• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

Suspected Accreta: Does Internal Iliac Balloon Occlusion Reduce Blood Loss

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Evidence of benefit for the use of intraoperative internal iliac balloon occlusion in the setting of placenta previa with suspected accreta is generally derived from retrospective studies
  • Chen et al. (Obstetrics & Gynecology, 2020) prospectively assessed the effect of intraoperative internal iliac artery balloon occlusion in women with placenta previa and suspected placenta accreta

METHODS:

  • Single-center, randomized controlled trial (RCT)
  • Participants
    • Placenta previa and suspected placenta accreta
    • Diagnosis based on strict ultrasound criteria (all patients) and MRI at discretion of managing ObGyn
  • Interventions
    • Balloon occlusion group
      • Catheter placed preoperatively, followed by intraoperative occlusion of bilateral internal iliac arteries
    • Control group: No balloon occlusion
  • Statistical analysis
    • Perioperative management similar for both groups
    • 80% and two-sided α of 0.05: A sample size of 48 women per group was required to identify mean reduction of 2 units packed RBCs
  • Primary outcome
    • Number of packed red blood cell (RBC) units transfused
  • Secondary outcomes
    • Transfusion of other blood products | EBL | Cesarean hysterectomy | Other maternal and newborn outcomes and adverse events

RESULTS:

  • 100 women participated were randomized
    • Balloon group: 50 women
    • Control group: 50 women
    • Demographic, obstetric, and placental imaging characteristics were similar between groups
    • Confirmation of accreta diagnosis
      • Surgical: 98% had surgical diagnosis
      • 70% had a histologic confirmation of accreta or percreta
  • There was no significant difference in the number of packed RBC units transfused between the groups (p=0.54)
    • Balloon group: 5.3±5.3 units
    • Control group: 4.7±5.4 units
  • There were no differences in secondary outcomes including
    • Other transfusion outcomes | Intraoperative EBL | Cesarean hysterectomy | Surgical injuries | Maternal ICU admission | Neonatal outcomes
  • Post hoc analysis analyzing only women who underwent cesarean hysterectomy also demonstrated no difference in primary outcome or EBL
  • The balloon group experienced significantly higher
    • Hospitalization costs: $7456 vs $4803 (P<.01)
    • Incidence of postoperative fever: 18% vs 2%; relative risk (RR) 10.8 (95% CI, 1.3 to 88.5, P=.02)

CONCLUSION:

  • Authors recognize limitations
    • Single center
    • Study not blinded and could introduce bias as surgeons determine need for transfusion
  • For women with placenta previa and suspected placenta accreta, intraoperative balloon occlusion of the internal iliac arteries did not result in a decrease in the number of packed RBC units transfused and may be associated with increased incidence of post-op fever

Learn More – Primary Sources:

Internal Iliac Artery Balloon Occlusion for Placenta Previa and Suspected Placenta Accreta – A Randomized Controlled Trial

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Try it Free »

image_pdfFavoriteLoadingFavorite
< Previous
All #Grand Rounds Posts
Next >

Related ObG Topics:

Placenta Accreta Spectrum Disorder: Definitions and Management
Internal Iliac Artery Balloon Occlusion for Placenta Previa Management
Does Intra-Aortic Balloon Improve Outcomes during Surgery for Adherent Placenta

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site