Analysis of the Clinical Efficacy of Prophylactic Iliac Artery Balloon Occlusion for Early Postpartum Hemorrhage Following Cesarean Delivery

Analysis of the Clinical Efficacy of Prophylactic Iliac Artery Balloon Occlusion for Early Postpartum Hemorrhage Following Cesarean Delivery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the Clinical Efficacy of Prophylactic Iliac Artery Balloon Occlusion for Early Postpartum Hemorrhage Following Cesarean Delivery Zhang Peijun, Wang Yuting This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7698461/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objective To investigate the clinical efficacy of prophylactic iliac artery balloon occlusion in the management of early postpartum hemorrhage during cesarean delivery. Methods A retrospective analysis was conducted on 140 patients who developed postpartum hemorrhage following cesarean section and were admitted to the Intensive Care Unit of the Women's Hospital, Zhejiang University School of Medicine between January 2020 and December 2023. Among them, 35 patients who underwent preoperative placement of bilateral iliac artery balloons were designated as the observation group, while 105 patients without balloon placement served as the control group. Statistical analyses were performed to compare the differences in biochemical indicators and clinical outcomes between the two groups. Results No statistically significant differences were observed between the two groups in terms of biochemical indicators (serum creatinine, total bilirubin, alanine aminotransferase, aspartate aminotransferase) or clinical outcome measures (mean arterial pressure, acute kidney injury, total/subtotal hysterectomy, thrombotic events, and length of ICU stay) ( P > 0.05). However, significant differences were identified in platelet count, volume of postpartum hemorrhage, albumin usage, SOFA score, APACHE II score, and total medical costs ( P < 0.05). Conclusion Preoperative placement of iliac artery balloons before cesarean delivery can reduce postpartum blood loss and lower the risk of maternal organ dysfunction and mortality. However, it is also associated with increased medical costs and a higher rate of central venous catheterization. Iliac artery balloon occlusion technique Postpartum hemorrhage Clinical outcome Organ Dysfunction Introduction Postpartum hemorrhage (PPH) is defined as a cumulative blood loss of ≥ 1000 mL within 24 hours after delivery (either vaginal or cesarean), or blood loss accompanied by signs and symptoms of hypovolemia [1] . It remains the leading cause of maternal mortality worldwide [ 2 ] . Postpartum blood loss is a major risk factor for maternal organ dysfunction. Consequently, the key objectives in the perioperative management of high-risk patients are to reduce blood loss, minimize the incidence of perioperative organ injury, and decrease mortality.With the advancement of interventional radiology, uterine artery embolization and balloon occlusion techniques have been increasingly used in the management of intractable postpartum hemorrhage. These two approaches differ in their timing of application: uterine artery embolization is primarily employed as a rescue therapy after delivery, whereas balloon occlusion can be utilized both antenatally and postpartum. Based on the anatomical level of vascular occlusion, balloon occlusion techniques can be classified into three types: bilateral internal iliac artery balloon occlusion, bilateral common iliac artery balloon occlusion, and abdominal aortic balloon occlusion.This study retrospectively analyzed the clinical data of 140 patients diagnosed with postpartum hemorrhage following cesarean section and admitted to the Intensive Care Unit of the Women's Hospital, Zhejiang University School of Medicine. The aim was to evaluate the impact of preoperative placement of iliac artery balloons (either bilateral common iliac artery balloons or bilateral internal iliac artery balloons) combined with intraoperative balloon inflation for blood occlusion on clinical outcomes, particularly focusing on organ function injury resulting from postpartum hemorrhage. Methods 1.1 Study Participants Patients admitted to the Intensive Care Unit of the Women's Hospital, Zhejiang University School of Medicine due to postpartum hemorrhage following cesarean delivery between January 2020 and December 2023 were included in this study. Based on the predefined inclusion and exclusion criteria, a total of 140 cases were enrolled. Among them, 35 patients underwent preoperative placement of bilateral iliac artery balloons, while 105 patients did not receive balloon placement prior to cesarean section. This study was approved by the Ethics Committee of the Women's Hospital, School of Medicine，Zhejiang University (Approval No. IRB-20240152-R). 1.2 Inclusion and Exclusion Criteria Inclusion Criteria ：（1）Gestational age ≥ 28 weeks.（2）Patients who underwent cesarean delivery at this institution and were transferred to the ICU within 24 hours postpartum.（3）Patients who underwent cesarean delivery at an external institution and were transferred to the ICU of our hospital within 24 hours postpartum.（4）Diagnosis of postpartum hemorrhage meeting the criteria outlined in the "Guidelines for the Prevention and Management of Postpartum Hemorrhage (2023)": estimated blood loss ≥ 1000 mL within 24 hours following cesarean delivery, or presence of signs/symptoms of hypovolemia secondary to blood loss.（5）Meeting the criteria for preoperative intravascular balloon placement as outlined in the Chinese Expert Consensus on Standardized Techniques for Temporary Intravascular Balloon Occlusion during Cesarean Delivery in Cases of Placenta Accreta Spectrum [3] : ①Preoperative ultrasound diagnosis of placenta previa with an implantation score ≥ 6 [4-5] . ②Magnetic resonance imaging (MRI) demonstrating ill-defined borders between placental tissue and the myometrium or discontinuity of the myometrium, leading to a diagnosis of placenta accreta入. ③Intraoperative confirmation of placenta accreta during cesarean delivery with failure to achieve hemostasis using conventional suturing techniques. Exclusion Criteria ：（1）Patients who underwent medical induction of labor or had intrauterine fetal demise.（2）Patients with incomplete medical records. 