We aim to describe our multidisciplinary approach to the management of patients with placenta percreta with intra-aortic balloon occlusion and regional anesthesia in improving surgical outcomes and patient experience.METHODS:
We performed and report on an IRB approved retrospective review of a tertiary care center's experience with a multidisciplinary approach to the use of intra-aortic balloon placement for the management of placenta percreta. Our approach involves the following departments: Interventional Radiology, Obstetrics, Anesthesia, and Neonatology, and is unique in that all our cases involve placement of an intra-aortic balloon to minimize bleeding. In addition, we report experience that has resulted in decreased blood loss, advances made with ultrasound use for guidance rather than fluoroscopy, and successful use of regional anesthesia.RESULTS:
9 patients with suspected placenta percreta were identified. EBL ranged from 1,500 to 3,000 mL and 5 out of 8 cases required transfusion (1–4 units pRBCs). 4 out of 9 cases involved exclusive use of regional anesthesia. Fluoroscopy time needed for aortic balloon placement ranged between 0–2.2 minutes. 2 of our cases had balloons placed with ultrasound guidance instead of fluoroscopy. Time of balloon occlusion ranged from 3–156 min. No complications from inflation were noted.CONCLUSION:
Our approach is unique in that we demonstrate use of a protocol that employs a novel technique that may limit surgical bleeding, utilizes regional anesthesia, and allows for advanced interventional techniques in one OR suite. We believe our protocol will lead to decreased maternal morbidity and provide the mother with an improved birth experience.