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Cook Cervical Ripening Balloon for placenta accreta spectrum disorders with placenta previa: a novel approach to uterus preserving

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the efficacy of intrauterine inflated Cook Cervical Ripening Balloon (ICRB) in postpartum hemorrhage (PPH) management and fertility preserving for placenta accreta spectrum disorders with placenta previa (previa PAS).

Methods

At a tertiary referral center, 74 patients suffering with previa PAS were entered into this retrospective cohort study from January, 2016 to December, 2020, and were confirmed intraoperatively that abnormal invasive placenta reaches the cervical internal ostium and the upper part of the cervical canal. In control group (n = 39), the combination of infrarenal abdominal aorta balloon occlusion (IAABO) and longitudinal parallel compression suture to lower uterine segment were performed. In study group (n = 35), in addition to the aforementioned surgical techniques, ICRB was implemented at the cervical internal ostium and the outside of the cervix simultaneously.

Results

Use of ICRB significantly reduced the rate of peripartum hysterectomy (2.9% vs 30.4%, p = 0.001), and associated with a reduction in surgical time and duration of IAABO (mean 172.7 min vs 206.6 min, p = 0.017; median 30 min vs 40 min, p < 0.001). Use of ICRB significantly reduced the estimated amount of blood loss (median 2500 ml vs 4000 ml, p < 0.001), amounts of packed red blood cells and fresh–frozen plasma transfusion (median 6 U vs 13.5 U, p < 0.001; median 450 ml vs 1200 ml, p < 0.001), postoperative hospital stay and the incidence of oligomenorrhea postoperatively (median 5 days vs 6 days, p = 0.009; 13.8% vs 61.1% p = 0.001). No significant difference was observed between both the groups regarding the use of cryo and PLT, injury of urinary system, relaparotomy, admission to the ICU, postpartum hematocele in uterine cavity, and postoperative complications (including incidence rate of DVT, incidence rate of femoral thrombosis, puerperal morbidity, intrauterine infection, surgical site infection, and deep tissue infection).

Conclusion

ICRB was a simple, effective procedure for PPH management and fertility preserving in some previa PAS cases in which abnormal invasive placenta reaches the cervical internal ostium and the upper part of the cervical canal, in tandem with IAABO and compression suture.

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Funding

This work was supported by National Key Research and Development Program of China (2021YFC2701504), Medical and Health Science Technology Development Plan of Shandong Province (2018WS274).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China

    Yongzhong Gu, Yu Zhou, Lei Li, Hongyan Li, Shan Wang, Yunxia Wang & Changting Zuo

Authors
  1. Yongzhong Gu
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  2. Yu Zhou
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  3. Lei Li
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  4. Hongyan Li
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  5. Shan Wang
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  6. Yunxia Wang
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  7. Changting Zuo
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Contributions

YZG: manuscript writing, data collection, and data analysis; YZ: data collection; LL: data management; HYL: data analysis; S Wang: data management; YXW: manuscript writing/editing; CTZ: project development.

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Correspondence to Yunxia Wang or Changting Zuo.

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The authors declared that they have no conflicts of interest to this work.

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Gu, Y., Zhou, Y., Li, L. et al. Cook Cervical Ripening Balloon for placenta accreta spectrum disorders with placenta previa: a novel approach to uterus preserving. Arch Gynecol Obstet 306, 1979–1987 (2022). https://doi.org/10.1007/s00404-022-06476-6

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  • DOI: https://doi.org/10.1007/s00404-022-06476-6

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