1.3 Methods Patients were divided into two groups based on whether preoperative bilateral iliac artery balloon occlusion was performed: those who underwent the procedure (n=35) were assigned to the observation group, and those who did not (n=105) were assigned to the control group. The following biochemical and clinical outcome measures were compared between the two groups: Biochemical indicators :Serum creatinine, total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin levels, and platelet count. Clinical outcome indicators :Volume of postpartum blood loss、Mean arterial pressure、Amount of albumin administered、Central venous catheterization rate、Sequential Organ Failure Assessment (SOFA) score、Acute Physiology and Chronic Health Evaluation II (APACHE II) score、Incidence of acute kidney injury (AKI)、Rate of total or subtotal hysterectomy、Occurrence of thrombotic events、Length of ICU stay、Total medical costs，Statistical analyses were performed to assess differences in these parameters between the two groups. 1.4 Statistical Analysis All statistical analyses were performed using SPSS version 25.0. Continuous variables with normal distribution were expressed as mean ± standard deviation and compared using the independent samples t-test. Continuous variables that did not follow a normal distribution were presented as median and interquartile range [M (P25, P75)] and compared using the Mann-Whitney U test. Categorical variables were dichotomized and analyzed using the Chi-square test, continuity-corrected Chi-square test, or Fisher’s exact test, as appropriate; results were reported as rates or proportions (%). A two-sided p-value < 0.05 was considered statistically significant for all tests. Result 2.1 Analysis of Clinical Biochemical Indicators This study included a total of 140 parturients who developed postpartum hemorrhage after cesarean section. Among them, 35 patients underwent preoperative placement of bilateral iliac artery (common iliac artery or internal iliac artery) balloon occlusion during cesarean section, while 105 patients did not receive preoperative iliac artery balloon occlusion. There were no statistically significant differences between the two groups in clinical biochemical indicators such as serum creatinine ( P =0.639), total bilirubin ( P =0.348), alanine aminotransferase ( P =0.110), and aspartate aminotransferase ( P =0.468). However, statistically significant differences were observed between the two groups in albumin levels ( P =0.033) and platelet count ( P =0.036). Details are shown in Table 1 . 2.2 Analysis of Clinical O utcome I ndicators Statistically significant differences were observed between the groups in the following clinical outcome measures: postpartum blood loss ( P =0.032), albumin usage ( P =0.004), central venous catheterization rate ( P <0.001), SOFA score ( P =0.014), APACHE II score ( P =0.020), and total medical costs ( P <0.001). In contrast, no statistically significant differences were found in Mean Arterial Pressure (MAP) ( P =0.644), incidence of acute kidney injury ( P =0.314), hysterectomy/subtotal hysterectomy rate ( P =1.000), occurrence of thrombotic events ( P =0.083), or length of ICU stay ( P =0.958). Details are shown in Table 2 . Discussion 3.1 Analysis of the Effectiveness of Iliac Artery Balloon Occlusion in Postpartum Hemorrhage With the adjustment of fertility policies, the proportion of pregnant women with conditions such as advanced maternal age and scarred uterus has increased, leading to a rise in cases of pernicious placenta previa accompanied by placenta accreta. Pernicious placenta previa carries the potential risk of catastrophic hemorrhage [2] .Literature reports indicate that the average blood loss in women with pernicious placenta previa and placenta accreta ranges from 3,000 to 5,000 mL, with approximately 10% of parturients experiencing intraoperative hemorrhage exceeding 10,000 mL during cesarean delivery [6] ，The mortality rate is as high as 7% [7] .For intractable massive postpartum hemorrhage following cesarean section, hysterectomy is often the last resort. However, this procedure results in the permanent loss of fertility, causing both psychological and physical trauma to the mother. With advances in interventional radiology, iliac artery balloon occlusion technique has been increasingly used in high-risk patients with postpartum hemorrhage. Nevertheless, its therapeutic efficacy remains a subject of ongoing debate.Studies have indicated that for high-risk populations susceptible to postpartum hemorrhage, preoperative placement of bilateral iliac artery (common or internal iliac artery) balloons during cesarean section, followed by intraoperative balloon inflation to temporarily block blood flow and reduce uterine perfusion, can maintain a clear surgical field and decrease both intraoperative blood loss and transfusion requirements [8] .In a 2018 study published by Gulino et al. [9] , it was also indicated that the perioperative prophylactic placement of balloon catheters not only reduces intraoperative blood loss, the need for hemostatic interventions during the perioperative period, and the volume of red blood cell transfusions, but also decreases the rate of hysterectomy.In this study, the observation group exhibited significantly less intraoperative blood loss during cesarean section compared to the control group. Additionally, the observation group demonstrated higher postoperative platelet counts and albumin levels, along with lower albumin consumption. The differences between the two groups in postpartum blood loss, platelet count, albumin level, and albumin usage were statistically significant ( P =0.032、 P =0.036、 P =0.033、 P =0.004).Furthermore, the observation group showed lower SOFA and APACHE II scores after ICU admission, indicating a reduced risk of postoperative organ dysfunction and maternal mortality. These differences were also statistically significant ( P =0.014、 P =0.020). However, a study by Feng et al. [10] presented a contrasting view, indicating that preoperative placement of iliac artery balloons does not reduce maternal blood loss or hysterectomy rates. In the present study, no cases of acute kidney injury (AKI) occurred in the observation group, while one case underwent total/subtotal hysterectomy. In contrast, three cases of AKI and three hysterectomies were recorded in the control group. However, possibly due to the limited sample size, the differences in the incidence of acute kidney injury ( P =0.573) and hysterectomy ( P =1.000) between the two groups were not statistically significant. 