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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (3): 405-408    DOI: 10.31083/j.ceog.2020.03.5239
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Intrauterine balloon failure: unrecognized placenta accreta spectrum disorders
K. Tamura1, H. Takahashi1, *(), S. Uchida1, M. Ogoyama1, R. Usui1, S. Matsubara1
1Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
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Abstract  

Several studies indicate that intrauterine balloon (IUB) use is less effective for postpartum hemorrhage (PPH) due to placenta accreta spectrum (PAS) disorders than that due to atonic bleeding. IUB failed to achieve hemostasis because the present two cases had normally positioned PAS. Case Report: A 37-year-old woman was transferred due to PPH. She vaginally delivered. The placenta was without macroscopic defect. Atonic bleeding was suspected. An IUB was placed, without achieving hemostasis. Her status deteriorated, necessitating a hysterectomy. The placenta remained, adhering to the uterine body. Histological examination revealed placenta accreta. The second case was a 40-year-old woman that was transferred due to PPH of atonic bleeding after vaginal delivery. The placenta was without macroscopic defect. An IUB was placed, without hemostasis, and was subsequently was removed. Conservative treatment achieved hemostasis. An Ultrasound revealed the placenta in the uterine body. We diagnosed her with clinical PAS. Nonprevia PAS may be present when an IUB fails to achieve hemostasis.
Key words:  Intrauterine balloon      Hysterectomy      Postpartum hemorrhage      Placenta accreta spectrum      Transfusion     
Submitted:  22 April 2019      Accepted:  24 June 2019      Published:  15 June 2020     
*Corresponding Author(s):  HIRONORI TAKAHASHI     E-mail:  hironori@jichi.ac.jp
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K. Tamura, H. Takahashi, S. Uchida, M. Ogoyama, R. Usui, S. Matsubara. Intrauterine balloon failure: unrecognized placenta accreta spectrum disorders. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(3): 405-408.

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https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.03.5239     OR     https://ceog.imrpress.com/EN/Y2020/V47/I3/405

Figure 1.  — Clinical course of Case 1. The blood loss (vaginal + from intrauterine balloon drain) steadily increased to as much as 300 mL at one hour after intrauterine balloon use (bold arrow). CS: cesarean section, TAE: transarterial embolization.

Figure 2.  — Macroscopic (a) and microscopic (b) findings in Case 1. Placenta accreta spectrum is observed. A placental fragment adhered to the posterior uterine body (arrow). Chorionic villi directly attached to the myometrium (arrowhead) without decidua, suggesting placenta accreta.

Figure 3.  — Imaging findings in Case 2. Transvaginal ultrasound shows the residual placenta (high-echoic part: star) in the uterus on postpartum day 8. The placenta is retained in the anterior uterus (asterisk) based on magnetic resonance imaging (T1 gadolinium enhanced) on postpartum day 10.

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