To observe the effect of bilateral internal iliac artery balloon occlusion and uterine artery embolization in cesarean section of patients with pernicious placenta previa.

From March 2015 to November 2021, a total of 93 cases of placenta previa who underwent cesarean section assisted by bilateral internal iliac artery balloon occlusion at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine were enrolled. Prior to the caesarean section, the balloons were prepositioned in the bilateral internal iliac arteries. Once the fetus was successfully delivered, the bilateral balloons were manually dilated by pushing the contrast agent to block the blood flow in the bilateral internal iliac arteries. Subsequently, in cases of uncontrolled hemorrhage during routine placenta dissection, a procedure referred to as "primary embolization" of the bilateral internal iliac and uterine arteries was conducted using gelatin sponge particles. In cases where uterine artery reperfusion occurred or incomplete embolization was observed during internal iliac artery angiography after abdominal wall closure, additional gelatin sponge particles were introduced to enhance the efficacy of the initial "primary embolization". This technique was referred to as "secondary embolization". The patients' intraoperative blood loss, blood transfusion, postoperative hospital stay, hysterectomy and fetal condition were observed.

All 93 cases underwent successful prepositioning of balloons within the bilateral internal iliac arteries prior to cesarean section. Among these cases, ten (10.8%) required dual uterine artery embolizations with gelatin sponge particles during and after the cesarean section, while 83 cases (89.2%) received a single embolization following abdominal closure. All patients successfully underwent cesarean section, and 96 live fetuses were delivered. The mean preoperative hemoglobin concentration was 110 g/L, which decreased to a median of 97 g/L postoperatively. The median intraoperative blood loss and transfusion volume were 1 475 mL and 1 150 mL, respectively. Placenta accreta, placenta increta, and placenta percreta were diagnosed in 30 cases (32.3%), 49 cases (52.7%), and 8 cases (8.6%), respectively. Hysterectomy was performed in eight patients (8.6%).

Cesarean section assisted with bilateral internal iliac artery balloon occlusion is an effective modality for the treatment of pernicious placenta previa. The utility of "secondary embolization" for uterine artery is an effective supplementary way to strengthen the effect of balloons occlusion in the procedure of cesarean section.