A.V. GANEEVA¹, K.I. GABDULLINA¹, I.I. GABDULLIN², I.R. VEKKER^2, 3, Е.Е. MKHITARYAN³, L.R. TENCHURINA³, М.G. KUZNETSOV¹

 ¹Kazan State Medical University, Kazan

²Orenburg Regional Clinical Hospital No. 2, Orenburg

³Orenburg State Medical University, Orenburg

 Contact details:

Ganeeva A.V. — PhD (Medicine), Associate Professor of the Department of Obstetrics and Gynecology named after Prof. V.S. Gruzdev

Address: 49 Butlerov St., 420012 Kazan, Russian Federation, tel.: +7-917-253-15-78, e-mail: a.v.ganeeva@gmail.com

Childbirth in women with placenta accreta is accompanied by a high risk of massive hemorrhage. Temporary balloon occlusion of aa. Iliacae communes allows for controlled blood flow to the uterus during surgery and helps to reduce the blood loss.

The purpose — to evaluate the safety and effectiveness of temporary balloon occlusion of aa. Iliacae communes during caesarean section in women with different degrees of placenta accreta that comes with placenta previa.

Material and methods. Medical records of 12 patients who underwent temporary balloon occlusion of aa. Iliacae communes during caesarean section were analyzed retrospectively. All patients were diagnosed with placenta accreta: 9 women had degree 1 and 3 women had degree 3b (according to PAS FIGO classification).

Results. Organ-preserving surgeries were performed in 10 patients (83.3%). The median value of blood loss among all study participants was 1,190 ml (1^st quartile — 1,155 ml, 3^rd quartile — 2,180 ml). Blood loss exceeding 2,000 ml was observed only in one woman with degree 1 of placenta accreta (11.1%). At the same time, in women with degree 3b, massive blood loss was recorded in two of three cases. No complications associated with the use of balloon occlusion of aa. Iliacae communes were observed in any of the 12 study participants.

Conclusions. The study confirmed that the technique of temporary balloon occlusion of the aa. Iliacae communes is safe and effective when used in women with placenta previa and degree 1 placenta accreta, which allows organ-preserving surgeries. The intervention also proved safe in degree 3b placenta accretа that comes with placenta previa, but its effectiveness was limited.

Key words: balloon occlusion of aa. Iliacae communes, blood-saving techniques, placenta accreta

 REFERENCES

1. Akaishi T., Tarasawa K., Hamada H. et al. Prenatal hypertension as the risk of eclampsia, HELLP syndrome, and critical obstetric hemorrhage. Hypertens Res, 2024, vol. 47, pp. 455–466. DOI: 10.1038/ s41440-023-01511-8
2. Phillips J.M., Eppes C., Rodriguez M. et al. Traditional uterine tamponade and vacuum-induced uterine tamponade devices in obstetrical hemorrhage management. Am. J. Obstet. Gynecol. MFM, 2023, vol. 5 (2), p. 100739. DOI: 10.1016/j.ajogmf.2022.100739
3. Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 183: postpartum hemorrhage. Obstet. Gynecol, 2017, vol. 130 (4), pp. 168–186. DOI: 10.1097/AOG.0000000000002351
4. Patologicheskoye prikrepleniye platsenty (predlezhaniye i vrastaniye platsenty). Klinicheskiye rekomendatsii [Pathological placental attachment (placenta previa and accreta). Clinical guidelines]. Moscow, 2023. 76 p.
5. Kurtser M.A., Breslav I.Yu., Grigor′yan A.M. et al. Temporary balloon occlusion of the common iliac arteries during organ-preserving surgeries in patients with placenta accreta. Akusherstvo i ginekologiya: novosti, mneniya, obucheniye, 2018, vol. 6, no. 4, pp. 31–37 (in Russ.). DOI:10.24411/2303-9698-2018-14003
6. Gayazov D.R., Teregulov A.Yu., Teregulova L.E. et al. Radiation diagnostics and organ-preserving surgeries for placenta accreta. Prakticheskaya meditsina, 2017, no. 7 (108), pp. 22–25 (in Russ.).
7. Nankali A., Salari N., Kazeminia M. et al. The effect prophylactic internal iliac artery balloon occlusion in patients with placenta previa or placental accreta spectrum: a systematic review and meta‐analysis. Reprod. Biol. Endocrinol, 2021, vol. 19, p. 40. DOI: 10.1186/s12958-021-00722-3
8. Liang D., Zhao H., Liu D. et al. Internal iliac artery balloon occlusion in the management of placenta accreta: A systematic review and meta-analysis. Eur. J. Radiol, 2021, vol. 139, p. 109711. DOI: 10.1016/j.ejrad.2021.109711
9. Saito K., Mariya T., Fujibe Y., Saito M., Hirokawa N., Ishioka S., Saito T. Common iliac artery dissection as a complication of common iliac artery balloon occlusion for placenta percreta: A case report. J. Obstet. Gynaecol. Res, 2021, vol. 47 (3), pp. 1172–1177. DOI: 10.1111/jog.14601