The effect prophylactic internal iliac artery balloon occlusion in patients with placenta previa or placental accreta spectrum: a systematic review and meta‐analysis

Abstract

Background Placenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide. Another cause of bleeding in pregnant women is Placenta accreta spectrum. Therefore, the aim of the present systematic review and meta-analysis is to determine the effect of prophylactic balloon occlusion of the internal iliac arteries in patients with placenta previa or placental accreta spectrum (PAS). Methods In this systematic review and meta-analysis, to identify and select relevant studies, the SID, MagIran, ScienceDirect, Embase, Scopus, PubMed, Web of Science, and Google Scholar databases were searched, using the keywords of internal iliac artery balloon, placenta, previa, balloon, accreta, increta and percreta, without a lower time limit and until 2020. The heterogeneity of the studies was examined using the I2 index, and subsequently a random effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2). Results In the review of 29 articles with a total sample size of 1140 in the control group, and 1225 in the balloon occlusion group, the mean difference between the two groups was calculated in terms of Intraoperative blood loss index (mL) and it was derived as 3.21 ± 0.38; moreover, in 15 studies with a sample size of 887 in the control group, and 760 in the balloon occlusion group, the mean difference between the two groups in terms of gestation index (weeks) was found as 2.84 ± 0.49; and also with regards to hysterectomy balloon occlusion after prophylactic closure of the iliac artery, hysterectomy (%) balloon occlusion was calculated as 8.9 %, and this, in the hysterectomy control group (%) was obtained as 31.2 %; these differences were statistically significant and showed a positive effect of the intervention (P < 0.05). Conclusion The results of this study show that the use of prophylactic internal iliac artery balloon occlusion in patients with placenta previa or Placenta accreta spectrum has benefits such as reduced intraoperative blood loss, reduced hysterectomy and increased gestation (weeks), which can be considered by midwives and obstetricians.

Placenta Accreta Spectrum (PAS) Disorders: Lessons Learned from the Introduction of Different Management Strategies in an Australian Tertiary Hospital. Retrospective Study (2004 to 2020)

“…A planned hysterectomy was performed as the woman didn't want to preserve fertility. The use of iliac artery balloons (in earlier cases placed in the internal iliac arteries and later in the common iliac arteries, as the latter will additionally block the supply to the placenta from the external iliac arteries) [17][18][19][20][21] was associated with a reduction in blood loss, although not statistically significant. This may have been related to the fact that the cases who had iliac balloons placed were the most complex and were expected to be associated with high blood loss.…”

Placenta accreta risk—antepartum score in predicting clinical outcomes of placenta accreta spectrum: A multicenter validation study

“…Yet, conclusions have been conflicting even when study results were pooled. 12,13 Therefore, the procedure has not been endorsed by international guidelines although the procedure is considered by many PAS-specialized centers To our knowledge, this is the first study that validates a riskstratification scoring system of clinical outcomes of PAS, which was generated using machine-learning algorithms. However, the study is limited by a lack of global standardization of outcome measurements.…”

“…Prophylactic internal iliac artery balloon occlusion has been numerously investigated in women with placenta previa and PAS. Yet, conclusions have been conflicting even when study results were pooled 12,13 . Therefore, the procedure has not been endorsed by international guidelines although the procedure is considered by many PAS‐specialized centers based on their internal data 11,14 .…”

Endovascular Strategy in Obstetrics

“…IIABO cannot control the collateral flow from the external iliac artery; thus, previous research reported that it could not reduce bleeding [24,25]. A recent systematic review and meta-analysis, evaluating 29 articles, suggested IIABO in patients with placenta previa contributes to reducing intraoperative blood loss and hysterectomy [26]. Some recommend CIABO because it occludes both internal and external iliac arteries, but it also carries the risk of distal embolism of the leg.…”