The management of placenta accreta spectrum with internal iliac artery balloon occlusion: a systematic review and meta analysis

Background Placenta Accreta Spectrum (PAS) is characterised by the invasion of the chorionic villi into the myometrium. It arises most commonly from previous caesarean sections (CS) in patients, wherein lower segment scars interrupt the decidualisation of the placenta when preparing for a foetus. Internal Iliac Artery Balloon Occlusion provide a way to block the blood flow to the uterus and in turn improve clinical outcomes for patients with PAS disorders. This review aims to determine the effectiveness of the balloon occlusion technique in reducing blood loss in patients with PAS, the resulting neonatal outcomes, and the proportion of previous CS in PAS patients. Methods A systematic review was conducted by searching 4 databases for keywords. A meta-analysis was performed using OpenMeta-Analyst software using arscine transformed proportion, binary random effects and maximum likelihood, as well as RevMan web software, using a continuous, arm-level model. Results Fourteen eligible studies were included with data from a total of 927 patients. A statistically significant difference was found for all analyses. A decreased amount of estimated blood loss was found in the balloon group against the control group, neonates were found to have higher 5’ Apgar scores in the control group rather than the balloon group, and a majority of patients were found to have had at least one previous caesarean section. Conclusion This review provides evidence that the balloon occlusion technique can provide PAS patients with better clinical outcomes in relation to the amount of blood lost during delivery.