Comparison of the safety and efficacy of PABO above or below the ovarian artery during cesarean delivery in patients with coexisting placenta accreta and placenta previa

Abstract

Purpose: To determine the effect of ovarian arteries on the use of prophylactic abdominal aortic balloon occlusion (PABO) in patients with coexisting placenta accreta and placenta previa.

Methods: Thirty-two pregnant women with coexisting placenta accreta and placenta previa treated with PABO in our hospital during 2013-2020 were retrospectively analyzed. The patients were divided into two groups: one with infra-renal abdominal aortic balloon occlusion above the ovarian artery (Group A, n = 15) and the other with occlusion below the ovarian artery (Group B, n = 17). Medical records and relevant imaging of all patients were reviewed. All Cesarean deliveries were scheduled and we decided to perform hysterectomy based on the surgical findings.

Results: Patients in both groups were similar in terms of age, gravidity history, and status of placenta. Regarding their outcomes, estimated blood loss was not significantly different in both groups, although it was lower in Group B than in Group A (3949.5 vs. 4333.8 ml). The other tested parameters did not show any difference. The uterus was preserved in 13 (41%) patients. No access-related or balloon occlusion-related complications occurred in either group.

Conclusions: PABO was safe. However, the balloon location (above or below the ovarian arteries) did not influence the outcomes. Further evaluation and prospective studies are required to evaluate the safety and efficacy of balloon occlusion above or below the ovarian artery in patients with coexisting placenta accreta and placenta previa.

Keywords: CTCAE, common terminology criteria for adverse events; EBL, estimated blood loss; MAP, morbidly adherent placenta; Ovarian artery; PABO, prophylactic abdominal aortic balloon occlusion; Placenta accreta; Placenta previa; Prophylactic abdominal aortic balloon occlusion (PABO); US, ultrasound.

Fig. 1

Coexisting placenta accreta and placenta previa. Sagittal MR image (T2-weighted image) showing the abnormal placental tissue abutting the bladder wall (arrow).

Fig. 2

Prophylactic balloon occlusion of the intra-abdominal aorta in patients with coexisting placenta accreta and placenta previa. (a) A digital subtraction abdominal aortogram was performed via the right femoral approach prior to the placement of an aortic occlusion balloon. Angiography showed the renal artery opening (circle), ovarian arteries (arrows), and position of the common iliac artery bifurcation (star). (b) In Group A, the occlusion balloon was placed between the renal and ovarian arteries. (c) In Group B, the occlusion balloon was placed between the ovarian artery and bifurcation.