Prophylactic Caesarean Iliac Artery Balloon Insertion in Patients with Abnormal Placental Implantation

Abstract

Introduction: We evaluated the safety and obstetric outcomes of patients with abnormal placental implantation who underwent prophylactic Caesarean iliac balloon insertion. Methods: Clinical and procedural records of patients with abnormal placental implantation (i.e., high-grade placenta praevia and/or placenta accreta) undergoing prophylactic Caesarean iliac artery balloon insertion in a tertiary referral hospital from September 2009 to April 2016 were reviewed. Patients’ demographics, procedural complications (e.g., dissection and thromboembolism) and outcomes (estimated blood loss, transfusion requirements, immediate/delayed hysterectomy rate, postoperative sepsis, and immediate maternal/fetal mortality) were analysed. Results: Twenty-three cases were included in the study. The median age of the patients was 36 years (range, 28-47 years). A total of 91.3% (21/23) were high-grade placenta praevia (34.8% grade III and 56.5% grade IV) with 69.6% (16/23) co-existing placenta accreta. All prophylactic iliac balloon insertion procedures were uneventful without major complications such as dissection or thromboembolic events. The median blood loss was 1700 mL (100-8000 mL). The mean units of packed cells, platelets, and fresh frozen plasma transfused were 2.5, 2.2, and 2.0, respectively. The immediate and delayed hysterectomy rates were 34.8% (8/23) and 13.0% (3/23), respectively. Postoperative sepsis incidence was 8.7% (2/23). No immediate maternal or fetal mortality was recorded. Overall, the obstetric outcomes were comparable to data published in the literature. Conclusion: Prophylactic Caesarean iliac artery balloon insertion for patients with abnormal placental implantation is feasible and safe. The obstetric outcomes were comparable to data published in the literature.