BACKGROUND AND PURPOSE:

• Yu et al. (AJOG, 2020) assessed whether internal iliac artery balloon occlusion during cesarean delivery for placenta previa reduces postpartum hemorrhage (PPH) and other complications

METHODS:

• Prospective randomized controlled trial (RCT)
• Participants
  • Confirmed placenta previa at 32 to 34 weeks following identification of low-lying placenta at 18 to 22 weeks ultrasound | Scheduled for cesarean delivery
  • Placenta previa definition:  Lower placenta edge within 2cm from the internal os
• Interventions
  • Internal iliac artery balloon occlusion (Occlusion)
    • Balloon catheter placed in internal iliac arteries and inflated following delivery  
  • Standard management (Control)
• Primary outcome
  • PPH Reduction
• Secondary outcomes
  • Hemoglobin drop after delivery | Amount of blood product transfusion
  • Incidence of hysterectomy
  • Maternal complications: Renal failure | DIC | ARDS
  • Length of stay | NICU admission
  • Maternal death
• Statistical analysis – Power calculation
  • Average blood loss in typical cesarean with previa: 800 to 1000 mL
  • 80% Power | Significance level of 5% | Ability to detect a 400 mL blood loss difference
  • 10 subjects needed in each arm (increased to allow for drop out)

RESULTS:

• 40 women were randomized | 20 to each group
  • Demographic and obstetric characteristics were similar between the two groups
• In the occlusion group, 4 women did not receive the scheduled procedure
  • Antepartum hemorrhage and emergency cesarean: 3 patients  
  • Resolution of placenta previa at 36 weeks (edge of placenta >2cm from internal os)
• An intention-to-treat analysis found no significant differences for the following
  • Median intra-operative blood loss (p=0.945)
  • Median length of surgery (p=0.204)
  • Need for blood transfusion during operation (p=0.621)
• None of the patients experienced
  • Rebleeding after operation
  • Complication related to baloon procedure
  • Any other maternal complications
• A re-analysis of the data using an on-treatment approach showed the same results

CONCLUSION:

• Internal iliac artery balloon occlusion did not demonstrate benefit for reduction of PPH or other perinatal complications for placenta previa

Learn More – Primary Sources:

Perioperative prophylactic internal iliac artery balloon occlusion in the prevention of postpartum hemorrhage in placenta previa: a randomized controlled trial.

Related ObG Topics:

Placenta Previa – Nomenclature, Diagnosis and Clinical Management

How Effective is Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage

Does Time of Day Impact Ordering and Completion of Breast and Colon Cancer Screening Tests?

Does Prophylactic TXA Reduce Postpartum Hemorrhage?