Clinical and hemodynamic insights into the use of internal iliac artery balloon occlusion as a prophylactic technique for treating postpartum hemorrhage

Recently, the effectiveness of internal iliac artery balloon occlusion (IIABO) for treating postpartum hemorrhage caused by pernicious placenta previa (PPP) has been questioned. We conducted a retrospective analysis and hemodynamic simulation to assess the IIABO’s effectiveness. The retrospective an...

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Bibliographic Details
Published in:Journal of biomechanics 2021-12, Vol.129, p.110827-110827, Article 110827
Main Authors: Li, Zhongyou, Chen, Yu, Zeng, Xiaoxi, Stephen, Salerno, Li, Yi, Li, Huafeng, Dong, Lihua, He, Teng, Zhang, Shihong, Yang, Pei, Jiang, Wentao, Fan, Haidong
Format: Article
Language:English
Subjects:
Anemia
Arteries
Balloon
Balloon Occlusion
Balloon treatment
Biomechanics
Blood
Blood circulation
Blood groups
Blood Loss, Surgical
Blood transfusions
Blood vessels
Cesarean Section
Circulation
Diabetes mellitus
Female
Gestational age
Hemodynamics
Hemorrhage
Humans
Hysterectomy
Iliac Artery
Indicators
Invasive placenta
Modeling
Multiple regression analysis
Numerical models
Occlusion
Placenta
Postoperative period
Postpartum
Postpartum hemorrhage
Postpartum Hemorrhage - prevention & control
Pregnancy
Pregnancy complications
Retrospective Studies
Reversed flow
Simulation
Uterus
Veins & arteries
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Summary:Recently, the effectiveness of internal iliac artery balloon occlusion (IIABO) for treating postpartum hemorrhage caused by pernicious placenta previa (PPP) has been questioned. We conducted a retrospective analysis and hemodynamic simulation to assess the IIABO’s effectiveness. The retrospective analysis involved 480 patients with PPP, among which 288 underwent IIABO treatment and the remaining 192 were used as controls. Blood loss and preoperative indicators were recorded, and multiple regression analysis was applied to test the effect of preoperative indicators on blood loss. Hemorrhage mechanisms were simulated using a numerical model. Results suggested that no significant difference in blood loss (1836 ± 1440 ml vs. 1784 ± 1647 ml, p = 0.22) was observed between the two groups. In addition, preoperative indicators, including age, weight, gestational age, gravidity, parity, blood type, anemia, or diabetes, were not associated with blood loss. In the simulation, after the intra-iliac artery was blocked, blood loss was caused by a reversed flow in the intrapelvic arteries, uterine veins, and uterine venules. The ratio of the time-averaged hemorrhage velocity (TAHV) in the balloon group to that in the control group was lower than that obtained in a clinical study (13.0% vs. 88.9%); in the presence of collateral circulation, blood loss occurred from collateral circulation and uterine venules after IIABO intervention, and the TAHV was 60%–90% that of the control group, which was closer to the clinical results (88.9%). These results suggest that IIABO cannot effectively treat postpartum hemorrhage because of the collateral circulation and reversed flow in the uterine venules.
ISSN:0021-9290
1873-2380
DOI:10.1016/j.jbiomech.2021.110827