ORIGINAL ARTICLE| Volume 20, ISSUE 4, P282-287, October 2011

Download started.


Role of prophylactic uterine artery balloon catheters in the management of women with suspected placenta accreta

Published:August 19, 2011DOI:



      Placenta praevia and accreta are leading causes of major obstetric haemorrhage and peripartum hysterectomy. Detection is largely based on a high index of clinical suspicion, though the diagnostic accuracy of radiological imaging is improving. Interventional radiological techniques can reduce blood loss and the incidence of hysterectomy.


      We have reviewed our experience with bilateral prophylactic uterine artery balloon occlusion in the management of women with suspected placenta accreta. Thirteen women at high risk of major haemorrhage due to placenta praevia or suspected placenta accreta were retrospectively studied. Uterine artery balloons were placed prophylactically under neuraxial anaesthesia in the angiography suite followed by caesarean delivery in the obstetric operating theatre.


      Intraoperative blood loss and transfusion requirements were low in our case series. There were no hysterectomies or admissions to the intensive care unit. Fetal bradycardia necessitating immediate caesarean delivery occurred in two women (15.4%).


      In our case series in women with suspected placenta accreta, prophylactic use of uterine artery balloons was associated with a low requirement for blood transfusion but with possible increased risk of fetal compromise. Performing the interventional procedure at a different site from the operative room complicated management.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Knight M.
        Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage.
        BJOG. 2007; 114: 1380-1387
        • Wu S.
        • Kocherginsky M.
        • Hibbard J.U.
        Abnormal placentation: twenty-year analysis.
        Am J Obstet Gynecol. 2005; 192: 1458-1461
        • Pelage J.P.
        • Le Dref O.
        • Mateo J.
        • et al.
        Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization.
        Radiology. 1998; 208: 359-362
        • Salazar G.M.
        • Petrozza J.C.
        • Walker T.G.
        Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies.
        Tech Vasc Interv Radiol. 2009; 12: 139-147
        • Levine A.B.
        • Kuhlman K.
        • Bonn J.
        Placenta accreta: comparison of cases managed with and without pelvic artery balloon catheters.
        J Matern Fetal Med. 1999; 8: 173-176
        • Thon S.
        • McLintic A.
        • Wagner Y.
        Prophylactic endovascular placement of internal iliac occlusion balloon catheters in parturients with placenta accreta: a retrospective case series.
        Int J Obstet Anesth. 2011; 20: 64-70
        • Tan C.H.
        • Tay K.H.
        • Sheah K.
        • et al.
        Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta.
        AJR Am J Roentgenol. 2007; 189: 1158-1163
        • Belfort M.A.
        Placenta accreta.
        Am J Obstet Gynecol. 2010; 203: 430-439
        • Clark S.L.
        • Phelan J.P.
        • Yeh S.Y.
        • Bruce S.R.
        • Paul R.H.
        Hypogastric artery ligation for obstetric hemorrhage.
        Obstet Gynecol. 1985; 66: 353-356
        • Provansal M.
        • Courbiere B.
        • Agostini A.
        • D’Ercole C.
        • Boubli L.
        • Bretelle F.
        Fertility and obstetric outcome after conservative management of placenta accreta.
        Int J Gynaecol Obstet. 2010; 109: 147-150
        • Mok M.
        • Heidemann B.
        • Dundas K.
        • Gillespie I.
        • Clark V.
        Interventional radiology in women with suspected placenta accreta undergoing caesarean section.
        Int J Obstet Anesth. 2008; 17: 255-261
        • Sivan E.
        • Spira M.
        • Achiron R.
        • et al.
        Prophylactic pelvic artery catheterization and embolization in women with placenta accreta: can it prevent cesarean hysterectomy?.
        Am J Perinatol. 2010; 27: 455-461
