Photo Credit: Paola Tellez

The following is a summary of “Efficacy and safety of prophylactic balloon occlusion in the management of placenta accreta spectrum disorder: a retrospective cohort study,” published in the April 2024 issue of Obstetrics and Gynecology by Chen et al.

Placenta accreta spectrum disorder (PAS) poses a significant threat to maternal health, often leading to severe morbidity and mortality. Prophylactic balloon occlusion (PBO), an intravascular interventional therapy, has emerged as a potential strategy to manage massive hemorrhage in PAS patients. However, the current evidence regarding the clinical application of PBO remains inconclusive. This retrospective cohort study assessed PBO’s efficacy and safety in managing PAS.

Methodologically, a retrospective analysis was conducted, encompassing PAS patients who underwent cesarean delivery at a tertiary hospital between January 2015 and March 2022. The study cohort was divided into two groups based on whether PBO was performed during the procedure. Comparative analyses were conducted concerning demographic characteristics, intraoperative and postoperative parameters, maternal and neonatal outcomes, PBO-related complications, and follow-up outcomes. Multivariate logistic regression analysis was further employed to discern the definitive associations between PBO and the risk of massive hemorrhage and hysterectomy.

The study included 285 PAS patients meeting the inclusion criteria, among whom 57 underwent PBO (PBO group), and 228 underwent cesarean section without PBO (control group). Despite differences in baseline characteristics, PBO intervention did not yield reductions in blood loss, hysterectomy rates, or postoperative hospital stays; however, it prolonged operation times and increased hospitalization costs (all P < 0.05). Notably, there were no significant differences in postoperative complications, neonatal outcomes, or follow-up outcomes (all P > 0.05). Nevertheless, patients undergoing PBO were at a higher risk of developing postoperative venous thrombosis (P = 0.001). Multivariate logistic regression analysis revealed that PBO significantly decreased the risk of massive hemorrhage (OR 0.289, 95% CI: 0.109–0.766, P = 0.013). Additionally, the grade of PAS and MRI evidence of S2 invasion were identified as significant risk factors for massive hemorrhage (OR: 6.232 and OR: 5.380, P < 0.001).

In conclusion, PBO holds promise in reducing massive hemorrhage in PAS patients undergoing cesarean section, although obstetricians should remain vigilant regarding potential complications associated with PBO. Furthermore, MRI evidence of S2 invasion and PAS grade may aid in identifying high-risk PAS patients who could benefit from PBO. Nonetheless, robust randomized controlled trials are warranted to conclusively establish the benefits of PBO and determine its necessity in PAS management.

Source: bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03049-4