3.2 Analysis of the Disadvantages of Iliac Artery Balloon Occlusion Technique Although pre-placement of iliac artery balloon occlusion is a minimally invasive interventional technique, it still carries unavoidable complications and disadvantages. Studies have shown that the overall complication rate of bilateral internal iliac artery balloon occlusion ranges from 6% to 16%, with thrombosis being the most common complication.In a retrospective study, Dilauro et al. [11] reported that among 132 parturients with placenta accreta who underwent preoperative internal iliac artery balloon occlusion placement, 7 cases developed postpartum thrombosis, representing an incidence rate of approximately 5.3%. In the present study, 35 parturients received preoperative bilateral iliac artery balloon occlusion placement. Vascular ultrasound examinations of both lower limbs prior to discharge showed no cases of mural thrombosis, resulting in a thrombosis incidence rate of 0%.The etiology of post-endovascular puncture thrombosis is complex and involves multiple factors. These include disruption of vascular endothelial integrity due to the puncture technique, endothelial injury caused by balloon expansion and compression, the inherent hypercoagulable state of pregnancy, and prolonged lower limb immobilization. These factors can collectively contribute to the formation of in-situ thrombosis at the puncture site and deep vein thrombosis in the distal lower limbs. Early and aggressive anticoagulation therapy, combined with physical interventions, may help reduce the incidence of peripartum thrombotic events.An ideal vascular injury assessment method should be highly accurate, safe, non-invasive, and easily repeatable [12] . Color Doppler flow imaging, which displays blood flow signals using color differentiation [13] , is a commonly used auxiliary examination tool. Computed tomography angiography (CTA) offers higher accuracy than color Doppler ultrasound; however, the iodine-based contrast agents used in CTA may affect breastfeeding.Digital Subtraction Angiography (DSA) remains the gold standard for definitive diagnosis. In addition, parturients undergoing preoperative iliac artery balloon placement are all at high risk of postpartum hemorrhage, and most undergo central venous catheter insertion before surgery to ensure vascular access patency in case of major hemorrhagic events. The observation group had a higher rate of central venous catheterization compared to the control group. Finally, preoperative placement of iliac artery balloons increases medical costs to some extent, and the difference in medical expenses between the observation and control groups was statistically significant (P < 0.001). Given these disadvantages, thorough discussion and strict adherence to indications are essential when considering the placement of iliac artery balloon catheters. 3.3 Discussion on the Indications and Safety of Iliac Artery Balloon Occlusion Technology During preoperative placement of bilateral iliac artery balloon catheters, the fetus is exposed to a certain amount of radiation. Studies have reported that the average radiation dose for bilateral internal iliac artery balloon catheter placement ranges from 20 to 45 mGy [14] . In our hospital, the interventional radiology department has developed a high level of proficiency in this procedure, resulting in short operation times and radiation doses consistently kept below 50 mGy. International research indicates that the risk of radiation-induced fetal malformations significantly increases only when the radiation dose exceeds 150 mGy [15] . Since the intraoperative radiation exposure is well below this 150 mGy teratogenicity threshold, preoperative placement of iliac artery balloon catheters prior to cesarean delivery is considered safe for the fetus.Iliac artery balloon occlusion technology is currently primarily used in patients with morbidly adherent placenta (e.g., placenta accreta spectrum disorders) as a preventive intervention to mitigate hemorrhage during cesarean delivery. It can also be employed as a rescue therapy for managing refractory postpartum hemorrhage.However, not all pregnant women diagnosed with placenta accreta require preoperative iliac artery balloon occlusion. Both the Royal College of Obstetricians and Gynaecologists (RCOG) Guidelines [16] and the International Society for Abnormally Invasive Placenta (IS-AIP) Guidelines [17] explicitly recommend against the routine use of prophylactic iliac artery balloon occlusion in all cases of placenta accreta.In the "Chinese Expert Consensus on Technical Standards for Temporary Intravascular Balloon Occlusion during Cesarean Delivery in Cases of Placenta Accreta" published by Han Xinwei et al. [3], the indications for preoperative iliac artery balloon occlusion include:Ultrasonographic diagnosis of placenta previa with accreta scoring ≥6, or Magnetic resonance imaging (MRI) showing an unclear boundary between placental tissue and the myometrium or discontinuity of the myometrium.Given the ongoing debate regarding the efficacy of preoperative iliac artery balloon occlusion in preventing postpartum hemorrhage, there is currently no unified national standard in China for its use prior to cesarean delivery. Our institution primarily follows the inclusion criteria outlined in the Chinese Expert Consensus on Technical Standards for Temporary Intravascular Balloon Occlusion during Cesarean Delivery in Cases of Placenta Accreta . After thorough communication with the parturient and her family, the procedure is performed by interventional radiologists.Similarly, there are no standardized criteria for the use of rescue iliac artery balloon occlusion following delivery. In such cases, rescue uterine artery embolization is generally preferred. In this study, all 35 parturients who underwent iliac artery balloon occlusion received the procedure preoperatively. Nevertheless, the indications and effectiveness of prophylactic balloon occlusion in high-risk populations for postpartum hemorrhage still require further validation. In summary, preoperative placement of iliac artery balloon catheters prior to cesarean delivery may reduce postpartum blood loss, lower the risk of maternal organ dysfunction, and decrease maternal mortality. However, it may also increase medical costs and the rate of central venous catheterization. Therefore, thorough discussion and individualized assessment are essential when considering this intervention. Limitations: This study is a single-center retrospective analysis with a relatively small sample size. Further clinical studies with larger cohorts are needed to validate these findings. Declarations Ethics approval and consent to participate: This study was approved by the Ethics Committee of the Women's Hospital, School of Medicine,Zhejiang University (Approval No. IRB-20240152-R). And agree to waive informed consent. Consent for publication: Not Applicable. Availability of data and materials: Yes. All the data are truly available. Competing interests : NO. Funding: NO. Authors' contributions: Zhang Peijun was directly involved in the research design, data collection, statistical analysis, and article writing. Wang Yuting participated in data collection and organization. Acknowledgement: Not applicable References Committee on Practice Bulletins-Obstetrics. Practice bulletin 183: postpartum hemorrhage[J]. Obstet Gynecol. 