4-French Aortic Balloon Occlusion in Cesarean Hysterectomy for Placenta Accreta Spectrum Disorder.

Objective: To evaluate whether using a 4-French balloon aortic occlusion device was associated with lower blood loss and subsequent blood transfusions in placenta accreta spectrum (PAS) cesarean hysterectomy.

Methods: This was a retrospective cohort study of patients with ultrasound findings consistent with complex PAS (placenta increta or percreta) who were delivered at a single tertiary care center from March 2022 to November 2024 with confirmed placenta increta or percreta on histopathology. We compared patients who had a 4-French aortic balloon inflated with those who had a sheath placed without balloon inflation and those who had no sheath placement for planned cesarean hysterectomy. Our primary outcome was quantitative blood loss. Our secondary outcomes included operative time and blood transfusion.

Results: A total of 81 patients with histopathologic confirmation of placenta increta or percreta were included. Twenty-seven patients (27/81, 33.3%) did not have the 4-French sheath placement at time of surgery. A 4-French balloon sheath was placed in 54 patients; among these, 25 had sheath-only placement with no balloon inflation, and 29 had aortic balloon inflation during cesarean hysterectomy. There were no differences in baseline demographics among the three groups. Pregnancy complications before cesarean hysterectomy were similar. Operative time was longer in surgeries with balloon inflation compared with those with no sheath placement (319±93 minutes vs 244±64 minutes, P <.01). Aortic balloon inflation was associated with lower blood loss compared with no sheath placement (1,526±635 mL vs 2,686±1,420 mL, P <.01). Overall blood transfusion rates were not significantly different between groups, but balloon inflation was associated with a lower overall number of units transfused compared with no sheath (median [25 th percentile, 75 th percentile] 2 [1, 2] units vs 3 [1, 5] units, P <.04) One patient in the aortic balloon group developed a thrombus.

Conclusions: In our cohort, inflation of a 4-French aortic occlusion balloon for PAS surgeries was associated with lower blood loss and less blood transfusions but longer operative times compared with no sheath placement. Larger studies are needed to assess for rare outcomes and complications.