Prophylactic endovascular hypogastric balloon catheters during cesarean hysterectomy for placenta accreta spectrum

The utility of prophylactic endoscopic hypogastric balloon placement in the management of placenta accreta spectrum (PAS) is debated. In this study, we review outcomes of surgical management of PAS with and without prophylactic balloon use at a single institution. This is a retrospective cohort study of consecutive viable singleton pregnancies with a confirmed pathologic diagnosis of PAS undergoing scheduled delivery from October 2018 through November 2020. In the T1 period, prophylactic endovascular hypogastric balloon catheters were placed in the operating room prior to the start of surgery. Balloons were inflated after neonate delivery and were deflated after hysterectomy completion. In the T2 period endovascular catheters were not used. In both time periods, all surgeries were performed by a dedicated multidisciplinary team using the same standardized surgical approach. The outcomes compared included the estimated blood loss (EBL), anesthesia duration and surgical complications. Comparisons were made using the Wilcoxon rank sum test and the Fisher exact test. 30 patients were included in the study (T1= 10; T2 =20). Findings are summarized in Table 1. The proportion of patients with placenta increta/percreta was 80% in both groups.The median EBL was 875 mL in T1 and 1000 mL in T2 (p= .84) (Figure 1). The proportion of patients requiring any RBC transfusion was 60% in T1 and 40% in T2 (p= .44). The proportion of patients requiring more than 4 units of RBC was 20% in T1 and 5% in T2 (p=.25). Surgical complications were observed in one patient in each group. Median operative anesthesia duration was 497 minutes in T1 and 296 minutes in T2 ( p < .01). The median length of stay was similar in both groups (6 days in T1 and 5.5 days in T2; p= .36). The use of prophylactic endovascular hypogastric balloon catheters was not associated with decreased blood loss, RBC transfusion or surgical complications, although results were limited by sample size. Catheter use was associated with increased duration of anesthesia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)