International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025
A systematic review and meta-analysis of randomized controlled trials on the effects of internal iliac artery balloon occlusion in placenta previa and placenta accreta spectrum in reducing perioperative bleeding.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Iskander Rula, Massalha Manal, Remer Chen, Izhaki Ido, Salim Raed
Аннотация
BACKGROUND: Preoperative prophylactic balloon occlusion (PPBO) of internal iliac arteries (IIAs) in placenta previa and placenta accreta spectrum (PAS) has been widely used as a preventive adjuvant technique to reduce blood loss and to preserve fertility. Nevertheless, the efficacy of PPBO is based primarily on retrospective studies.
OBJECTIVE: To examine the effectiveness of PPBO of the IIAs in placenta previa and PAS in reducing perioperative bleeding.
SEARCH STRATEGY: MEDLINE, EMBASE, Web-of-Science, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from their inception to July 2023.
SELECTION CRITERIA: Randomized controlled trial (RCT) in which the use of PPBO on the IIAs was compared to non-use.
DATA COLLECTION AND ANALYSIS: The primary outcome was number of packed red blood cell (RBC) units transfused. We executed meta-analysis using a random-effects model. Quality of the studies was assessed using the Cochrane Risk-of-Bias tool. The GRADE criteria were used to assess evidence certainty.
MAIN RESULTS: Of 164 reports identified, three RCTs representing 167 women (83 and 84 in the intervention and control groups, respectively) were eligible. Mean number of RBC units transfused was 4.52 ± 1.70 and 3.70 ± 1.88 in the intervention and control groups, respectively (weighted mean difference, 1.04; 95% CI: 0.52-1.55; P = 0.001; I2, 0%; low certainty evidence). Transfusion of other blood products was comparable. Incidence of postoperative fever was higher (P = 0.024) and hospitalization duration was longer (P = 0.001) in the intervention group compared to the control group.
CONCLUSIONS: Use of PPBO of the IIAs in placenta previa and PAS was associated with increase in number of RBC units transfused.
OBJECTIVE: To examine the effectiveness of PPBO of the IIAs in placenta previa and PAS in reducing perioperative bleeding.
SEARCH STRATEGY: MEDLINE, EMBASE, Web-of-Science, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from their inception to July 2023.
SELECTION CRITERIA: Randomized controlled trial (RCT) in which the use of PPBO on the IIAs was compared to non-use.
DATA COLLECTION AND ANALYSIS: The primary outcome was number of packed red blood cell (RBC) units transfused. We executed meta-analysis using a random-effects model. Quality of the studies was assessed using the Cochrane Risk-of-Bias tool. The GRADE criteria were used to assess evidence certainty.
MAIN RESULTS: Of 164 reports identified, three RCTs representing 167 women (83 and 84 in the intervention and control groups, respectively) were eligible. Mean number of RBC units transfused was 4.52 ± 1.70 and 3.70 ± 1.88 in the intervention and control groups, respectively (weighted mean difference, 1.04; 95% CI: 0.52-1.55; P = 0.001; I2, 0%; low certainty evidence). Transfusion of other blood products was comparable. Incidence of postoperative fever was higher (P = 0.024) and hospitalization duration was longer (P = 0.001) in the intervention group compared to the control group.
CONCLUSIONS: Use of PPBO of the IIAs in placenta previa and PAS was associated with increase in number of RBC units transfused.