Abstract No. 439 Evaluation of blood loss and transfusion requirements in patients with invasive placenta treated with arterial occlusion balloons or internal iliac artery ligation

To evaluate the postoperative outcomes of patients who underwent cesarean hysterectomy for invasive placenta and were treated with either prophylactic internal iliac artery (IIA) or aortic occlusion balloons compared to IIA ligation. A multi-institutional retrospective analysis from 2011 to 2017 identified 46 patients with invasive placenta treated with prophylactic occlusion balloons or IIA ligation. Blood loss and transfusion requirements were compared. 17 patients were treated with prophylactic IIA balloons, 11 patients with aortic occlusion balloons, and 18 patients with IIA ligation. Baseline demographics were not significantly different for patient age, gestational age at delivery, gravidity, parity or number of previous C-sections. Median estimated blood loss (EBL) for the 18 patients who underwent IIA ligation was 2.8 L (1.0-15 L) compared to 1.75 L (0.9-4 L) for the combined balloon occlusion group of 28 patients (p = 0.007). Patients treated with IIA ligation were transfused a median of 6 units (0-32 units) of packed red blood cells (pRBCs) compared to a median of 0 units (0-15 units) in the combined occlusion balloon group (p<0.001). Transfusion of platelets and fresh frozen plasma were also significantly less in the balloon occlusion group compared to the ligation group (median 0 units vs 1 unit; p<0.001 and median 0 units vs 4.5 units; p<0.001). We next compared operative outcomes between the two occlusion balloon treatment groups. Median EBL was 1.5 L (0.9-4.0 L) in the IIA balloon group vs 2.0 L (1.0-3.0 L) in the aortic balloon placement group (p = 0.97). Transfusion requirements were not statistically different between the balloon occlusion groups. Patients undergoing cesarean hysterectomy for invasive placenta managed with arterial occlusion balloons demonstrated significantly less EBL and transfusion requirements compared to patients treated with internal iliac artery ligation. Blood loss and transfusion requirements did not differ between the IIA and aortic occlusion balloon groups.