Effect of prophylactic balloon occlusion of internal iliac artery in pregnancies complicated by placenta previa and accreta

Abstract

Background Placenta previa and accreta are serious obstetric conditions that are associated with a high risk of intraoperative massive hemorrhage, the prophylactic intravascular balloon occlusion technique is increasingly used in managing uncontrolled hemorrhage in cesarean section (CS). We aim to examine the clinical effectiveness of prophylactic balloon occlusion of the internal iliac artery (PBOIIA) during CS in improving maternal outcomes for patients with placenta previa and accreta. Methods A total of 420 women with placenta previa and accreta who underwent CS from January 2014 to December 2018 were included retrospectively. Patients were divided into balloon group in which patients had PBOIIA (n = 248) and the control group in which patients did not have PBOIIA (n = 172). Meanwhile, we performed a subgroup analysis in whether taking parallel transverse uterine incision (PTUI) surgery. Information on conditions of patients and newborns, perioperative blood indicators, surgical outcomes were collected. Results Median estimated blood loss (mEBL) was 2200 mL in the balloon group and 2150 mL in the control group respectively, there was no significant difference between two-groups comparison (P > 0.05), and the rate of patients with hysterectomy was also has no difference between the two groups (36.3% verus 35.5%, P > 0.05), while there is a significant difference between two groups in the amount of PRBCs transfused [3 (0–31.5) verus 3 (0–39), P <0.05], moreover, the proportion of PRBCS> 8 units in the balloon group is significantly lower than that in control group (11.29% verus 23.26%, P <0.05).. However, the total hospitalization costs (45,624.4 ± 11,061.9 verus 37,523.1 ± 14,662.2, CYN) and surgery costs (19,910.6 ± 2622.6 verus 11,850.5 ± 3146.1, CYN) in balloon group were significantly higher than those in control group (P < 0.05). Subgroup analysis showed PTUI surgery had no significant differences in EBL (P >0.05), but it could significantly decrease hysterectomy rates (P <0.05). Conclusions PBOIIA has no significant effect on reducing intraoperative EBL and hysterectomy rate in patients with placenta previa and accreta. and although it could reduce the intraoperative PRBCs in patients with massive hemorrhage, it significantly increases the financial cost for patients. Therefore, PBOIIA should not be routinely recommended to patients with placenta previa and accreta.

Study of patients with placenta accreta spectrum in a tertiary care hospital

“…However, length of hospitalization after surgery as well as ICU admission were comparable. In contrast to our study another study Chen et al [15] suggested that Prophylactic internal iliac artery balloon occlusion has no significant effect on reducing hysterectomy rate in patients with placenta previa and accreta, although it could reduce the intraoperative blood loss in patients with massive haemorrhage but it significantly increases the financial cost for patients. Therefore, it should not be routinely recommended to patients with placenta previa and accreta.…”

Nomogram to predict postpartum hemorrhage in cesarean delivery for twin pregnancies: a retrospective cohort study in China

“…Placenta previa and placenta accrete spectrum, which acts as the strongest predictor for PPH, may result in severe PPH or even a hysterectomy ( 30 , 31 ). In recent years, intravascular balloon occlusion has become an increasingly popular prophylactic measure, which includes intravascular balloon occlusion of the abdominal aorta or internal iliac arteries ( 32 – 36 ). During the surgery, the abdominal aorta/internal iliac artery can be temporarily blocked by the balloon, thus reducing the uterine artery's blood supply, and the hemostatic procedures can be simplified and shortened.…”

Cesarean hysterectomy in pregnancies complicated with placenta previa accreta: A retrospective hospital-based study

“…9 According to recent studies, the effectiveness of intraoperative internal iliac artery balloon occlusion in women with PAS was not reliable. 10,11 Therefore, most of the women in our study who had bilateral internal iliac artery balloon occlusion were delivered before the year 2020. After 2020, prophylactic balloon occlusion of the internal iliac artery was not routinely conducted in our hospital, and prophylactic abdominal aortic balloon was performed in some severe cases of PPA at the multidisciplinary team's discretion.…”