Abstract
INTRODUCTION: This study aimed to assess the efficacy and risks of prophylactic internal iliac artery balloon occlusion (IIABO) in managing placenta accreta spectrum (PAS) disorders and to discuss the clinical implications of this technique. METHODS: We retrospectively analyzed 616 confirmed patients with PAS, including placenta accreta, increta, and percreta, between December 2013 and December 2022. Patients were divided into two groups based on whether or not they received prophylactic IIABO (balloon group, n = 310; no balloon group, n = 306). The primary outcomes were intraoperative bleeding volume and operation duration. Secondary outcomes included transfusion volumes, arterial injury rates, thrombosis, lower extremity ischemia, and hospitalization costs. The diagnosis of PAS was based on ultrasonography and verified by MRI when needed. Clinical management, surgical outcomes, complications, and hospitalization-related outcomes were compared between the groups using independent sample t tests, Mann‒Whitney U tests, or Fisher's exact tests, as appropriate. RESULTS: The balloon group had less intraoperative bleeding and lower transfusion volumes, with a significant difference only between placenta percreta patients (P = 0.03), who also demonstrated a shorter operation duration (P = 0.02). No significant differences were observed in demographics, placenta removal, hysterectomy, or obstetric complications between the groups. The balloon group had greater rates of arterial injury, thrombosis, and lower extremity ischemia (without significant differences) and experienced greater hospitalization costs (P = 0.01). The balloon blocking time significantly increased from the placenta accreta to placenta increta subgroups and then to the placenta percreta subgroup (P = 0.03). CONCLUSIONS: Prophylactic IIABO can be beneficial for reducing intraoperative bleeding and operation duration in selected PAS patients, particularly those with placenta percreta. However, the increased vascular complications and costs must be weighed carefully. Further studies should focus on optimizing patient selection and minimizing complications.