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:

• 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

Related ObG Topics:

Placenta Accreta: When is the Optimal Time to Deliver?

Can Aspirin Decrease Risk of Placental Abruption and Antepartum Hemorrhage?

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