Clinical efficacy of aortic balloon occlusion during caesarean section in patients with placenta accreta spectrum disorders: a systematic review and meta-analysis

Abstract

Clinical efficacy of aortic balloon occlusion during caesarean section in patients with placenta accreta spectrum disorders: a systematic review and meta-analysis Yu Huang1 , Fang-Yuan Luo1, * 1Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, No.32 West Second Section First Ring Road, 610041 Chengdu, Sichuan, China *Correspondence: 20180299120030@stu.swmu.edu.cn (Fang-Yuan Luo) DOI:10.31083/j.ceog.2021.02.2293 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 13 September 2020 Revised: 07 November 2020 Accepted: 13 November 2020 Published: 15 April 2021 Object: This systematic review and meta-analysis aim to examine evidence on the eȞfectiveness and safety of aortic balloon occlusion (ABO) during caesarean deliveries in placenta accreta spectrum (PAS) disorders. Methods: MEDLINE, Science Citation Index, Elsevier, clin icaltrials.gov, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for articles dated from database inception to February 2020. The primary outcomes were intraoperative blood loss volume (BLV) and hysterectomy rate. Results: Of the 793 articles, 11 were included in this study, with a total of 915 patients. Of the 535 patients who underwent ABO, 48 (9%) had placenta creta; 309 (57%), placenta increta; and 124 (23%), placenta percreta. Meta-analysis showed that ABO significantly reduced BLV and blood transfused volume (P < 0.001), and reduced the rate of hysterectomy (P < 0.001). The overall catheter-related complication rate was 3.36%. The primary outcomes were available for 60 patients with placenta percreta. Meta-analysis of these patients showed ABO was associated with a decrease in BLV (P < 0.001), but not a statistically significant reduction in hysterectomy (P = 0.48). Conclusions: ABO is eȞfective at controlling haemorrhage and reducing the need for hysterectomy in PAS disorders, but it did not appear to be eȞfective for uterine preservation in patients with placenta percreta. Keywords Aorta; Balloon occlusion; Placenta accreta; Placenta percreta; Caesarean section