Patient with Placenta Accreta.
Researchers have reported on a procedure that can preserve fertility and potentially save the lives of women with a serious pregnancy complication called placenta accreta. Results of the new study presented at the annual meeting of the Radiological Society of North America (RSNA) showed that placement of balloons in the main artery of the mother’s pelvis prior to a Caesarean section protects against hemorrhage and is safe for both mother and baby.
Placenta accreta, a condition in which the placenta abnormally implants in the uterus, can lead to additional complications, including massive obstetric hemorrhage at delivery. Surgical removal of the uterus, called hysterectomy, is commonly required to control such bleeding.
“Massive obstetric hemorrhage is the number one cause of maternal mortality worldwide and abnormal placental implantation is a major risk factor for this,” said Patrick Nicholson, M.B., B.Ch., an interventional radiologist trainee at Cork University Hospital in Cork, Ireland.
At Dr. Nicholson’s hospital, patients with abnormal placental implantation are treated by a multidisciplinary team that plans both an elective Caesarean (C-)section and prophylactic internal iliac balloon placement under fluoroscopic guidance. Immediately prior to the patient’s C-section, an interventional radiologist uses specialized techniques to insert balloons into the two internal iliac arteries in the pelvis that supply the uterus with blood flow.
“Following the delivery of the baby, these balloons can be inflated to slow blood flow to the uterus, which allows the obstetrician time to gain control of the hemorrhage,” Dr. Nicholson said.
For his study, Dr. Nicholson retrospectively reviewed the charts of all patients with abnormal placental implantation who received prophylactic internal iliac balloon placement since 2009. Over a 44-month period, the hospital treated 21 patients (mean age 35) who underwent balloon placement immediately followed by C-section.
In 13 of the 21 deliveries, the arterial balloons were inflated and when no longer needed, deflated and removed from the patient. The interventional radiology procedure was a technical succ