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Poster session II Diabetes, labor, medical-surgical-disease, obstetric quality & safety, prematurity, ultrasound-imaging: Abstracts 237 – 386| Volume 206, ISSUE 1, SUPPLEMENT , S153, January 01, 2012

323: Preoperative intravascular balloon catheters and surgical outcomes in pregnancies complicated by placenta accreta–a management paradox

      Objective

      To examine the impact of preoperatively placed intravascular balloon catheters in pregnancies complicated by placenta accreta.

      Study Design

      Retrospective study of pregnancies with pathology proven placenta accreta from 1990-2011.

      Results

      A total of 117 cases with pathology-proven placenta accreta were reviewed. Fifty-nine subjects (50.4%) diagnosed prenatally with accreta had preoperative balloon catheters placed. Estimated blood loss was significantly lower in the group with preoperative balloon placement compared to those without balloons (2.2 L vs 2.8 L respectively, p<0.02). Balloons were deployed intraoperatively in thirty of the fifty-nine subjects (51%). The decision to deploy the balloons was left to the operating surgeon, and in 29/30 cases anticipated or ongoing severe hemorrhage was the indication for deployment. Balloon deployment was associated with significantly greater blood loss (2.7L vs. 1.7L, P=0.001) and greater transfusion volumes (5.7u vs. 3.4u PRBCs respectively, P=0.02). Two patients (3.3%) had balloon-related complications: one developed a femoral artery thrombus requiring thrombectomy and one developed a catheter site hematoma that was managed expectantly without further event.

      Conclusion

      Preoperative placement of balloon catheters was associated with overall reduced total blood loss. However, in cases where the balloons were deployed intraopertively, blood loss and transfusion volumes were greater than in those without deployment. This paradox is likely the consequence of the balloons being deployed only in the setting of impending or actual catastrophic hemorrhage. Further studies with rigid protocol-driven use of balloon catheters are needed to address their true utility. To date, this study represents one of the largest series of cases with pathology-proven accreta in which preoperative intravascular balloon placement was routinely utilized.