BALLOON OCCLUSION OF THE INTERNAL ILIAC ARTERIES IN THE MULTIDISCIPLINARY MANAGEMENT OF PLACENTA ACCRETA AT ZAGAZIG UNIVERSITY HOSPITALS

Objective: The aim of this work to evaluate the efficacy of temporary balloon occlusion of the internal iliac arteries in reducing intraoperative blood loss and blood transfusion requirements in caesarean hysterectomy in pregnant women with prenatal diagnosis of placenta accreta. Methods: Thirty patients who were admitted in high risk pregnancy unit, obstetric department, Zagazig university hospitals with prenatal diagnosis of placenta accreta had been included in this one step random assignment control trial over the period from June 2015 to June 2017.All cases were diagnosed by ultrasonography, color Doppler imaging and supplemented with MRI where necessary. The patients included in the study were divided randomly into two groups; Group A (case): In this group prophylactic temporary balloon occlusion of internal iliac arteries was done followed by CS hysterectomy. Group B (control): In this group CS hysterectomy was done and internal iliac artery ligation was done in selected cases. Intraoperative blood loss, Volume of blood transfused (ml), perioperative hemoglobin change (g/dl), Duration of surgery (min), Length of hospitalization (d), Duration of ICU admission (d) were recorded and compared in both groups ; Fluoroscopy, balloon occlusion time, any complication arisen during the procedure of balloon occlusion also were recorded. Results: The mean intraoperative blood loss in the balloon group (A) (1315 mL; range, 800–2500 mL) was significantly less than in the control group (B) (1766.7 mL; range, 850–3500 mL) (p = 0.04). The mean volume of blood transfused was significantly less in the balloon group than in the control group (p = 0.03). There was also significant difference in the perioperative change in hemoglobin levels (p = 0.04).There were no significant differences regarding operation time (p=0.83), length of hospitalization (p = 0.27), or ICU admission (p = 0.64). Mean fluoroscopy time was 9.20 min; balloon occlusion time was 116.30 min with no reported maternal or fetal complications related to balloon procedure. Conclusions: The results demonstrated that prophylactic balloon occlusion of internal iliac artery is a safe method and appears to reduce blood loss and transfusion requirements in patients diagnosed with placenta accreta who undergo cesarean hysterectomy. Antenatal imaging diagnosis of placenta accreta enables preoperative planning.