2017;130:e168–86. Obstetrics, Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association. ; Chinese Society of Perinatal Medicine, Chinese Medical Association. [Guidelines for prevention and treatment of postpartum hemorrhage (2023)]. Zhonghua Fu Chan Ke Za Zhi. 2023;58(6):401–409. Chinese. 10.3760/cma.j.cn112141-20230223-00084 . PMID: 37357598. Han X, Wang Y, Zhang K. Chinese Expert Consensus on Technical Specifications for Temporary Intravascular Balloon Occlusion during Cesarean Section for Placenta Accreta [J]. J Interventional Radiol 2023,32(05):415–20. Yun W, Lijuan W, Wenchuan W, et al. Application value of ultrasound scoring and magnetic resonance imaging in the diagnosis of placenta accreta spectrum disorders [J]. Chin J Ultrasound Med. 2022;38(10):1142–4. Chong Y, Zhang A, Wang Y, Chen Y, Zhao Y. An ultrasonic scoring system to predict the prognosis of placenta accreta: A prospective cohort study. Med (Baltim). 2018;97(35):e12111. 10.1097/MD.0000000000012111 . PMID: 30170439; PMCID: PMC6392640. Tan CH, Tay KH, Sheah K, et al. Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta [J]. AJR Am J Roentgenol. 2007;189:1158–63. Buca D, Liberati M, Calì G. et a1. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol. 2018;52(3):304–9. MURAYAMA Y, SEKI H. TAKEDA S.Intra-arterial balloon occlusion tO reduce operative Needing for placenta prev-ia accreta spectrum[J]. Surg J. 2021;7(1):11–9. Gulino FA, Guardo FD, Zambrotta E, et al. Placenta accreta and balloon catheterization: the experience of a single center and an update of latest evidence of literature[J]. Arch Gynecol Obstet. 2018;298(1):83–8. Feng S, Liao Z, Huang H. Effect of prophylactic placement of internal iliac artery balloon catheters on outcomes of women with placenta accreta: an impact study. Anaesthesia. 2017;72(7):853–8. Dilauro MD, Dason S, Athreya S. Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: literature review and analysis[J]. Clin Radiol. 2012;67(6):515–20. Zheng Xi. Color Doppler Ultrasonography Diagnosis of Limb Artery Injury and Analysis of Misdiagnosis and Missed Diagnosis Causes [J]. Mod Med Imaging. 2024;33(09):1749–51. Liang Y, Jianbo G, Junyan M, et al. Diagnostic efficacy and imaging characteristics of high-frequency ultrasound in limb skeletal muscle injury [J]. J Kunming Med Univ. 2021;42(10):157–61. Mengyao L, Li Hejiang. Application of Internal Iliac Artery Balloon Occlusion in the Treatment of Vaginal Premature Placenta [J]. Int J Obstet Gynecol. 2020;47(02):173–7. Thabet A, Kalva SP, Liu B, et al. Interventional radiology in pregnancy complications: indications, technique, and methods for minimizing radiation exposure[J]. Radiographics. 2012;32(1):255–74. Jauniaux E, Alfirevic Z, Bhide AG, et al. Placenta Praevia and Placenta Accreta: Diagnosis and Management:Green-top Guideline [J]. No. 27a. BJOG. 2019;126(1):e1–48. Collins SL, Alemdar B, et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta [J]. Am J Obstet Gynecol. 2019;220(6):511–26. Tables Tables 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 28 Nov, 2025 Reviewers agreed at journal 14 Nov, 2025 Reviewers invited by journal 11 Nov, 2025 Editor assigned by journal 15 Oct, 2025 Submission checks completed at journal 12 Oct, 2025 First submitted to journal 12 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Delivery","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePostpartum hemorrhage (PPH) is defined as a cumulative blood loss of \u0026ge; 1000 mL within 24 hours after delivery (either vaginal or cesarean), or blood loss accompanied by signs and symptoms of hypovolemia\u003csup\u003e\u0026nbsp;[1]\u003c/sup\u003e. It remains the leading cause of maternal mortality worldwide\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Postpartum blood loss is a major risk factor for maternal organ dysfunction. Consequently, the key objectives in the perioperative management of high-risk patients are to reduce blood loss, minimize the incidence of perioperative organ injury, and decrease mortality.With the advancement of interventional radiology, uterine artery embolization and balloon occlusion techniques have been increasingly used in the management of intractable postpartum hemorrhage. These two approaches differ in their timing of application: uterine artery embolization is primarily employed as a rescue therapy after delivery, whereas balloon occlusion can be utilized both antenatally and postpartum. Based on the anatomical level of vascular occlusion, balloon occlusion techniques can be classified into three types: bilateral internal iliac artery balloon occlusion, bilateral common iliac artery balloon occlusion, and abdominal aortic balloon occlusion.This study retrospectively analyzed the clinical data of 140 patients diagnosed with postpartum hemorrhage following cesarean section and admitted to the Intensive Care Unit of the Women\u0026apos;s Hospital, Zhejiang University School of Medicine. The aim was to evaluate the impact of preoperative placement of iliac artery balloons (either bilateral common iliac artery balloons or bilateral internal iliac artery balloons) combined with intraoperative balloon inflation for blood occlusion on clinical outcomes, particularly focusing on organ function injury resulting from postpartum hemorrhage.