#Grand Rounds

Does Intra-Aortic Balloon Improve Outcomes during Surgery for Adherent Placenta

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

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

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

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)

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