Maternal Outcomes in Placenta Accreta Spectrum Disorders Managed With REBOA [ID: 1370002

Abstract

INTRODUCTION: Pregnancies complicated by placenta accreta spectrum (PAS) are increasing. In PAS, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control life-threatening hemorrhage, although supporting data are conflicting. The aim of this study was to determine the outcomes in pregnancies complicated by PAS managed with REBOA. METHODS: This was an IRB-exempt retrospective cohort study of pregnancies complicated by PAS at a single institution. The primary outcome was arterial thrombus. Secondary outcomes were estimated blood loss, operative room time, transfusion risk, and hospital and intensive care unit stays. Demographics and outcomes were compared by univariate analysis. Multivariable logistic regression with a mixed effects model was used to control for confounders. RESULTS: Ninety-one pregnancies (16 REBOA and 75 non-REBOA) were included. REBOA was associated with an increased risk of arterial thrombus, adjusted odds ratio of 1.33 (95% CI 1.05–1.77, P<.001). Patients with an arterial thrombus had longer hospital (P<.003) and intensive care unit stays (P<.001). REBOA use was associated with increased total operative time (249 versus 171 minutes, P=.001). REBOA was not associated with lower total estimated blood loss (EBL, 2,699 versus 3,455 mL, P=.28). CONCLUSION: The use of REBOA in PAS is associated with an increased risk of arterial thrombus compared to management without. This risk remains elevated after controlling for demographic and clinical variables. REBOA use was not associated with clinical benefits such as decreased EBL or operative time.