Role of Abdominal Aortic Balloon Placement in Planned Conservative Management of Placenta Previa With Placenta Increta or Percreta

Abstract

Background: We investigated the role of balloon placement in the abdominal aorta (BPAA) in planned conservative management of placenta previa with placenta increta or percreta and the effects of BPAA on perinatal adverse maternal events.Methods: This retrospective case-control study included women with placenta previa (increta or percreta), who underwent pregnancy termination at the Qilu Hospital of Shandong University between January 2016 and June 2019. Patients were categorized into the BPAA and non-BPAA groups based on the BPAA placement before delivery. The Chi-square and non-parametric rank-sum tests were used for the intergroup comparison of patient characteristics. The propensity score matching algorithm was used to minimize the intergroup differences in clinical characteristics. Logistic regression analysis was used to identify the factors associated with a high risk of adverse pregnancy outcomes. The area under the receiver operating characteristic curve [area under the curve (AUC)] was used to evaluate the classification of the selected high-risk factors.Results: The study included 260 patients, and 104 patients were identified after propensity score matching. In the post-matched cohort, intraoperative blood loss was significantly lower in the BPAA than in the non-BPAA group (median 1,000 vs. 2,250 ml, P < 0.001). Intraoperative B-Lynch suture was performed in fewer patients in the BPAA (15.4 vs. 34.6%, P = 0.024) than in the non-BPAA group. The packed red blood cell (PRBC) transfusion rate was lower in the BPAA group (median 4 vs. 8 units, P < 0.001). Overall, 46 (45.1%) patients developed adverse maternal events; however, the rate of adverse maternal events was lower in the BPAA group (19.6 vs. 80.4%, P < 0.001). No ligation of the ascending branch of the uterine artery (P = 0.034), no BPAA (P < 0.001), intraplacental vascular lacunae (P = 0.046), and cervical hypervascularity (P = 0.001) were associated with a high risk of adverse perinatal maternal events. The AUC of the high-risk factors was 0.89 in the post-matched and 0.76 in the pre-matched cohorts.Conclusion: Planned conservative management using BPAA significantly minimized the intraoperative blood loss, the need for a B-Lynch suture, and PRBC transfusion in patients with severe placenta accreta spectrum and placenta previa.

Animal models of the placenta accreta spectrum: current status and further perspectives

“…This corresponds to the extensively altered expression of genes involved in cellular invasion at the placental interface, such as Mmp2 , Mmp9 , Mmp3 , and Dock4 ( 50 – 52 ). Meanwhile, the number of blood vessels in the placenta increased significantly in this model, which is similar to the hypervascularity in the placenta of PAS patients ( 53 , 54 ). In accordance with the hypervascularity in the maternal–fetal interface, the serum levels of the angiogenic factors epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) tended to increase, while the levels of the antiangiogenic factors soluble fms-like tyrosine kinase 1 (sFlt) and endoglin (ENG) decreased in this model ( 50 ).…”

Early Detection and Good Team Collaboration for Preventing Maternal Death Caused by Placenta Accreta Spectrum Disorder

“…After the baby is born and the cord is cut, the balloon is quickly inflated to temporarily cut off the blood supply to the uterus. This helps prevent bleeding when the OB/GYN surgeon removes the placenta and sews up the uterine cut [43,44] .…”