Balloon occlusion of the internal iliac arteries in the multidisciplinary management of placenta percreta

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Abstract

Objective.

To evaluate our experience with prophylactic balloon occlusion of the internal iliac arteries as a part of a multidisciplinary algorithm for the management of placenta percreta. Design. Consecutive case series. Setting. Rigshospitalet, Copenhagen University Hospital, Denmark. Sample. Seventeen women with placenta percreta. Methods. Demographic characteristics, intraoperative data and outcomes are summarized and discussed. Main outcome measures. Feasibility of local resection, intraoperative blood loss and transfusion requirements. Results. The multidisciplinary management allowed for local resections in nine of the 11 women who requested preservation of fertility. The mean intraoperative blood loss was 4050 mL (range 450–16 000 mL, median 2500 mL). Adhesions to the bladder or the parietal peritoneum were associated with an intraoperative blood loss >6000 mL. Conclusions. Prophylactic balloon occlusion of the internal iliac arteries as part of a multidisciplinary algorithm allowed for a safe management of all cases in our consecutive series of 17 women with placenta percreta. However, intraoperative blood loss and transfusion requirements were significant. We have therefore decided to modify our multidisciplinary algorithm to include balloon occlusion of the common iliac arteries rather than the internal iliac arteries.

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