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The effect of prophylactic balloon occlusion in patients with placenta accreta spectrum: a Bayesian network meta-analysis

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  • Published:
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Abstract

Objectives

Placenta accreta spectrum (PAS) can induce severe life-threatening obstetric hemorrhage. Herein, we conducted a Bayesian network meta-analysis of previous studies to evaluate the relative benefits of different prophylactic balloon occlusion (PBO) procedures.

Methods

PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to July 2021. Blood loss volume, blood transfusion volume, and hysterectomy rate were regarded as the primary endpoints. The data were pooled using a Bayesian network and traditional pairwise meta-analysis.

Results

Fifty-nine articles with a total sample size of 5150 patients were included. Compared with no PBO (non-PBO) intervention, PBO of the abdominal aorta (PBOAA, mean difference(MD) − 1.02, 95% credible interval (CrI) − 1.4 to − 0.67), common iliac artery (PBOCIA, MD − 0.84; 95%CrI − 1.36 to − 0.06) and internal iliac artery (PBOIIA, MD − 0.42; 95%CrI − 0.72 to − 0.13) significantly lowered blood loss volume, with PBOAA being more effective than PBOIIA (MD − 0.60; 95%CrI − 1.05 to − 0.17). PBOAA and PBOIIA also significantly decreased blood loss volume (MD − 2.33; 95%CrI − 3.74 to − 0.94, MD − 1.57; 95%CrI − 2.77 to − 0.47 respectively) and hysterectomy rate (OR 0.31; 95%CrI 0.16 to 0.54, OR 0.53; 95%CrI 0.29 to 0.92 respectively). PBOAA has the highest probability of being more effective in reducing the blood loss volume, blood transfusion volume, and hysterectomy rate.

Conclusions

Performing PBOAA, PBOCIA, or PBOIIA in PAS patients is an effective way to minimize blood loss volume, while PBOAA and PBOIIA also reduce blood transfusion volume and hysterectomy rate. PBOAA is a notably more effective strategy to reduce blood loss volume than PBOIIA.

Key Points

• PBOAA, PBOCIA, and PBOIIA procedures can significantly reduce the blood loss volume compared to non-PBO intervention in PAS patients, of which PBOAA was more effective than the PBOIIA procedure.

• PBOAA and PBOIIA could significantly reduce the blood transfusion volume and hysterectomy rate in contrast to the non-PBO intervention in patients with PAS.

• According to our statistical treatment ranking, PBOAA was statistically superior in reducing blood transfusion volume, blood transfusion volume, and hysterectomy rate than other PBO procedures.

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Abbreviations

CI:

Confidence interval

CrI:

Credibility interval

DIC:

Deviance information criterion

MD:

Mean difference

OR:

Odds ratios

PAS:

Placenta accreta spectrum

PBO:

Prophylactic balloon occlusion

PBOAA:

Prophylactic balloon occlusion of the abdominal aorta

PBOCIA:

Prophylactic balloon occlusion of the common iliac artery

PBOIIA:

Prophylactic balloon occlusion of the internal iliac arteries

PBOUA:

Prophylactic balloon occlusion of the uterine artery

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Acknowledgements

The authors gratefully acknowledge the financial supports of the Science and Technology Program of Science and Technology Commission Shanghai Municipality under Grant numbers 19441907000.

Funding

This study has received funding from the Science and Technology Program of Science and Technology Commission Shanghai Municipality under Grant numbers 19441907000.

Author information

Author notes

  1. Mengjun Dai and Fangqin Zhang contributed equally to this work.

  2. Yidan Chen and Xuebin Zhang also contributed equally to this work.

Authors and Affiliations

  1. Department of Interventional Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, 200127, China

    Mengjun Dai, Fangqin Zhang, Guangxin Jin & Xuebin Zhang

  2. School of Clinical Medicine, North China University of Science and Technology, Tangshan, 063210, China

    Kangbo Li

  3. Department of Rheumatology & Immunology, West China Hospital of Sichuan University, Sichuan Province, Chengdu, 610041, China

    Yidan Chen

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  1. Mengjun Dai
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Corresponding authors

Correspondence to Yidan Chen or Xuebin Zhang.

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Guarantor

The scientific guarantor of this publication is Xuebin Zhang.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Approval from the institutional animal care committee was not required because this is a meta-analysis based on published studies.

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Institutional Review Board approval was not required because this is a meta-analysis based on published studies.

Methodology

• Bayesian network meta-analysis.

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Dai, M., Zhang, F., Li, K. et al. The effect of prophylactic balloon occlusion in patients with placenta accreta spectrum: a Bayesian network meta-analysis. Eur Radiol 32, 3297–3308 (2022). https://doi.org/10.1007/s00330-021-08423-6

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  • DOI: https://doi.org/10.1007/s00330-021-08423-6

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