        • Diop A.N.
        • Chabrot P.
        • Bertrand A.
        • et al.
        Placenta accreta: management with uterine artery embolization in 17 cases.
        J Vasc Interv Radiol. 2010; 21: 644-648
        • Ganguli S.
        • Stecker M.S.
        • Pyne D.
        • Baum R.A.
        • Fan C.M.
        Uterine artery embolization in the treatment of postpartum uterine hemorrhage.
        J Vasc Interv Radiol. 2011; 22: 169-176
        • Burchell R.C.
        Physiology of internal iliac artery ligation.
        J Obstet Gynaecol Br Commonw. 1968; 75: 642-651
        • Shahin A.Y.
        • Farghaly T.A.
        • Mohamed S.A.
        • Shokry M.
        • Abd-El-Aal D.E.
        • Youssef M.A.
        Bilateral uterine artery ligation plus B-Lynch procedure for atonic postpartum hemorrhage with placenta accreta.
        Int J Gynaecol Obstet. 2010; 108: 187-190
        • Hansch E.
        • Chitkara U.
        • McAlpine J.
        • El-Sayed Y.
        • Dake M.D.
        • Razavi M.K.
        Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience.
        Am J Obstet Gynecol. 1999; 180: 1454-1460
        • O’Rourke N.
        • McElrath T.
        • Baum R.
        • et al.
        Cesarean delivery in the interventional radiology suite: a novel approach to obstetric hemostasis.
        Anesth Analg. 2007; 104: 1193-1194
        • Sundaram R.
        • Brown A.G.
        • Koteeswaran S.K.
        • Urquhart G.
        Anaesthetic implications of uterine artery embolisation in management of massive obstetric haemorrhage.
        Anaesthesia. 2006; 61: 248-252
        • Shrivastava V.
        • Nageotte M.
        • Major C.
        • Haydon M.
        • Wing D.
        Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta.
        Am J Obstet Gynecol. 2007; 197: e401-e405
        • Horton A.W.
        • Patel U.
        • Belli A.M.
        An unusual arterial supply to the uterus. A case report and review of anatomy-implications for uterine artery embolization.
        Clin Radiol. 2010; 65: 1038-1042
        • Lau T.K.
        • Leung T.Y.
        Prenatal diagnosis of morbidly adherent placenta.
        Int J Obstet Anesth. 2011; 20: 107-109
        • Dwyer B.K.
        • Belogolovkin V.
        • Tran L.
        • et al.
        Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging?.
        J Ultrasound Med. 2008; 27: 1275-1281
        • Warshak C.R.
        • Eskander R.
        • Hull A.D.
        • et al.
        Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta.
        Obstet Gynecol. 2006; 108: 573-581
        • Saravanan S.
        • Kocarev M.
        • Wilson R.C.
        • Watkins E.
        • Columb M.O.
        • Lyons G.
        Equivalent dose of ephedrine and phenylephrine in the prevention of post-spinal hypotension in caesarean section.
        Br J Anaesth. 2006; 96: 95-99
        • Sadashivaiah J.
        • Wilson R.
        • McLure H.
        • Lyons G.
        Double-space combined spinal-epidural technique for elective caesarean section: a review of 10 years’ experience in a UK teaching maternity unit.
        Int J Obstet Anesth. 2010; 19: 183-187
        • Angstmann T.
        • Gard G.
        • Harrington T.
        • Ward E.
        • Thomson A.
        • Giles W.
        Surgical management of placenta accreta: a cohort series and suggested approach.
        Am J Obstet Gynecol. 2010; 202: e31-e39
        • Fuller A.J.
        • Carvalho B.
        • Brummel C.
        • Riley E.T.
        Epidural anesthesia for elective cesarean delivery with intraoperative arterial occlusion balloon catheter placement.
        Anesth Analg. 2006; 102: 585-587
        • Parekh N.
        • Husaini S.W.
        • Russell I.F.
        Caesarean section for placenta praevia: a retrospective study of anaesthetic management.
        Br J Anaesth. 2000; 84: 725-730
        • Kodali B.S.
        Bloodless trilogy? Anesthesia, obstetrics and interventional radiology for cesarean delivery.
        Int J Obstet Anesth. 2010; 19: 131-132