A systematic review and meta-analysis of randomized controlled trials on the effects of internal iliac artery balloon occlusion in placenta previa and placenta accreta spectrum in reducing perioperative bleeding

Abstract

Background

Preoperative prophylactic balloon occlusion (PPBO) of internal iliac arteries (IIAs) in placenta previa and placenta accreta spectrum (PAS) has been widely used as a preventive adjuvant technique to reduce blood loss and to preserve fertility. Nevertheless, the efficacy of PPBO is based primarily on retrospective studies.

Objective

To examine the effectiveness of PPBO of the IIAs in placenta previa and PAS in reducing perioperative bleeding.

Search strategy

MEDLINE, EMBASE, Web-of-Science, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from their inception to July 2023.

Selection criteria

Randomized controlled trial (RCT) in which the use of PPBO on the IIAs was compared to non-use.

Data collection and analysis

The primary outcome was number of packed red blood cell (RBC) units transfused. We executed meta-analysis using a random-effects model. Quality of the studies was assessed using the Cochrane Risk-of-Bias tool. The GRADE criteria were used to assess evidence certainty.

Main results

Of 164 reports identified, three RCTs representing 167 women (83 and 84 in the intervention and control groups, respectively) were eligible. Mean number of RBC units transfused was 4.52 ± 1.70 and 3.70 ± 1.88 in the intervention and control groups, respectively (weighted mean difference, 1.04; 95% CI: 0.52–1.55; P = 0.001; I², 0%; low certainty evidence). Transfusion of other blood products was comparable. Incidence of postoperative fever was higher (P =  0.024) and hospitalization duration was longer (P = 0.001) in the intervention group compared to the control group.

Conclusions

Use of PPBO of the IIAs in placenta previa and PAS was associated with increase in number of RBC units transfused.