Severe hemorrhage during cesarean hysterectomy associated with abnormal placentation is a major cause of maternal morbidity and mortality in the US. Intravascular occlusive balloon catheter placement has been hypothesized to lessen blood loss during planned cesarean hysterectomy. This study explored patterns associated with balloon placement during cesarean hysterectomyMETHODS:
We retrospectively studied women ≥18 years of age who underwent cesarean hysterectomy for abnormal placental implantation within our large, community-based hospital system during 2012-2016. Three patient groups were studied: (1) balloon not placed, (2) balloon placed but not deployed, and (3) balloon placed and deployed. Data were abstracted from the electronic medical record and compared among patient groups using basic descriptive and inferential statistics.RESULTS:
Of 17 total patients identified (mean age 37.1 years, body mass index 33.8 kg/m2, and gestational age 32.3 weeks), 11 (65%) had balloons placed and 3 (18%) had balloons deployed. Odds of balloon placement (regardless of subsequent deployment) were greater in women with placenta accreta (P=0.01), preoperative anemia (P<0.01), and larger, multidisciplinary teams of providers (P=0.02). Significant complications (thromboembolic events and/or stent placement) were experienced by 2 women who underwent balloon placement but no one in the balloon deployment group. No significant group differences were detected in provider characteristics or other outcomes (e.g., estimated blood loss, transfusion, surgery duration).CONCLUSION:
In this community-based study, use of occlusive balloon catheters did not improve outcomes but rather increased complications directly related to placement. Prospective multicenter studies are needed to evaluate the efficacy of balloon placement and deployment.