Anesthetic Management and Outcome in Patients Undergoing Caesarean Section with Intra-Aortic Balloon Occlusion to Control Intraoperative Blood Loss: A Case Series

Abnormalities of placenta can cause severe peripartum hemorrhage, leading to maternal morbidity and mortality. Imaging modalities, like magnetic resonance imaging (MRI) and ultrasonography, help in antenatal diagnosis of these abnormalities. Intravascular interventional therapy, like intra-aortic balloon occlusion (IABO), has been used to effectively reduce intraoperative blood loss in patients with placental abnormalities. We report anesthetic management of three cases of placenta increta and one case of placenta accreta who underwent IABO preoperatively before elective cesarean section for decreasing intraoperative hemorrhage. All cases were administered general anesthesia in anticipation of massive blood loss and prolonged duration of surgery. Though IABO helped in controlling intraoperative blood loss in three patients, one patient lost approximately 4000 ml of blood intraoperatively and required massive blood transfusion. A proper preoperative planning and communication between the anesthesiologist, surgical team, cardiology team, and blood bank are important for safe outcome of these patients.