Key result
Prophylactic abdominal aortic balloon occlusion significantly reduced the composite risk of estimated blood loss ≥ 2.0 L, massive transfusion, and hysterectomy (adjusted OR 0.46) in women with placenta previa accreta.
Why the study?
Placenta previa accreta is a life-threatening pregnancy complication, and reducing blood loss during operative treatment remains a major challenge.
Does prophylactic abdominal aortic balloon occlusion reduce the composite of estimated blood loss ≥ 2.0 L, massive transfusion, and hysterectomy in women with placenta previa accreta undergoing caesarean section?
Cohort (n=156)
No
Does prophylactic abdominal aortic balloon occlusion reduce the composite of estimated blood loss ≥ 2.0 L, massive transfusion, and hysterectomy in women with placenta previa accreta undergoing caesarean section?
Odds Ratio: 0.46 (95% CI 0.23–0.96)
p-value: p=0.04
Prophylactic abdominal aortic balloon occlusion during caesarean section in women with placenta previa accreta significantly reduces severe hemorrhage, massive transfusion, and the need for hysterectomy.
May improve maternal outcomes in placenta previa accreta; leaves open need for randomized trials before practice change.
BACKGROUND: Placenta previa accreta is a life-threatening pregnancy complication, and reducing blood loss during operative treatment remains a major challenge. The aim of our study was to investigate the effect of prophylactic abdominal aortic balloon occlusion (AABO) during caesarean section in women with placenta previa accreta. METHODS: A retrospective study of women with placenta previa accreta was conducted in a tertiary hospital from January 1, 2015, to December 31, 2020. Women were divided into balloon and control groups by whether AABO was performed. Baseline characteristics and pregnancy outcomes were compared in the two groups. A propensity score analysis was applied to minimise the indication bias. The primary outcome was composite, including estimated blood loss (EBL) ≥ 2.0 L, massive transfusion and hysterectomy. RESULTS: A total of 156 patients participated in this study, with 68 in the balloon group and 88 in the control group. Propensity score analysis showed that women in the balloon group had less EBL (1590.36 ± 1567.57 vs. 2830.36 ± 2285.58 mL, P = 0.02) as well as a lower proportion of EBL ≥ 1.0 L (50.00% vs. 78.57%, P = 0.03), EBL ≥ 2.0 L (21.43% vs. 50.00%, P = 0.03) and EBL ≥ 3.0 L (14.29% vs. 42.86%, P = 0.04). In addition, women in the control group received more red blood cell transfusions (8.43 U ± 9.96 vs. 3.43 U ± 6.27, P = 0.03), and the proportion of massive transfusions was higher (35.71% vs. 7.14%, P = 0.02). The proportions of disseminated intravascular coagulation (0% vs. 28.57%, P < 0.01), haemorrhagic shock (3.57% vs. 32.14%, P = 0.02) and hysterectomy (10.71% vs. 39.29%, P = 0.03) were significantly lower in the balloon group. Sutures were performed more often in the balloon group (64.29% vs. 17.86%, P < 0.01). Multivariate logistic regression analysis showed that AABO was associated with the primary outcome (adjusted odds ratio 0.46, 95% confidence interval 0.23 ~ 0.96, P = 0.04). No serious balloon catheter-related complications occurred in the balloon group. CONCLUSION: AABO was an effective and safe approach to improve maternal outcomes for patients with placenta previa accreta.
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Yin et al. (2022) conducted a cohort in Placenta previa accreta (n=156). Prophylactic abdominal aortic balloon occlusion (AABO) vs. Caesarean delivery without AABO was evaluated on Composite of estimated blood loss ≥ 2.0 L, massive transfusion, and hysterectomy (adjusted OR 0.46, 95% CI 0.23-0.96, p=0.04). Prophylactic abdominal aortic balloon occlusion significantly reduced the composite risk of estimated blood loss ≥ 2.0 L, massive transfusion, and hysterectomy (adjusted OR 0.46) in women with placenta previa accreta.
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