Intra-abdominal aortic balloon occlusion in the management of placenta percreta

Abstract

Background:Massive bleeding is the main concern for the management of placenta percreta (PP). Intra-abdominal aortic balloon occlusion (IABO) is one method for pelvic devascularization, but the efficacy of IABO is uncertain. This study aims to investigate the outcomes of IABO in PP patients.Methods:We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015. PP cases with/without the use of IABO were analyzed. Propensity score matching analysis was performed to reduce the effect of selection bias. Postpartum hemorrhage (PPH) and the rate of hysterectomy, as well as neonatal outcomes, were analyzed.Results:One hundred and thirty-two matched pairs of patients were included in the final analysis. Compared with the control group, maternal outcomes, including PPH (68.9% vs. 87.9%, χ2 = 13.984, P < 0.001), hysterectomy (8.3% vs. 65.2%, χ2 = 91.672, P < 0.001), and repeated surgery (1.5% vs. 12.1%, χ2 = 11.686, P = 0.001) were significantly reduced in the IABO group. For neonatal outcomes, Apgar scores at 1 minute (8.67 ± 1.79 vs. 8.53 ± 1.68, t = −0.638, P = 0.947) and 5 minutes (9.43 ± 1.55 vs. 9.53 ± 1.26, t = 0.566, P = 0.293) were not significantly different between the two groups.Conclusions:IABO can significantly reduce blood loss, hysterectomies, and repeated surgeries. This procedure has not shown harmful effects on neonatal outcomes.

Efficacy and safety of prophylactic balloon occlusion in the management of placenta accreta spectrum disorder: a retrospective cohort study

“…The modalities of PBO varied in many hospitals and published results are conflicting and do not allow the extrapolation of robust evidence on the actual role of PBO in improving the outcome of PAS [24]. For instance, a previous meta-analysis and some retrospective research reported that balloon occlusion of IIA had benefits in reducing blood loss, blood transfusion, and even the rate of hysterectomy in women with placenta accreta [17,[25][26][27]. Nevertheless, one recent study showed that PBO was associated with reduced blood loss only for patients who underwent AA balloon occlusion [28].…”

Novel concepts and improvisation for treating postpartum haemorrhage: a narrative review of emerging techniques

“…Resuscitative endovascular balloon occlusion of the aorta has been used for life-threatening postpartum haemorrhage, with promising results in observational studies [ 56 ]. An abdominal aortic balloon has also been placed prior to CS in cases of placenta accreta spectrum [ 57 ]. Observational studies suggest improved outcomes with balloon occlusion of the abdominal aorta, the common ileac arteries or the internal ileac arteries [ 58 , 59 ].…”

Comparative analysis of the effectiveness of different methods of surgical hemostasis in patients with placenta accreta spectrum disorders

“…В многочисленных публикациях сообщалось, что ВБОБА может быть безопасным и эффективным методом при оперативном родоразрешении пациенток с приращением плаценты, способствует снижению объёма кровопотери во время кесарева сечения и снижает риски, связанные с гистерэктомией [46][47][48][49][50][51][52][53][54][55]. В то же время клиническая эффективность профилактической БОПА была описана различными авторами с различными результатами (табл.…”