Effect of prophylactic interventional therapy of internal iliac artery balloon occlusion in pregnancies complicated by placenta previa and accreta: a retrospective cohort study
Abstract Background: Placenta previa and accreta are serious obstetric conditions that are associated with a high risk of intraoperative massive hemorrhage, the prophylactic intravascular balloon occlusion technique is increasingly used in managing uncontrolled hemorrhage in cesarean section (CS). We aim to examine the clinical effectiveness of prophylactic interventional therapy of the internal iliac artery balloon occlusion (PBOIIA) during CS in improving maternal outcomes for patients with placenta previa and accreta. Methods: A total of 420 women with placenta previa and accreta who underwent CS from January 2014 to December 2018 were included retrospectively. Patients were divided into balloon group in which patients had PBOIIA (n=248) and the control group in which patients did not have PBOIIA (n=172). Meanwhile, we performed a subgroup analysis in whether taking PTUI surgery. Information on conditions of patients and newborns, perioperative blood indicators, surgical outcomes were collected.Results: Median estimated blood loss (mEBL) was 2200mL in the balloon group and 2150mL in the control group respectively, there was no significant difference between two-groups comparison (P>0.05). The rate of patients with hysterectomy (36.3% verus 35.5%) and amount of PRBCs transfused [(0-31.5) verus 3 (0-39)] were not different between two groups (P>0.05). However, the total hospitalization costs (7044.4±1708.0 verus 5793.6±2263.8) and surgery costs (3074.2±404.9 verus 1829.7±485.8) in balloon group were significantly higher than those in control group (P<0.05). Subgroup analysis showed PTUI surgery had no significant differences in EBL ((P>0.05), but it could significantly decrease hysterectomy rates (P<0.05).Conclusions: PBOIIA has no significant effect on reducing intraoperative EBL and hysterectomy rate in patients with placenta previa and accreta, but it significantly increases the financial cost for patients. PBOIIA should not be routinely recommended to patients with placenta previa and accreta.