280 - Fetal Radiation Exposure During Placement of an Aortic Occlusion Balloon Prior to Cesarean Hysterectomy in the Setting of Placenta Accreta Spectrum Disorder

Tuesday, April 14, 2026

3:45 PM - 3:54 PM ET

Author/Co-author(s)

JM

Jessian L. Munoz, MD, MPH

Assistant Professor
Baylor College of Medicine, United States
CH

Carly M. Hansen, MS

Senior Medical Physicist
Texas Children’s Hospital, United States
AP

Amir Pezeshkmehr, MD

Division Chief, Interventional Radiology
Texas Childrens Hospital, Baylor College of Medicine, United States
Jose Alberto Hernandez, MD

Associate Professor
Texas Children Hospital, United States
YM

Yamely Mendez Martinez, MD

Senior Research Coordinator
Baylor College of Medicine, United States
ST

Sheryl Tulin-Silver, MD

Interventional Radiologist
Texas Children's Hospital, United States
GG

Gregory C. Gardner, MD

Pediatric Interventional Radiologist
Texas Childrens Hospital, United States
HP

Hasmukh Prajapati, MD

Associate Professor
Baylor College of Medicine, United States
AC

Alex Chau, MD

Interventional Radiologist, Assistant Professor
Texas Children's Hospital, United States
EG

Edward Gayou, MD

Assistant Professor, Interventional Radiology Faculty
Texas Children's Hospital, United States
CR

Christina C. Reed, NP

Assistant Professor, Director of Clinical Research, Director of Operations of the PAS Care Team
Baylor College of Medicine, OB/Gyn Department, United States

Presenting Author(s)

JG

Jonathan S. Gross, MD

Associate Professor
Texas Children's Hospital, United States

Author/Co-author(s)

AS

Amir Shamshirsaz, MD

Assistant Professor of Maternal Fetal Medicine/Critical Care Medicine Department of Obstetrics
Baylor College of Medicine, United States
HL

Hendrik Lombaard, MD

Professor of Maternal Fetal Medicine
Baylor College of Medicine, United States
RP

Raymond B. Pahlka, PhD

Senior Diagnostic Medical Physicist
Texas Children’s Hospital, United States
MB

MIchael Belfort, MD, PhD

Professor of Maternal Fetal Medicine
Baylor College of Medicine, United States
KK

Kamlesh Kukreja, MD

Pediatric Interventional Radiology Attending
Texas Children`s Hospital, United States

Purpose: An aortic occlusion balloon (AOB) may be placed to decrease blood loss during cesarean hysterectomy for patients with placenta accreta spectrum disorder(PAS).(1) However, this approach exposes the fetus to radiation, the dose and effects of which are unknown. The goal of this study is to calculate fetal radiation dose during prophylactic placement of an occlusion balloon prior to cesarean hysterectomy for PAS.

Materials and Methods: The study included 20 patients with PAS who had a prenatal pelvic MRI and who had a 4 French AOB (COBRA OS, Frontline Medical Technologies, Ontario, Canada) placed prior to cesarean hysterectomy at a single tertiary care center. Occlusion balloons were positioned in the infrarenal aorta using a portable fluoroscopy unit (OEC 9900 Elite, GE Healthcare, Chicago, USA) in an operating room immediately prior to cesarean hysterectomy. Fetal dose was calculated by applying corrections to the reference point air kerma (reported by fluoroscopy unit) that account for maternal position relative to the reference point, fetal depth measured on MRI, and factors related to the x-ray technique that provided a conversion from air kerma to fetal absorbed dose. (2)

Results: Balloons were placed using an average of 15.8 seconds of fluoroscopy (range 2-105 seconds; median 6 seconds) leading to 4.2 mGy maternal exposure (range 0.4-29.4 mGy; median 2.3 mG). Average distance from the fetus to the back of the maternal patient was 13.1 cm (range 10.0-17.7 cm; median 13 cm) Calculated dose to the fetus was 1.6 mGy (range 0.2-10.9 mGy; median 0.8 mGy). Fetal dose is strongly associated with the maternal radiation dose and the depth of the fetus.

Conclusion: Fetal radiation exposure during occlusion balloon placement is low. While there is no absolute safe threshold of exposure, the measured doses are well below levels associated with deterministic effects and are unlikely to increase stochastic risks appreciably. (3, 4) Concerns about fetal irradiation should not preclude balloon occlusion of the aorta in the setting of PAS.