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eStudy Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients admitted to the Intensive Care Unit of the Women\u0026apos;s Hospital, Zhejiang University School of Medicine due to postpartum hemorrhage following cesarean delivery between January 2020 and December 2023 were included in this study. Based on the predefined inclusion and exclusion criteria, a total of 140 cases were enrolled. Among them, 35 patients underwent preoperative placement of bilateral iliac artery balloons, while 105 patients did not receive balloon placement prior to cesarean section. This study was approved by the Ethics Committee of the Women\u0026apos;s Hospital, School of Medicine，Zhejiang University (Approval No. IRB-20240152-R).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eInclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e：（1）Gestational age \u0026ge; 28 weeks.（2）Patients who underwent cesarean delivery at this institution and were transferred to the ICU within 24 hours postpartum.（3）Patients who underwent cesarean delivery at an external institution and were transferred to the ICU of our hospital within 24 hours postpartum.（4）Diagnosis of postpartum hemorrhage meeting the criteria outlined in the \u0026quot;Guidelines for the Prevention and Management of Postpartum Hemorrhage (2023)\u0026quot;: estimated blood loss \u0026ge; 1000 mL within 24 hours following cesarean delivery, \u003cstrong\u003eor\u003c/strong\u003e presence of signs/symptoms of hypovolemia secondary to blood loss.（5）Meeting the criteria for preoperative intravascular balloon placement as outlined in the \u003cem\u003eChinese Expert Consensus on Standardized Techniques for Temporary Intravascular Balloon Occlusion during Cesarean Delivery in Cases of Placenta Accreta Spectrum\u003c/em\u003e\u003csup\u003e[3]\u003c/sup\u003e: ①Preoperative ultrasound diagnosis of placenta previa with an implantation score \u0026ge; 6\u003csup\u003e[4-5]\u003c/sup\u003e. ②Magnetic resonance imaging (MRI) demonstrating ill-defined borders between placental tissue and the myometrium or discontinuity of the myometrium, leading to a diagnosis of placenta accreta入. ③Intraoperative confirmation of placenta accreta during cesarean delivery with failure to achieve hemostasis using conventional suturing techniques.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e：（1）Patients who underwent medical induction of labor or had intrauterine fetal demise.（2）Patients with incomplete medical records.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were divided into two groups based on whether preoperative bilateral iliac artery balloon occlusion was performed: those who underwent the procedure (n=35) were assigned to the observation group, and those who did not (n=105) were assigned to the control group. The following biochemical and clinical outcome measures were compared between the two groups:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBiochemical indicators\u003c/strong\u003e:Serum creatinine, total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin levels, and platelet count.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical outcome indicators\u003c/strong\u003e:Volume of postpartum blood loss、Mean arterial pressure、Amount of albumin administered、Central venous catheterization rate、Sequential Organ Failure Assessment (SOFA) score、Acute Physiology and Chronic Health Evaluation II (APACHE II) score、Incidence of acute kidney injury (AKI)、Rate of total or subtotal hysterectomy、Occurrence of thrombotic events、Length of ICU stay、Total medical costs，Statistical analyses were performed to assess differences in these parameters between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using SPSS version 25.0. Continuous variables with normal distribution were expressed as mean \u0026plusmn; standard deviation and compared using the independent samples t-test. Continuous variables that did not follow a normal distribution were presented as median and interquartile range [M (P25, P75)] and compared using the Mann-Whitney U test. Categorical variables were dichotomized and analyzed using the Chi-square test, continuity-corrected Chi-square test, or Fisher\u0026rsquo;s exact test, as appropriate; results were reported as rates or proportions (%). A two-sided p-value \u0026lt; 0.05 was considered statistically significant for all tests.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003e2.1 \u003cstrong\u003eAnalysis of Clinical Biochemical Indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included a total of 140 parturients who developed postpartum hemorrhage after cesarean section. Among them, 35 patients underwent preoperative placement of bilateral iliac artery (common iliac artery or internal iliac artery) balloon occlusion during cesarean section, while 105 patients did not receive preoperative iliac artery balloon occlusion. There were no statistically significant differences between the two groups in clinical biochemical indicators such as serum creatinine (\u003cem\u003eP\u003c/em\u003e=0.639), total bilirubin (\u003cem\u003eP\u003c/em\u003e=0.348), alanine aminotransferase (\u003cem\u003eP\u003c/em\u003e=0.110), and aspartate aminotransferase (\u003cem\u003eP\u003c/em\u003e=0.468). However, statistically significant differences were observed between the two groups in albumin levels (\u003cem\u003eP\u003c/em\u003e=0.033) and platelet count (\u003cem\u003eP\u003c/em\u003e=0.036). Details are shown in Table 1 .\u003c/p\u003e\n\u003cp\u003e2.2 \u003cstrong\u003eAnalysis of Clinical\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eO\u003c/strong\u003e\u003cstrong\u003eutcome\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003cstrong\u003endicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistically significant differences were observed between the groups in the following clinical outcome measures: postpartum blood loss (\u003cem\u003eP\u003c/em\u003e=0.032), albumin usage (\u003cem\u003eP\u003c/em\u003e=0.004), central venous catheterization rate (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), SOFA score (\u003cem\u003eP\u003c/em\u003e=0.014), APACHE II score (\u003cem\u003eP\u003c/em\u003e=0.020), and total medical costs (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). In contrast, no statistically significant differences were found in Mean Arterial Pressure (MAP) (\u003cem\u003eP\u003c/em\u003e=0.644), incidence of acute kidney injury (\u003cem\u003eP\u003c/em\u003e=0.314), hysterectomy/subtotal hysterectomy rate (\u003cem\u003eP\u003c/em\u003e=1.000), occurrence of thrombotic events (\u003cem\u003eP\u003c/em\u003e=0.083), or length of ICU stay (\u003cem\u003eP\u003c/em\u003e=0.958). Details are shown in Table 2 .