Department of Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Reprod Biol Endocrinol. 2021 Mar 4;19(1):40. doi: 10.1186/s12958-021-00722-3.
Placenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide. Another cause of bleeding in pregnant women is Placenta accreta spectrum. Therefore, the aim of the present systematic review and meta-analysis is to determine the effect of prophylactic balloon occlusion of the internal iliac arteries in patients with placenta previa or placental accreta spectrum (PAS).
In this systematic review and meta-analysis, to identify and select relevant studies, the SID, MagIran, ScienceDirect, Embase, Scopus, PubMed, Web of Science, and Google Scholar databases were searched, using the keywords of internal iliac artery balloon, placenta, previa, balloon, accreta, increta and percreta, without a lower time limit and until 2020. The heterogeneity of the studies was examined using the I index, and subsequently a random effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2).
In the review of 29 articles with a total sample size of 1140 in the control group, and 1225 in the balloon occlusion group, the mean difference between the two groups was calculated in terms of Intraoperative blood loss index (mL) and it was derived as 3.21 ± 0.38; moreover, in 15 studies with a sample size of 887 in the control group, and 760 in the balloon occlusion group, the mean difference between the two groups in terms of gestation index (weeks) was found as 2.84 ± 0.49; and also with regards to hysterectomy balloon occlusion after prophylactic closure of the iliac artery, hysterectomy (%) balloon occlusion was calculated as 8.9 %, and this, in the hysterectomy control group (%) was obtained as 31.2 %; these differences were statistically significant and showed a positive effect of the intervention (P < 0.05).
The results of this study show that the use of prophylactic internal iliac artery balloon occlusion in patients with placenta previa or Placenta accreta spectrum has benefits such as reduced intraoperative blood loss, reduced hysterectomy and increased gestation (weeks), which can be considered by midwives and obstetricians.
前置胎盘是指胎盘部分或完全覆盖子宫颈内口。前置胎盘是全球产后出血和产妇死亡的主要原因之一。孕妇出血的另一个原因是胎盘植入谱系。因此，本系统评价和荟萃分析的目的是确定预防性内髂动脉球囊闭塞在前置胎盘或胎盘植入谱系（PAS）患者中的效果。
在本系统评价和荟萃分析中，为了确定和选择相关研究，使用了 SID、MagIran、ScienceDirect、Embase、Scopus、PubMed、Web of Science 和 Google Scholar 数据库，使用了内髂动脉球囊、胎盘、前置、球囊、植入、植入和穿透等关键词，没有下限时间限制，直到 2020 年。使用 I 指数检查研究的异质性，随后应用随机效应模型。数据分析在 Comprehensive Meta-Analysis 软件（版本 2）中进行。
在对 29 篇文章进行综述后，对照组总样本量为 1140 例，球囊闭塞组为 1225 例，两组之间的平均差异以术中失血量指数（mL）计算，结果为 3.21±0.38；此外，在 15 项研究中，对照组样本量为 887 例，球囊闭塞组为 760 例，两组之间的平均差异以妊娠指数（周）计算，结果为 2.84±0.49；另外，关于预防性髂动脉闭合后行子宫动脉球囊阻断术，行子宫切除术的球囊阻断率（%）计算为 8.9%，而在子宫切除术对照组（%）中，获得了 31.2%；这些差异具有统计学意义，表明干预具有积极作用（P<0.05）。
本研究结果表明，在前置胎盘或胎盘植入谱系患者中预防性使用内髂动脉球囊闭塞术可减少术中失血量、减少子宫切除术和增加妊娠（周），这可被助产士和产科医生考虑。
