BACKGROUND AND PURPOSE:

• Placenta accreta, increta, and percreta are becoming more common and the usual treatment option is cesarean hysterectomy
• Blumenthal et al. (American Journal of Perinatology Reports, 2018) sought to determine whether using an intra-aortic balloon (IAB) during cesarean hysterectomy decreased adverse outcomes in the setting of severe, morbidly adherent placenta

METHODS:

• Retrospective cohort study
• Participants: Deliveries complicated by suspected abnormal placentation (placenta accreta, increta, or percreta)
• Patients received either
  • Cesarean hysterectomy without IAB (largely historical controls)
  • Cesarean hysterectomy with IAB (after 2013, prophylactic placement of IAB – cases collected prospectively)
• Primary outcome: Quantified blood loss (QBL)
• Secondary outcomes: Multiple maternal and neonatal outcomes

RESULTS:

• 35 cases were included in the study
  • 16 cases with IAB
  • 19 without IAB
• There was no observed difference when comparing IAB vs no IAB in the following outcomes
  • Median QBL between the two groups (1,351 vs 1,397 mL; p = 0.90)
  • Overall surgical complications (19% vs 21%; p = 0.86)
  • Bladder complications (12 vs. 21%; p = 0.66)
  • ICU admissions (12 vs. 26%; p = 0.41)
  • Surgical duration (2.9 vs. 2.8 hour; p = 0.83)
  • Blood transfusions (median 2 vs. 2; p = 0.27)
• There was one groin hematoma at the balloon site that was managed conservatively
• There were no complications involving thrombosis or limb ischemia in the IAB group

CONCLUSION:

• There were no differences QBL, surgical complications, or surgical duration when comparing IAB to non-IAB cases
• Pilot study and therefore small ‘n’
  • 3,000 patients would be required to determine whether the 5% difference in QBL between the 2 groups was significant
• Future studies are needed with greater number of subjects in order to warrant IAB a helpful method in the management of these cases as trends were seen, especially in the secondary outcomes (e.g. ICU admission)

Learn More – Primary Sources:

Pilot Study of Intra-Aortic Balloon Occlusion to Limit Morbidity in Patients with Adherent Placentation Undergoing Cesarean Hysterectomy

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Placenta Accreta Spectrum Disorder: Definitions and Management

Can Aspirin Decrease Risk of Placental Abruption and Antepartum Hemorrhage?

Does Elective Induction Lower Risk for Adverse Obstetrical Outcomes in the Setting of Obesity