Retrospective analysis of 586 cases of placenta previa and accreta

Abstract

In this study, we conducted a retrospective investigation of all cases of placenta previa and accreta that were treated at a tertiary-level hospital to assess the effectiveness of balloon catheterisation at different levels. We evaluated the surgical and neonatal outcomes of 586 cases of placenta previa and accreta that were treated at our facility. This is the largest study of its kind. Depending on the severity and position of accreta, patients underwent balloon catheter placement in the aorta (n = 252) or common iliac artery (n = 38) before delivery by caesarean section. Data were collected regarding the duration of the surgery, number of cases (percentage) of balloon occlusion, and annual rate of hysterectomy. The blood loss (2207.89 ± 2044.95 ml) and transfusion volume (7.42 ± 7.872 U) in the common iliac occlusion group was greater than those in the aortic occlusion group (1967.66 ± 1466.64 ml and 6.54 ± 5.67 U, respectively); however, this difference did not reach statistical significance (p > .05). With the increase in the number of procedures performed over the years of study, the surgeons’ skills improved significantly. The choice of balloon catheterisation must be made with careful consideration. Our results highlight the significance of suture skill and the experience level of surgeons.IMPACT STATEMENTWhat is already known on this subject: The optimal method for the management of placenta accreta remains debateable. Prophylactic balloon catheters placed within arteries to control intraoperative bleeding play an important role in the management of patients with placenta accreta.What the results of this study add: The common iliac artery occlusion group tended to have a greater amount of blood loss and a higher requirement of transfusion than the aortic occlusion group; however, this difference was not statistically significant. We also analysed the difference in the complications across different periods of the study period and observed a clear improvement in the operative procedures over time.What the implications are of these findings for clinical practice and/or further research: Our study revealed that the surgeons’ proficiency increases over time, leading to improved results and a lower rate of hysterectomy over the course of several years. We recommend that the choice for balloon catheter occlusion be made with caution and after careful consideration.