Abstract
Background
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.
Methods
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.
Results
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%).
Conclusion
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.
Keywords
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Article info
Publication history
Published online: August 19, 2011
Accepted:
June 18,
2011
Presented in part at the Obstetric Anaesthetists’ Association, Jersey 2009 and the Society for Obstetric Anesthesiology and Perinatology, Washington, DC, 2009.Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
