Intraoperative infrarenal aortic balloon occlusion in pregnancies with placenta accreta spectrum disorder

Abstract

Intraoperative infrarenal aortic balloon occlusion in pregnancies with placenta accreta spectrum disorder Mengdie Luo1,† , Junxing Li2,† , Xiaofeng Yang3 , Qiang Huang3 , Mengwei Huang3 , Jie Mei1, * 1Department of Obstetrics and Gynecology, Affiliated Hospital of Southwest Medical University, 646000 Luzhou, Sichuan Province, China 2Department of Obstetrics and Gynecology, People's Hospital of Deyang City, 618000 Deyang, Sichuan Province, China 3Department of Obstetrics and Gynecology, Department of Interventional Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, Affiliated Hospital of University of Electronic Science and Technology of China, 610031 Chengdu, Sichuan Province, China *Correspondence: meijie2023@swmu.edu.cn (Jie Mei) † These authors contributed equally. DOI:10.31083/j.ceog.2021.03.2295 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 16 September 2020 Revised: 8 December 2020 Accepted: 28 December 2020 Published: 15 June 2021 Background: The objective of this study was to evaluate the efficacy of intraoperative aortic balloon occlusion (IABO) during caesarean section for placenta accreta, increta or percreta and explore the relationship between different profile balloon catheters and catheter-related complications. Methods: This retrospective case control study included 295 patients with pathologically confirmed placenta accreta spectrum (PAS) disorder at the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital between 2013 and 2019. The characteristics of 162 patients who had aortic balloon occlusion (balloon group) were compared with those of 133 patients who had no catheterization (control group). Results: There were significant differences between the two groups in estimated blood loss, calculated blood loss, number of transfusions, transfused packed red blood cells (PRBCs), haemoglobin reduction, operation time and caesarean hysterectomy (P < 0.05). Regarding different PAS disorders, the estimated blood loss among women with placenta accreta and placenta increta was lower in the balloon group (n = 32 and 102, respectively) than in the non-balloon group (n = 33 and 85; P = 0.04 and P < 0.01, respectively). Only the placenta increta group showed a significant difference (P < 0.01) in transfused PRBCs. In patients who used the low-profile balloon catheters, we found a significant reduction in catheter-related complications compared with the highprofile group (n = 52 vs. 110, P = 0.04). Conclusions: Our study demonstrated that intraoperative infrarenal aortic balloon occlusion was effective in both reducing intraoperative haemorrhage and blood transfusion, and in preventing hysterectomy during caesarean section for pathologically diagnosed placenta accreta and increta. Lowprofile balloon catheters can reduce catheter-related complications. Keywords Aortic balloon occlusion; Caesarean section; Interventional therapy; Placenta accreta; Thrombus