\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e3.1\u0026nbsp;\u003cstrong\u003eAnalysis of the Effectiveness of Iliac Artery Balloon Occlusion in Postpartum Hemorrhage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith the adjustment of fertility policies, the proportion of pregnant women with conditions such as advanced maternal age and scarred uterus has increased, leading to a rise in cases of pernicious placenta previa accompanied by placenta accreta. Pernicious placenta previa carries the potential risk of catastrophic hemorrhage \u003csup\u003e[2]\u003c/sup\u003e.Literature reports indicate that the average blood loss in women with pernicious placenta previa and placenta accreta ranges from 3,000 to 5,000 mL, with approximately 10% of parturients experiencing intraoperative hemorrhage exceeding 10,000 mL during cesarean delivery\u003csup\u003e[6]\u003c/sup\u003e，The mortality rate is as high as 7%\u003csup\u003e[7]\u003c/sup\u003e.For intractable massive postpartum hemorrhage following cesarean section, hysterectomy is often the last resort. However, this procedure results in the permanent loss of fertility, causing both psychological and physical trauma to the mother. With advances in interventional radiology, iliac artery balloon occlusion technique has been increasingly used in high-risk patients with postpartum hemorrhage. Nevertheless, its therapeutic efficacy remains a subject of ongoing debate.Studies have indicated that for high-risk populations susceptible to postpartum hemorrhage, preoperative placement of bilateral iliac artery (common or internal iliac artery) balloons during cesarean section, followed by intraoperative balloon inflation to temporarily block blood flow and reduce uterine perfusion, can maintain a clear surgical field and decrease both intraoperative blood loss and transfusion requirements\u003csup\u003e[8]\u003c/sup\u003e.In a 2018 study published by Gulino et al. \u003csup\u003e[9]\u003c/sup\u003e, it was also indicated that the perioperative prophylactic placement of balloon catheters not only reduces intraoperative blood loss, the need for hemostatic interventions during the perioperative period, and the volume of red blood cell transfusions, but also decreases the rate of hysterectomy.In this study, the observation group exhibited significantly less intraoperative blood loss during cesarean section compared to the control group. Additionally, the observation group demonstrated higher postoperative platelet counts and albumin levels, along with lower albumin consumption. The differences between the two groups in postpartum blood loss, platelet count, albumin level, and albumin usage were statistically significant (\u003cem\u003eP\u003c/em\u003e=0.032、\u003cem\u003eP\u003c/em\u003e=0.036、\u003cem\u003eP\u003c/em\u003e=0.033、\u0026nbsp;\u003cem\u003eP\u003c/em\u003e=0.004).Furthermore, the observation group showed lower SOFA and APACHE II scores after ICU admission, indicating a reduced risk of postoperative organ dysfunction and maternal mortality. These differences were also statistically significant (\u003cem\u003eP\u003c/em\u003e=0.014、\u003cem\u003eP\u003c/em\u003e=0.020).\u0026nbsp;However, a study by Feng et al. \u003csup\u003e[10]\u0026nbsp;\u003c/sup\u003epresented a contrasting view, indicating that preoperative placement of iliac artery balloons does not reduce maternal blood loss or hysterectomy rates. In the present study, no cases of acute kidney injury (AKI) occurred in the observation group, while one case underwent total/subtotal hysterectomy. In contrast, three cases of AKI and three hysterectomies were recorded in the control group. However, possibly due to the limited sample size, the differences in the incidence of acute kidney injury (\u003cem\u003eP\u003c/em\u003e=0.573) and hysterectomy (\u003cem\u003eP\u003c/em\u003e=1.000) between the two groups were not statistically significant.\u003c/p\u003e\n\u003cp\u003e3.2\u0026nbsp;Analysis of the Disadvantages of Iliac Artery Balloon Occlusion Technique\u003c/p\u003e\n\u003cp\u003eAlthough pre-placement of iliac artery balloon occlusion is a minimally invasive interventional technique, it still carries unavoidable complications and disadvantages. Studies have shown that the overall complication rate of bilateral internal iliac artery balloon occlusion ranges from 6% to 16%, with thrombosis being the most common complication.In a retrospective study, Dilauro et al. \u003csup\u003e[11]\u003c/sup\u003e reported that among 132 parturients with placenta accreta who underwent preoperative internal iliac artery balloon occlusion placement, 7 cases developed postpartum thrombosis, representing an incidence rate of approximately 5.3%. In the present study, 35 parturients received preoperative bilateral iliac artery balloon occlusion placement. Vascular ultrasound examinations of both lower limbs prior to discharge showed no cases of mural thrombosis, resulting in a thrombosis incidence rate of 0%.The etiology of post-endovascular puncture thrombosis is complex and involves multiple factors. These include disruption of vascular endothelial integrity due to the puncture technique, endothelial injury caused by balloon expansion and compression, the inherent hypercoagulable state of pregnancy, and prolonged lower limb immobilization. These factors can collectively contribute to the formation of in-situ thrombosis at the puncture site and deep vein thrombosis in the distal lower limbs. Early and aggressive anticoagulation therapy, combined with physical interventions, may help reduce the incidence of peripartum thrombotic events.An ideal vascular injury assessment method should be highly accurate, safe, non-invasive, and easily repeatable\u003csup\u003e\u0026nbsp;[12]\u003c/sup\u003e. Color Doppler flow imaging, which displays blood flow signals using color differentiation \u003csup\u003e[13]\u003c/sup\u003e, is a commonly used auxiliary examination tool. Computed tomography angiography (CTA) offers higher accuracy than color Doppler ultrasound; however, the iodine-based contrast agents used in CTA may affect breastfeeding.Digital Subtraction Angiography (DSA) remains the gold standard for definitive diagnosis. In addition, parturients undergoing preoperative iliac artery balloon placement are all at high risk of postpartum hemorrhage, and most undergo central venous catheter insertion before surgery to ensure vascular access patency in case of major hemorrhagic events. The observation group had a higher rate of central venous catheterization compared to the control group. Finally, preoperative placement of iliac artery balloons increases medical costs to some extent, and the difference in medical expenses between the observation and control groups was statistically significant (P \u0026lt; 0.001). Given these disadvantages, thorough discussion and strict adherence to indications are essential when considering the placement of iliac artery balloon catheters.