A new scoring system for placement of abdominal aortic balloon in Placenta accreta spectrum patients with placenta previa: A retrospective cohort study

Background In recent years, abdominal aortic balloon occlusion is considered an effective method for placenta accreta spectrum patients with placenta previa. However, not all patients in this category require abdominal aortic balloon placement. This study aims to investigate whether the new scoring system is effective for the placement of the abdominal aortic balloon in Placenta accreta spectrum (PAS)patients with placenta previa. Methods PAS patients with placenta previa diagnosed by color Doppler ultrasound were included, and divided into three groups according to their scores graded by a new scoring system (grade Ⅰ group ≤ 5 points, 6 points ≤ grade Ⅱ group ≤ 9 points, grade Ⅲ group ≥ 10 points). Patients with grade Ⅲ were placed with an abdominal aortic balloon unless their families and patients strongly refused. Those with grade I were not placed with an abdominal aortic balloon. Those with grade II generally were not placed with an abdominal aortic balloon unless their families and patients strongly request. Indicators were analyzed, including postpartum hemorrhage, transfusion requirements, operation time, and the ability to preserve the uterus and fertility. Results Estimated blood loss, the number of intraoperative transfused patients, postoperative days were different among the three groups. In group 2 (grade II), there was no significant difference in other observation indexes༈intraoperative blood loss 629 ± 214 vs 758 ± 749, P = 0.488, packed red blood cells47 ± 194 vs 154 ± 445, P = 0.488, admission to ICU 0/7 vs 3/71, P = 1.000, total hysterectomies 0/7 vs 2/71, P = 1.000༉(except for the operation time81.4 ± 19.5 vs 61.7 ± 30.6, P = 0.013) between the abdominal aortic balloon and non-abdominal aortic balloon groups. In group 3 (grade III), significant differences were found in intraoperative blood loss (950 ± 390 vs 2238 ± 1052, P༜0.001), packed red blood cells(213 ± 311 vs 662 ± 528, P༜0.001), postoperative blood transfusion volume(105 ± 181 vs 300 ± 321, P = 0.008), operation time(90.0 ± 25.9 vs 115.9 ± 45.3, P = 0.013), the proportion of people who need blood transfusion(14 in the IABO vs 11 in the NIABO, P = 0.002) and the total Hysterectomies (0 in the IABO vs 2 in the NIABO, P = 0.011) between the abdominal aortic balloon and non-abdominal aortic balloon groups. Conclusion With the new scoring system, not all patients with PAS and placenta previa need a preventive temporary balloon occlusion of the subrenal abdominal aorta. We recommend placing an abdominal aortic balloon in patients with grade III, for it can control intraoperative bleeding and reduce intraoperative blood transfusion, and reduce the risk of hysterectomy. For patients with grade I and II, abdominal aortic balloon placement is not recommended.