415 Surgical and endovascular practice patterns in patients undergoing c-section for placenta accreta spectrum

Abstract

The main complication of placenta accreta spectrum (PAS) is massive bleeding. Endoarterial occlusion of pelvic vessels or the aorta has been incorporated into the management protocols of this pathology. We aimed to examine the surgical and endovascular practice patterns among pregnant women with PAS treated at the same institution during an 8-year period, focusing on changes in bleeding control techniques. The study evaluated a retrospective cohort including all patients with PAS treated from December 2011 to December 2019 at a Latin American hospital. We compared the clinical results obtained according to the type of endovascular device used. Ninety-seven patients were included (Table 1), and seventy-nine of them were prenatally diagnosed: 30 received Internal Iliac Artery Occlusion Balloons (Group 1), 40 used Resuscitative Endovascular Balloon Of the Aorta (Group 2), and 9 did not use arterial balloons due to S1 involvement, with a low risk of bleeding (Group 3). The remaining 18 women were diagnosed during a c-section for another reason (Group 4), receiving non-protocolized management by staff without formal training in AIP. Group 2 patients had a bleeding volume (average: 1,700 mL) and frequency of transfusions (42%) slightly lower than those of Group 1 patients (2,000 mL and 50% transfusions, respectively), with a lower hysterectomy frequency (65% vs. 77% in group 1) and surgical time (205 minutes vs. 275 in group 1) despite a similar frequency of confirmed PAS, placenta percreta and S2 compromise. Group 3 patients had the lowest volume of blood transfusion frequency of the entire population studied Multiple valid strategies are available to prevent massive bleeding due to PAS. Some selected patients can be safely managed without endovascular devices in specialized centers.