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.3\u0026nbsp;\u003cstrong\u003eDiscussion on the Indications and Safety of Iliac Artery Balloon Occlusion Technology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring preoperative placement of bilateral iliac artery balloon catheters, the fetus is exposed to a certain amount of radiation. Studies have reported that the average radiation dose for bilateral internal iliac artery balloon catheter placement ranges from 20 to 45 mGy\u003csup\u003e\u0026nbsp;[14]\u003c/sup\u003e. In our hospital, the interventional radiology department has developed a high level of proficiency in this procedure, resulting in short operation times and radiation doses consistently kept below 50 mGy. International research indicates that the risk of radiation-induced fetal malformations significantly increases only when the radiation dose exceeds 150 mGy\u003csup\u003e\u0026nbsp;[15]\u003c/sup\u003e. Since the intraoperative radiation exposure is well below this 150 mGy teratogenicity threshold, preoperative placement of iliac artery balloon catheters prior to cesarean delivery is considered safe for the fetus.Iliac artery balloon occlusion technology is currently primarily used in patients with morbidly adherent placenta (e.g., placenta accreta spectrum disorders) as a preventive intervention to mitigate hemorrhage during cesarean delivery. It can also be employed as a rescue therapy for managing refractory postpartum hemorrhage.However, not all pregnant women diagnosed with placenta accreta require preoperative iliac artery balloon occlusion. Both the Royal College of Obstetricians and Gynaecologists (RCOG) Guidelines\u003csup\u003e\u0026nbsp;[16]\u003c/sup\u003e and the International Society for Abnormally Invasive Placenta (IS-AIP) Guidelines\u003csup\u003e\u0026nbsp;[17]\u0026nbsp;\u003c/sup\u003eexplicitly recommend against the routine use of prophylactic iliac artery balloon occlusion in all cases of placenta accreta.In the \u0026quot;Chinese Expert Consensus on Technical Standards for Temporary Intravascular Balloon Occlusion during Cesarean Delivery in Cases of Placenta Accreta\u0026quot; published by Han Xinwei et al. [3], the indications for preoperative iliac artery balloon occlusion include:Ultrasonographic diagnosis of placenta previa with accreta scoring \u0026ge;6, or Magnetic resonance imaging (MRI) showing an unclear boundary between placental tissue and the myometrium or discontinuity of the myometrium.Given the ongoing debate regarding the efficacy of preoperative iliac artery balloon occlusion in preventing postpartum hemorrhage, there is currently no unified national standard in China for its use prior to cesarean delivery. Our institution primarily follows the inclusion criteria outlined in the \u003cem\u003eChinese Expert Consensus on Technical Standards for Temporary Intravascular Balloon Occlusion during Cesarean Delivery in Cases of Placenta Accreta\u003c/em\u003e. After thorough communication with the parturient and her family, the procedure is performed by interventional radiologists.Similarly, there are no standardized criteria for the use of rescue iliac artery balloon occlusion following delivery. In such cases, rescue uterine artery embolization is generally preferred. In this study, all 35 parturients who underwent iliac artery balloon occlusion received the procedure preoperatively. Nevertheless, the indications and effectiveness of prophylactic balloon occlusion in high-risk populations for postpartum hemorrhage still require further validation.\u003c/p\u003e\n\u003cp\u003eIn summary, preoperative placement of iliac artery balloon catheters prior to cesarean delivery may reduce postpartum blood loss, lower the risk of maternal organ dysfunction, and decrease maternal mortality. However, it may also increase medical costs and the rate of central venous catheterization. Therefore, thorough discussion and individualized assessment are essential when considering this intervention.\u0026nbsp;\u003cstrong\u003eLimitations:\u003c/strong\u003e This study is a single-center retrospective analysis with a relatively small sample size. Further clinical studies with larger cohorts are needed to validate these findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Women\u0026apos;s Hospital, School of Medicine,Zhejiang University (Approval No. IRB-20240152-R). And agree to waive informed consent.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not Applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: Yes. All the data are truly available.\u003c/p\u003e\n\u003cp\u003eCompeting interests : NO.\u003c/p\u003e\n\u003cp\u003eFunding: NO.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: Zhang Peijun was directly involved in the research design, data collection, statistical analysis, and article writing. Wang Yuting participated in data collection and organization.\u003c/p\u003e\n\u003cp\u003eAcknowledgement: Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCommittee on Practice Bulletins-Obstetrics. Practice bulletin 183: postpartum hemorrhage[J]. Obstet Gynecol. 2017;130:e168\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eObstetrics, Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association. ; Chinese Society of Perinatal Medicine, Chinese Medical Association. [Guidelines for prevention and treatment of postpartum hemorrhage (2023)]. Zhonghua Fu Chan Ke Za Zhi. 2023;58(6):401\u0026ndash;409. Chinese. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3760/cma.j.cn112141-20230223-00084\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.cn112141-20230223-00084\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 37357598.