Timing of intra‐abdominal aortic balloon occlusion for prevention of hemorrhage in patients with placenta previa and placenta accreta spectrum

Abstract

ObjectivePlacenta accreta spectrum (PAS) has been linked to severe negative maternal–fetal pregnancy outcomes, including a high risk of maternal death. The goal of this study was to determine whether an abdominal aortic balloon block performed before fetal birth lowered intraoperative bleeding and the risk of severe bleeding, as opposed to a block performed after fetal birth.MethodsIn this retrospective cohort study, patients who underwent pre‐delivery or post‐delivery inflation were compared for intraoperative hemorrhage, transfusion rate, hysterectomy rate, intensive care unit (ICU) hospitalization, and newborn indices. To ensure the robustness of our findings, we applied multivariate logistic regression, propensity score analysis, and an inverse probability‐weighting model.ResultsThis study included 168 patients who underwent balloon occlusion (62 pre‐delivery, 106 post‐delivery). The overall probability of major bleeding was 56.5% (95/168), and the pre‐delivery and post‐delivery probabilities for major bleeding were 64.5% (40/62) and 51.9% (55/106) (P = 0.112), respectively. In the multivariable‐adjusted model, post‐delivery inflation was associated with a 33% numerically higher probability of massive bleeding (odds ratio 1.33, 95% confidence interval 0.54–3.25, P = 0.535). However, the difference was not statistically significant.ConclusionAccording to our findings, pre‐delivery inflation did not significantly reduce the risk or amount of severe bleeding.

Letter to the editor: Timing of intra‐abdominal aortic balloon occlusion for prevention of hemorrhage in patients with placenta previa and placenta accreta spectrum

“…Huang et al 1 showed important findings regarding the timing of aortic balloon occlusion (ABO) in placenta accreta spectrum (PAS) surgery: before versus after infant delivery. Nevertheless, I have some questions.…”

“…The findings fundamentally supported this. They state some merits of pre-ABO over post-ABO: (1) to reduce bleeding at uterine and placental incisions (the latter sometimes required in uterus-preserving surgeries);…”

“…This is true; however, this sounds negative toward pre-ABO, as "pre-ABO is not recommended". 1 The second question regards the fundamental strategy of PAS…”