Prophylactic balloon occlusion of internal iliac arteries, common iliac arteries and infrarenal abdominal aorta in pregnancies complicated by placenta accreta: a retrospective cohort study.

OBJECTIVES

To evaluate the efficacy of prophylactic balloon occlusion (PBO), and to compare haemostatic effects and perioperative outcomes of PBO of the internal iliac arteries (IIA), common iliac arteries (CIA) and infrarenal abdominal aorta (IAA) in patients with placenta accreta.

METHODS

One hundred and ninety-nine patients with placenta accreta were retrospectively reviewed. One hundred and twelve cases who underwent PBO were allocated into PBO group, and 87 cases without endovascular intervention were classified as the control group. According to different methods, 112 patients in the PBO group were divided into IIA (n = 37), CIA (n = 42) and IAA (n = 33) subgroups.

RESULTS

Patients in the PBO group had decreased estimated blood loss (EBL) and blood transfusion volume (BTV), as well as improved other perioperative outcomes. PBO (vs controls) could independently predict less EBL. As to comparison among subgroups, patients had decreased EBL and BTV, as well as improved other perioperative outcomes in CIA and IAA subgroups compared to the IIA subgroup. Further validation by multivariate analysis revealed that PBO of IIA (vs others) could independently predict more EBL.

CONCLUSIONS

PBO reduces intraoperative blood loss and improves other perioperative outcomes in patients with placenta accreta, and PBO of the CIA and IAA is more effective compared to PBO of IIA.

KEY POINTS

• PBO of IIA, CIA and IAA is effective in placenta accreta. • PBO of CIA and IAA is more effective. • PBO could independently predict less EBL. • Accreta depth was an independent risk factor for EBL.