• Jordan Gagnon, Louis Boucher, Ian Kaufman, Richard Brown, and Albert Moore.
• Department of Anesthesia, Royal Victoria Hospital, McGill University Health Centre, 687 Avenue des Pins Ouest, Montreal, QC, H3A 1A1, Canada.
• Can J Anaesth. 2013 Dec 1;60(12):1212-7.

PurposeThe use of internal iliac artery balloons for prevention of hemorrhage in cases of placenta accreta is increasing. Most described complications of this technique are maternal and thromboembolic in nature. Complications related to vascular rupture are rare, their presentation is not well described, and the resultant neonatal consequences are infrequently reported.Clinical FeaturesA 35-yr-old term parturient with suspected placenta accreta underwent prophylactic endovascular placement of iliac balloons prior to Cesarean delivery. The patient complained of contraction-like pain during balloon placement, and an arterial wall tear was discovered after abdominal incision. This produced significant maternal bleeding and the birth of a neonate with an umbilical venous pH of 6.95 and Apgar scores of 3 and 7.ConclusionIn addition to the known maternal risks, fetal risks must be considered when planning the placement of endovascular iliac balloons during pregnancy. We recommend continuous monitoring of maternal and fetal status when performing the procedure. Contraction-like pain during placement should raise the suspicion of arterial disruption.

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