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHan X, Wang Y, Zhang K. Chinese Expert Consensus on Technical Specifications for Temporary Intravascular Balloon Occlusion during Cesarean Section for Placenta Accreta [J]. J Interventional Radiol 2023,32(05):415\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYun W, Lijuan W, Wenchuan W, et al. Application value of ultrasound scoring and magnetic resonance imaging in the diagnosis of placenta accreta spectrum disorders [J]. Chin J Ultrasound Med. 2022;38(10):1142\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChong Y, Zhang A, Wang Y, Chen Y, Zhao Y. An ultrasonic scoring system to predict the prognosis of placenta accreta: A prospective cohort study. Med (Baltim). 2018;97(35):e12111. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MD.0000000000012111\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000012111\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 30170439; PMCID: PMC6392640.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTan CH, Tay KH, Sheah K, et al. Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta [J]. AJR Am J Roentgenol. 2007;189:1158\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuca D, Liberati M, Cal\u0026igrave; G. et a1. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol. 2018;52(3):304\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMURAYAMA Y, SEKI H. TAKEDA S.Intra-arterial balloon occlusion tO reduce operative Needing for placenta prev-ia accreta spectrum[J]. Surg J. 2021;7(1):11\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGulino FA, Guardo FD, Zambrotta E, et al. Placenta accreta and balloon catheterization: the experience of a single center and an update of latest evidence of literature[J]. Arch Gynecol Obstet. 2018;298(1):83\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFeng S, Liao Z, Huang H. Effect of prophylactic placement of internal iliac artery balloon catheters on outcomes of women with placenta accreta: an impact study. Anaesthesia. 2017;72(7):853\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDilauro MD, Dason S, Athreya S. Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: literature review and analysis[J]. Clin Radiol. 2012;67(6):515\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZheng Xi. Color Doppler Ultrasonography Diagnosis of Limb Artery Injury and Analysis of Misdiagnosis and Missed Diagnosis Causes [J]. Mod Med Imaging. 2024;33(09):1749\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiang Y, Jianbo G, Junyan M, et al. Diagnostic efficacy and imaging characteristics of high-frequency ultrasound in limb skeletal muscle injury [J]. J Kunming Med Univ. 2021;42(10):157\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMengyao L, Li Hejiang. Application of Internal Iliac Artery Balloon Occlusion in the Treatment of Vaginal Premature Placenta [J]. Int J Obstet Gynecol. 2020;47(02):173\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThabet A, Kalva SP, Liu B, et al. Interventional radiology in pregnancy complications: indications, technique, and methods for minimizing radiation exposure[J]. Radiographics. 2012;32(1):255\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJauniaux E, Alfirevic Z, Bhide AG, et al. Placenta Praevia and Placenta Accreta: Diagnosis and Management:Green-top Guideline [J]. No. 27a. BJOG. 2019;126(1):e1\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCollins SL, Alemdar B, et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta [J]. Am J Obstet Gynecol. 2019;220(6):511\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Iliac artery balloon occlusion technique, Postpartum hemorrhage, Clinical outcome, Organ Dysfunction","lastPublishedDoi":"10.21203/rs.3.rs-7698461/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7698461/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo investigate the clinical efficacy of prophylactic iliac artery balloon occlusion in the management of early postpartum hemorrhage during cesarean delivery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003e A retrospective analysis was conducted on 140 patients who developed postpartum hemorrhage following cesarean section and were admitted to the Intensive Care Unit of the Women's Hospital, Zhejiang University School of Medicine between January 2020 and December 2023. Among them, 35 patients who underwent preoperative placement of bilateral iliac artery balloons were designated as the observation group, while 105 patients without balloon placement served as the control group. Statistical analyses were performed to compare the differences in biochemical indicators and clinical outcomes between the two groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNo statistically significant differences were observed between the two groups in terms of biochemical indicators (serum creatinine, total bilirubin, alanine aminotransferase, aspartate aminotransferase) or clinical outcome measures (mean arterial pressure, acute kidney injury, total/subtotal hysterectomy, thrombotic events, and length of ICU stay) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, significant differences were identified in platelet count, volume of postpartum hemorrhage, albumin usage, SOFA score, APACHE II score, and total medical costs (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePreoperative placement of iliac artery balloons before cesarean delivery can reduce postpartum blood loss and lower the risk of maternal organ dysfunction and mortality. However, it is also associated with increased medical costs and a higher rate of central venous catheterization.\u003c/p\u003e","manuscriptTitle":"Analysis of the Clinical Efficacy of Prophylactic Iliac Artery Balloon Occlusion for Early Postpartum Hemorrhage Following Cesarean Delivery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-21 05:57:53","doi":"10.21203/rs.3.rs-7698461/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-28T12:00:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145726536377125882071760512968914531326","date":"2025-11-14T06:39:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-11T21:19:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-15T20:45:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-12T14:47:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-10-12T14:29:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff848a47-dbf8-4186-bedf-3fb7e508f071","owner":[],"postedDate":"November 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-21T05:57:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-21 05:57:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7698461","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7698461","identity":"rs-7698461","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}