Efficacy of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control in patients with abnormally invasive placenta: a historical cohort study

Background: Patients with abnormally invasive placenta (AIP) are at high risk of massive postpartum hemorrhage. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct therapeutic strategy for hemostasis offers the obstetrician an alternative for the treatment of patients with abnormally invasive placenta. This study aimed to evaluate the role of REBOA for hemorrhage control in patients with AIP. Methods: : This is a historical cohort study with prospectively collected data at a single tertiary center between January 2014 to July 2021. In total, 364 singleton pregnant AIP patients with desire to preserve uterus and delivered were separated into two groups. The study group (balloon group, n=278) underwent REBOA during cesarean section, whereas the reference group (n=86) did not undergo REBOA. Surgical details and maternal outcomes were collected. The primary outcome was estimated blood loss and the rate of uterine preservation. Results: : A total of 278 [76.4%] participants experienced REBOA during cesarean section. Patients in the balloon group had less mean (SD) blood loss during cesarean section (1370.5 [752.0] ml vs. 3536.8 [1383.2] ml; P <.001) and had their uterus salvaged more often (264 [95.0%] vs. 23 [26.7%]; P <.001). These patients were also less likely to be admitted to the intensive care unit after delivery (168 [60.4%] vs. 67 [77.9%]; P =.003) and had less mean (SD) operating time (96.3 [37.6] min vs. 160.6 [45.5] min; P <.001). The rate of neonatal intensive care unit admission (176 [63.3%] vs. 52 [60.4%]; P =.70) and total mean (SD) maternal medical costs ($4925.4 [1740.7] vs. $5083.2 [1705.1]; P =0.13) did not differ between the groups. Conclusions: : As a robust hemorrhage-control technique, REBOA can reduce intraoperative hemorrhage in patients with AIP. The next step is to identify associated risk factors and define REBOA inclusion criteria to identify the subgroups of AIP patients who may gain more benefits.