Comparison of Efficacy between Internal Iliac Artery and Abdominal Aorta Balloon Occlusions in Pernicious Placenta Previa Patients with Placenta Accrete

Abstract

Background: We aimed to compare the hemostatic effect and perioperative outcomes between internal iliac artery (IIA) and abdominal aorta (AA) balloon occlusions in pernicious placenta previa patients complicated with placenta accrete and underwent cesarean delivery. Methods: One hundred and twenty-three pernicious placenta previa patients complicated with placenta accrete were retrospectively reviewed. Patients who received IIA or AA occlusions were subsequently divided into the IIA group (n = 71) and AA group (n = 52). Estimated blood loss (EBL) and blood transferring volume were evaluated. Results: No difference was observed in EBL during cesarean delivery, EBL within 24 h or blood transferring volume between IIA and AA groups. Subgroup analysis disclosed that AA occlusion presented lower EBL during cesarean delivery and EBL within 24 h compared to IIA occlusion in placenta percreta subgroup. For secondary outcomes, IIA occlusion caused better Apgar score at 1 min but higher rates of IIA ligation and iodoform gauze packing of the uterine cavity compared to AA occlusion. Multivariate linear analysis revealed that invasion depth independently predicted worse EBL. Conclusion: IIA and AA occlusions have similar hemostatic effects in pernicious placenta previa patients with placenta accrete underwent cesarean delivery, while AA occlusion is more effective in reducing EBL in placenta percreta subgroup.

Preserve the Uterus For Placenta Accreta Spectrum Overlying Cesarean Scar: a Step-by-step Surgical Technique

“…Preoperative aortic balloon has been proved to be effective to reduce bleeding and shorter surgical time. 7 In this cohort, in the 44 patients determined to be severe, the EBL in the balloon group was not significantly lower than those without balloon. The reason maybe that following this protocol, the immediate blockage of hemorrhage with hand and oval clamps resembled the effect of blockage of the aortic balloon.…”

“…Due to the high maternal morbidity and surgical complications, in addition to loss of fertility and its accompanying psychological trauma caused by cesarean-hysterectomy, innovative approaches are being investigated for uterine preservation. These methods include preoperative arterial balloon , 7,8 pelvic arterial ligation, 3 compression sutures, 8-10 local resection and uterine reconstruction. 11,12 However, the successful rate of uterine preservation in literatures varied greatly, and the sample size of studies with total uterine preservation are not large enough for an reassuring consensus.…”

A modified suture technique for the treatment of patients with pernicious placenta previa and placenta accreta spectrum: a case series

“…A series of conservative treatments can be administered, including uterus artery ligation, external compression with different methods of uterine sutures (6-10), uterine cavity compressions using different types of balloons (11)(12)(13)(14), placement of abdominal aortic balloons prior to surgery, or any combination of these methods (15)(16)(17). Currently, there are no standardized surgical procedures for this condition, because there are many methods, and there is no sufficient clinical data to accurately compare and evaluate the effect and prognosis of each suture method.…”

Comparison of the safety and efficacy of PABO above or below the ovarian artery during cesarean delivery in patients with coexisting placenta accreta and placenta previa

“…past few decades, prophylactic abdominal aortic balloon occlusion (PABO) before cesarean delivery has been employed by surgeons to prevent intraoperative and postoperative hemorrhage [3]. PABO may be safe and effective in treating patients with placenta accreta, which might control hemorrhages during cesarean delivery and reduce hysterectomy-associated risks [4][5][6][7][8][9][10][11][12]. When placental removal and uterus reconstruction is needed to prevent hysterectomy, PABO may be useful.…”

“…Among them, the adequate position of the aortic balloon has not been sufficiently evaluated. Many studies described it only as "below the level of the renal artery" or "under the origin of renal artery" [4][5][6][7][8][9][10][11][12].…”