Accreta

Prophylactic placement of arterial balloons prior to performing a Caesarean section in patients with placenta accreta preserves the uterus, according to new study presented this week at the annual meeting of the Radiological Society of North America (RSNA).

Researchers from Ireland performed a retrospective chart review in order to assess maternal and fetal outcomes from the placement of a prophylactic internal iliac balloon under fluoroscopic guidance among patients with placenta accreta, immediately prior to undergoing elective Caesarean sections.

"Massive obstetric hemorrhage is the number one cause of maternal mortality worldwide and abnormal placental implantation is a major risk factor for this," Patrick Nicholson, MB, BCh, interventional radiologist trainee, Cork University Hospital, said in a release.

A total of 21 patients with placenta accreta or a variant thereof underwent balloon placement at the researchers’ facility over a 44-month period, starting in 2009. Patient mean age was 35, average gestational age was 37 weeks, mean gravidity was 2.8, and mean number of Caesarian sections was 2.4. Mean intraoperative blood loss was 1.4 liters, and the mean number of blood units transfused was two.

Of the 21 deliveries, arterial balloons were inflated in 13, and were deflated and removed when no longer necessary.

Results showed that 23 live infants were delivered with mean Apgar scores of 8.9 at one minute and 9.6 at 10 minutes. No maternal or fetal complications due to the procedure were noted, although two patients did require a hysterectomy.

"Without the balloons, many more of the patients would likely have required a hysterectomy," Nicholson said in the release.

The researchers concluded that prophylactic placement of an internal iliac balloon is a potentially life-saving, fertility preserving procedure that is safe for both mother and infant.