Abstract
Objective: This study aimed to evaluate the clinical efficacy of internal iliac artery(IIA) balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta. Background: Pernicious placenta previa is frequently reported to be complicated with placenta accreta, which contributes to serious consequences such as severe obstetric postpartum hemorrhage or even maternal mortality. Methods: Fifty-eight pernicious placenta previa patients complicated with placenta accreta were retrospectively reviewed. The ballon group consisted of 23 patients, who underwent a caesarean delivery with internal iliac artery occlusion. 35 patients were in the control group, who had a standard caesarean delivery. The primary outcomes were estimated blood loss (EBL), cesarean hysterectomy, and blood transferring volume. The secondary outcomes were operating time, intraoperative hemostatic approaches, surgical complications, balloon catheter–related complications, length of maternal stay, cost of hospitalization, and neonatal outcomes.Results: No difference was observed in estimated blood loss (EBL), blood transferring percentages and volume, additional measures to secure hemostasis , surgical complications, hospital stay postoperatively and newborn outcomes. More than 40% of the balloon group underwent hysterectomy because of uncontrollable postpartum bleeding (10[43.48%] vs. 11[31.43%],P=0.350).Complications related to occlusion of IIA did not occur.The duration of the surgery of the balloon group was significantly longer than that of the control group(123.52 min±74.76 versus 89.17±48.68,P=0.038), and the total hospitalization cost was also significantly higher than that of the control group(45116.67±9358.67 yuan versus 30615.41±11587.44yuan,P=0.000).Conclusion: IIA balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta did not reduce the hysterectomy rate during cesarean section, nor did it reduce blood loss and blood transfusion, but it prolonged the duration of the surgery and increased the total cost.
Is there a role of prophylactic bilateral internal iliac artery ligation on reducing the bleeding during cesarean hysterectomy in patients with placenta percreta? A retrospective cohort study
