A B Levine1, K Kuhlman, J Bonn. 1. Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Abstract
OBJECTIVE: To describe our experience with the use of prophylactic pelvic artery balloon catheters in cases of placenta accreta diagnosed by antenatal ultrasound and to compare these cases with contemporary controls. METHODS: In this prospective study, all patients seen at our institution between January 1994 and August 1997 with the antenatal sonographic diagnosis of placenta accreta were offered prophylactic preoperative pelvic artery balloon catheterization. Patients who were delivered by cesarean hysterectomy for unsuspected placenta accreta in our institution during the same time interval served as controls. Five patients with the sonographic diagnosis of placenta accreta underwent prophylactic pelvic artery balloon catheterization. Surgical outcomes in patients who received balloon catheters were compared with those managed without them. Statistical analysis was performed using the Mann-Whitney U test. RESULTS: Five patients with placenta accreta or one of its variants were correctly identified with antenatal ultrasonography. Of the five patients who underwent pelvic artery balloon catheterization, all had placenta accreta and four required cesarean hysterectomy. The mean estimated blood loss, transfusion requirement, and length of hospitalization in patients undergoing hysterectomy managed with and without the balloon catheters was not different (P > 0.06). CONCLUSIONS: Antenatal sonographic diagnosis of placenta accreta enables preoperative planning. In our experience, use of pelvic artery balloon occlusion catheters in patients requiring a cesarean hysterectomy for placenta accreta did not improve surgical outcomes compared with patients managed without them. These preliminary findings are based on a small number of patients; therefore, further investigation is needed.
OBJECTIVE: To describe our experience with the use of prophylactic pelvic artery balloon catheters in cases of placenta accreta diagnosed by antenatal ultrasound and to compare these cases with contemporary controls. METHODS: In this prospective study, all patients seen at our institution between January 1994 and August 1997 with the antenatal sonographic diagnosis of placenta accreta were offered prophylactic preoperative pelvic artery balloon catheterization. Patients who were delivered by cesarean hysterectomy for unsuspected placenta accreta in our institution during the same time interval served as controls. Five patients with the sonographic diagnosis of placenta accreta underwent prophylactic pelvic artery balloon catheterization. Surgical outcomes in patients who received balloon catheters were compared with those managed without them. Statistical analysis was performed using the Mann-Whitney U test. RESULTS: Five patients with placenta accreta or one of its variants were correctly identified with antenatal ultrasonography. Of the five patients who underwent pelvic artery balloon catheterization, all had placenta accreta and four required cesarean hysterectomy. The mean estimated blood loss, transfusion requirement, and length of hospitalization in patients undergoing hysterectomy managed with and without the balloon catheters was not different (P > 0.06). CONCLUSIONS: Antenatal sonographic diagnosis of placenta accreta enables preoperative planning. In our experience, use of pelvic artery balloon occlusion catheters in patients requiring a cesarean hysterectomy for placenta accreta did not improve surgical outcomes compared with patients managed without them. These preliminary findings are based on a small number of patients; therefore, further investigation is needed.
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