Outcome of Transient Hypogastric Artery Balloon Occlusion with Cesarean Hysterectomy in Abnormal Adherent Placenta: Case Series

Abstract

Objective: To evaluate the outcome of pregnant women with abnormal placentation who underwent transient hypogastric artery balloon occlusion with cesarean hysterectomy. Material and Methods: Descriptive retrospective study of patients with abnormal adherent placenta who underwent transient hypogastric artery balloon occlusion with cesarean hysterectomy between January 2014 and December 2016. Data were recorded and analyzed. Results: Fourteen pregnant women with abnormal placentation were included in our series. Most patients underwent cesarean hysterectomy at less than 37 weeks of gestational age. The sonograms of 7 cases overestimated the severity of placenta adherence compared with the pathological diagnosis. The median estimated blood loss was 4,350 milliliters (mL). The median estimated blood loss in placenta accrete, increta and percreta were 3,000 mL, 5,337 mL and 5,150 mL, respectively. One case had a procedure-related complication: perforation of the small branch of the anterior division of the right hypogastric artery from the guidewire. Conclusion: Intraoperative transient balloon occlusion of the hypogastric arteries was an effective method and safe treatment for controlling the massive intraoperative bleeding of cesarean hysterectomy. This technique can be an alternative option in combination with surgery in cases of abnormal placental adherence.

Keywords

• adherent placenta
• cesarean hysterectomy
• hypogastric artery
• transient balloon occlusion