Perioperative Internal Iliac Artery Balloon Occlusion, In the Setting of Placenta Accreta and its Variants: The Role of the Interventional Radiologist

Publication date: Available online 10 November 2017
Source:Current Problems in Diagnostic Radiology
Author(s): David A. Petrov, Benjamin Karlberg, Kamalpreet Singh, Matthew Hartman, Pardeep K. Mittal
Placenta accreta and its variants (increta and percreta) are conditions of variant placentation that are encountered with increasing frequency. The spectrum of placenta accreta (including placenta increta and percreta) involves abnormal attachment of the placental chorionic villi to the uterine myometrium. This attachment leads to increased adherence of the placenta to the uterus and abnormal placental-uterine separation at the time of delivery. Placental invasion into, or through the myometrium is associated with increased post-partum morbidity and mortality as a result of uterine hemorrhage during and following cesarean section.A multidisciplinary clinical approach to the treatment of patients with placenta accreta is recommended by the American College of Obstetricians and Gynecologists. As potential members of an interdisciplinary team, interventional radiologists can perform prophylactic internal iliac arterial balloon occlusion as an adjunctive therapy for reducing potentially life-threatening postpartum hemorrhage. The procedure involves placement of a balloon catheter into the internal iliac or common iliac arteries bilaterally prior to cesarean section. Following delivery, and prior to placental separation, the catheter balloons are inflated with a pre-determined volume of saline leading to transient occlusion of the internal iliac arteries and reduced uterine blood flow.



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