Pregnant women with a potentially deadly complication could be helped by a procedure that involves tiny balloons, new research suggests.
For women with the conditions placenta previa and placenta accreta — which both can cause severe bleeding — inflating a balloon in the arteries that feed the uterus can stop the bleeding, the research shows. This may spare women from having to undergo emergency hysterectomies, where their entire uterus is taken out, leaving them unable to have more children. The findings were presented today (Dec. 3) at the Radiological Society of North America conference in Chicago, Illinois.
"We found that the procedure was safe for both mother and baby," said study author Dr. Patrick Nicholson, an interventional radiologist at the Cork University Hospital in Ireland.
Deadly conditions
Both placenta accreta and placenta previa are leading causes of maternal bleeding and death worldwide. In women with placenta accreta, the placental tissue that nourishes the growing fetus invades the woman's uterine walls too deeply, and in the most extreme cases, the placental blood vessels infiltrate nearby organs, such as the bladder. When a woman delivers her baby, these deeply embedded placental vessels resist the normal detaching from the uterine walls, and women can bleed catastrophically. [9 Uncommon Conditions That Pregnancy May Bring]
In placenta previa, the placenta attaches low in the uterus, partially or completely covering the cervix. If the baby is delivered through the placenta, a highly vascular organ, that can cause torrential bleeding, Nicholson said.
It's not clear why the two conditions form, but many researchers believe that scar tissue in the uterus alters how the placenta attaches to the uterus. Women who have undergone one or more cesarian sections or certain uterine surgeries, older women, and those whose pregnancies were conceived through in vitro fertilization are all at greater risk for these conditions, Nicholson said.
Though placenta accreta occurs in just 1 in 500 pregnancies, and placenta previa occurs in about 1 in 200 pregnancies, according to the American College of Obstetrics and Gynecology, the conditions are on the rise as more women fit the risk profile, Nicholson added.
Doctors typically diagnose placenta accreta and placenta previa when conducting routine fetal ultrasounds during pregnancy and create a meticulous plan for the birth that includes a C-section. But some women still die from the conditions, even with the best care in developed nations. Another large fraction of women need to have emergency hysterectomies to stop the bleeding, Nicholson said.
Intervention
Nicholson and his colleagues wanted to see if there was a way to treat these conditions while sparing the uterus. In their study of 22 women — 13 with placenta previa, and nine with placenta accreta — the team threaded small balloons into the arteries that feed the uterus. The balloons were deflated, but could be inflated to temporarily stop blood flow at the first sign of excessive bleeding.
The women then underwent planned C-sections, and seven of the women with placenta previa and six with placenta accreta started bleeding excessively, leading the team to inflate the balloons.
In 11 of these women, the inflated balloons stemmed the bleeding long enough for doctors to find the tiny sources of bleeding in the uterus and stitch them up. When the doctors were done, they deflated the balloons, reinstating blood flow to the uterus.
Two patients with placenta accreta were not helped by the procedure and still had to undergo a hysterectomy. None faced other complications, such as infection.
"Happily, all the babies were well," and had no complications associated with the condition, Nicholson told Live Science.
Better option
While the balloon technique was first described in the 1990s, past studies of using it found high rates of complications or didn't assess the health of the babies after the procedure, Nicholson said.
The new findings provide evidence that the treatment is safe, Nicholson said.
However, the procedure requires a team of highly trained doctors used to performing these procedures, so not every hospital is equipped to deal with these conditions, Nicholson said.
"These patients should definitely be managed in the kind of setting that's used to dealing with these high-risk pregnancies," Nicholson said.
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