3:00 PM Abstract No. 302 Outcomes of the University of California Invasive Placenta Registry: how different adjunctive procedures reduce intraoperative blood loss during cesarean hysterectomy

To compare the efficacy of different adjunctive procedures to decrease estimated blood loss (EBL) during cesarean hysterectomy (C-hyst) in patients with invasive placenta. Retrospective analysis of the University of California registry for all patients with invasive placenta who underwent C-hyst between 1/2011 until 5/2016 was performed. Patient characteristics, surgical technique, laboratory parameters, and patient outcomes were reviewed. A total of 170 patients (median age: 34 years, range, 22-49 years) were identified. 124/170 patients (72.9%) did not undergo any adjunctive procedures during the C-hyst were considered the control group. Following cesarean delivery, 18/170 patients (10.6%) had internal iliac artery ligation, 16/170 patients (9.4%) had balloon occlusion of the internal iliac arteries, and 12/170 patients (7.1%) had occlusion of the infrarenal aorta prior to hysterectomy. The mean intraoperative EBL for patients with balloon occlusion of the internal iliac arteries and aorta was 1826 ± 584 mL compared to 2644 ± 1952 mL in the control group (p = 0.002) and compared to internal iliac artery ligation 3,717 ± 3,156 mL (p = 0.021). There was no significant difference in intraoperative EBL for patients undergoing internal iliac artery ligation compared to control (p = 0.15). Aortic and internal iliac artery balloon occlusion resulted in significantly less intraoperative EBL compared to internal iliac artery ligation and supportive care. With the increase in the incidence of invasive placenta, such adjunctive interventions should be considered in the management of pregnant women with invasive placenta.