Comprehensive prevention of massive bleeding/complications during childbirth in pregnant women with placenta previa/percreta 3b and 3c.

OBJECTIVE

Abnormal placenta accreta spectrum (PAS), particularly placenta percreta 3b and 3c (FIGO 2019), involving bladder wall or parametrial tissue attachment, presents significant surgical risks including massive bleeding and organ injury. Multidisciplinary management and innovative surgical approaches are essential. The aim of the present study was to evaluate endovascular balloon occlusion of the abdominal aorta (EBOAA) versus internal iliac artery ligation (IIAL) techniques in managing placenta percreta 3b and 3c and preventing massive bleeding and other complications, by a retrospective cohort case-control study.

METHODS

In order to undergo cesarean section (CS), the study examined pregnant women with placenta previa/percreta 3b and 3c types. Placenta percreta 3b and c in the groups were diagnosed prenatally by magnetic resonance imaging, color Doppler imaging, and ultrasound. Every instance was chosen based on imaging, and it was verified histologically, intra-, and postoperatively. The patients were divided into two groups based on surgical treatment received. Group I (n = 17) underwent corporal CS with EBOAA and hysterectomy. Group II (n = 21) received low-midline laparotomy, fundal CS, and IIAL before hysterectomy. Both groups utilized monopolar diathermy, argon plasma and bipolar coagulation.

RESULTS

Among 38 patients, 17 patients in Group I showed significantly reduced blood loss (1120 ± 95 mL vs. 1430 ± 110 mL, P = 0.03) and shorter surgery time (95 ± 8 vs. 130 ± 11 min, P = 0.007). Hospital stays were shorter in group I (6 ± 1 vs. 9 ± 1 days, P = 0.03).

CONCLUSION

The EBOAA following fundal CS and hysterectomy effectively minimizes blood loss in placenta previa/percreta 3b and 3c cases. When the EBOAA is not feasible, IIAL offers an alternative strategy for bleeding reduction before hysterectomy.