Long-term follow-up of abdominal aortic balloon occlusion for the treatment of pernicious placenta previa with placenta accreta

Yanli Wang; Tian Jiang; Guohao Huang; Xinwei Han; Zhimin Chen; Chuan Liu; Xinyan Wang; Xianlan Zhao

doi:10.1016/j.jimed.2020.01.004

Long-term follow-up of abdominal aortic balloon occlusion for the treatment of pernicious placenta previa with placenta accreta

J Interv Med. 2020 Jan 21;3(1):34-36. doi: 10.1016/j.jimed.2020.01.004. eCollection 2020 Feb.

Authors

Yanli Wang¹, Tian Jiang², Guohao Huang¹, Xinwei Han¹, Zhimin Chen³, Chuan Liu³, Xinyan Wang³, Xianlan Zhao³

Affiliations

¹ Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
² Department of Radiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, China.
³ Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.

Abstract

Objective: To evaluate the efficacy and safety of balloon occlusion of the abdominal aorta for the treatment of pernicious placenta previa with placenta accreta.

Methods: The clinical data of 623 patients with pernicious placenta previa combined with placenta accrete, who were admitted to our hospital from January 2013 to January 2019 were retrospectively analyzed. All patients underwent abdominal aortic balloon occlusion combined with cesarean section, and 78 patients underwent sequential bilateral uterine artery embolization. We analyzed the operation time, intraoperative blood loss, blood transfusion volume, intraoperative and postoperative complications, fetal radiation exposure time and dose, and the Apgar score of the newborns. We also performed other evaluations to ascertain the efficacy and safety of abdominal aortic balloon occlusion treatment for dangerous placenta previa with placenta accrete.

Results: Of the 623 patients, 545 underwent only abdominal aortic balloon occlusion, and 78 underwent uterine artery embolization due to intraoperative or postoperative bleeding. The uterus was successfully preserved in all patients. Except for five cases of right lower extremity arterial thrombosis, the remaining patients did not have postoperative lower extremity arteriovenous thrombosis, renal insufficiency, late postpartum hemorrhage, ectopic embolism, spinal cord or peripheral nerve damage, pelvic infection, or other serious complications. The mean operative time was 65.3 (±14.5) min. The mean intraoperative blood loss was620 (±570) ml. Ninety-six patients (15.4%, 96/623) were treated with blood transfusion, and the average amount of blood transfused was 750 (±400) ml. The average number of hospitalization days was 6.8 (±3.4) days, the average time of fetal ray exposure was 5.2 (±1.6) s, and the average radiation dose was 4.1 (±2.7) mGy. The neonatal Apgar score, was 8.4 (±0.6) points at 1 min, and 9.6 (±0.4) points at 5 min. In the follow-up to May 31, 2019, 29 patients were lost to follow-up, 96 were lactating, and 498 were menstruating. Except for the cases lost to follow-up, the remaining 596 surviving newborns (including 2 twins) showed no abnormalities at the 42-day postnatal outpatient follow-up examination.

Conclusion: Balloon occlusion of the abdominal aorta is a safe and effective method for the treatment of pernicious placenta previa with placenta accreta.

Keywords: Abdominal aortic balloon; Placenta accrete; Placenta previa; Safety.