The effectiveness of prophylactic combined pelvic artery balloon occlusion and embolization versus prophylactic balloon occlusion or embolization alone during cesarean hysterectomy in placenta accreta spectrum

Placenta accreta spectrum (PAS) is abnormal placental implantation that could lead to significant hemorrhage. Prior studies applied different techniques to reduce intraoperative blood loss with varying outcomes. This study aims to compare the effectiveness and safety of prophylactic combined balloon occlusion and embolization of the pelvic artery versus prophylactic balloon occlusion or gelfoam embolization in PAS women who had a cesarean hysterectomy. 

Materials and Methods:

The medical records and clinical data of 30 cesarean hysterectomy patients who underwent perioperative endovascular treatment between 2013-2021 were reviewed retrospectively. Twenty-nine pathological confirmed PAS were analyzed into two groups - prophylactic combined balloon occlusion and gelfoam embolization (n = 10) was in the study group, and prophylactic balloon occlusion or gelfoam embolization (n = 19) was in the control group. The intraoperative estimated blood loss (EBL), units of packed red blood cell (pRBC) transfusion requirement, surgical time, transfer to the ICU, postoperative hospitalization days, postoperative complications, and the Apgar scores were compared between the two groups.

Results:

Technical success was achieved in 29 cases (100%). There was no significant difference in demographic data, PAS grading (accreta, increta, percreta) and the presence of placenta previa between the two groups. The median (interquartile range) intraoperative EBL in the study group [1100 mL (IQR, 700-1500 ml)] had significantly decreased compared to the control group [1800 mL (IQR,1300-2800 ml)] (P = 0.03). Comparison of units of pRBC blood transfusion [0.5 units (IQR, 0-2 units) Vs 2 units(IQR, 0-3 units); P = 0.39 ], surgical time [239 mins (IQR,165-345 mins) Vs 205 mins (IQR, 150-290 mins) (P = 0.74)] , transfer to the ICU 4/10(40%) Vs 11/19 (58%);P =0.45, postoperative length of stay [7 days (IQR, 6-7 days) Vs 6 days (IQR, 6-13 days); P = 0.53], postoperative complications 2/10(20%) Vs 5/19 (26%); P = 1 and mean Apgar scores of 1 min (6.5 ± 2.5 Vs 6.1 ± 2.1; P = 0.62) and 5 min (8.6 ± 0.8 Vs 8.1 ± 1.4; P = 0.33) were not significantly different between these two groups.

Conclusion:

Prophylactic combined balloon occlusion and embolization of the pelvic artery prior to cesarean hysterectomy is more effective in reducing blood loss compared with prophylactic balloon occlusion or gelfoam embolization alone in placenta accreta spectrum with no difference in postoperative complications or neonatal outcomes.