MRI-Based Risk Factors for Adverse Maternal Outcomes in Prophylactic Aortic Balloon Occlusion for Placenta Accreta Spectrum and Placenta Previa

Abstract

Purpose: We previously reported that T2 dark bands and placental bulges observed in magnetic resonance imaging (MRI) can predict adverse maternal outcomes in patients with placenta accreta spectrum (PAS) and placenta previa undergoing prophylactic balloon occlusion of the internal iliac artery. On the other hand, the risk factors associated with the use of prophylactic aortic balloon occlusion (PABO) have not been sufficiently investigated. This retrospective study aimed to identify MRI-based risk factors associated with adverse maternal outcomes in the context of PABO during a cesarean section (CS) for PAS and placenta previa. Materials and Methods: Ethical approval was obtained for a data analysis of 40 patients diagnosed with PAS and placenta previa undergoing PABO during a CS. Clinical records, MRI features, and procedural details were examined. The inclusion criteria for the massive bleeding group were as follows: an estimated blood loss (EBL) > 2500 mL, packed red blood cell (pRBC) transfusion (>4 units), and the need for a hysterectomy or transcatheter arterial embolization after delivery. The massive and nonmassive bleeding groups were compared. Results: Among the 22 patients, those in the massive bleeding group showed significantly longer operative durations, a higher EBL (p < 0.001), an increased number of pRBC transfusions (p < 0.001), and prolonged postoperative hospital stays (p < 0.05). T2 dark bands on MRI were significant predictors of adverse outcomes (p < 0.05). Conclusion: T2 dark bands on MRI were crucial predictors of adverse maternal outcomes in patients undergoing PABO for PAS or placenta previa during a CS. Recognizing these MRI features proactively indicates the need for effective management strategies during childbirth and emphasizes the importance of further prospective studies to validate and enhance these findings.