Abstract
BackgroundPlacenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide. Another cause of bleeding in pregnant women is Placenta accreta spectrum. Therefore, the aim of the present systematic review and meta-analysis is to determine the effect of prophylactic balloon occlusion of the internal iliac arteries in patients with placenta previa or placental accreta spectrum (PAS).MethodsIn this systematic review and meta-analysis, to identify and select relevant studies, the SID, MagIran, ScienceDirect, Embase, Scopus, PubMed, Web of Science, and Google Scholar databases were searched, using the keywords of internal iliac artery balloon, placenta, previa, balloon, accreta, increta and percreta, without a lower time limit and until 2020. The heterogeneity of the studies was examined using the I2 index, and subsequently a random effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2).ResultsIn the review of 29 articles with a total sample size of 1140 in the control group, and 1225 in the balloon occlusion group, the mean difference between the two groups was calculated in terms of Intraoperative blood loss index (mL) and it was derived as 3.21 ± 0.38; moreover, in 15 studies with a sample size of 887 in the control group, and 760 in the balloon occlusion group, the mean difference between the two groups in terms of gestation index (weeks) was found as 2.84 ± 0.49; and also with regards to hysterectomy balloon occlusion after prophylactic closure of the iliac artery, hysterectomy (%) balloon occlusion was calculated as 8.9 %, and this, in the hysterectomy control group (%) was obtained as 31.2 %; these differences were statistically significant and showed a positive effect of the intervention (P < 0.05).ConclusionThe results of this study show that the use of prophylactic internal iliac artery balloon occlusion in patients with placenta previa or Placenta accreta spectrum has benefits such as reduced intraoperative blood loss, reduced hysterectomy and increased gestation (weeks), which can be considered by midwives and obstetricians.
Highlights
Placenta previa describes a placenta that extends partially or completely over the internal cervical oss
In 26 studies [15, 20, 24, 26,27,28,29,30,31,32,33,34,35,36,37,38,39,40, 42,43,44,45, 47,48,49,50] prophylactic internal iliac artery balloon occlusion significantly reduced this index in the balloon occlusion group compared to the control group (P < 0.05)
According to the results of studies by Yu et al (2020) [9], Feng et al (2017) [41] and McGinnis et al (2019) [46], no significant difference was observed between the control group and the balloon occlusion group with respect to this index (P > 0.05)
Summary
Placenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide Another cause of bleeding in pregnant women is Placenta accreta spectrum. Placenta previa is a type of placenta that extends partially or completely over the internal cervical oss [1]. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide [2]. Increasing the rate of cesarean delivery due to placenta previa has a significant effect on the cost of gynecological medical care [4]. Previous cesarean section, abortion, uterine myoma, high body mass index, high infant weight, male fetal, maternal tobacco use, and history of uterine surgery are among the predisposing factors of this disease [5]
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