Rationale and Objectives
Placenta accreta spectrum (PAS) disorders are increasingly common and associated with
significant maternal and neonatal morbidity and mortality due to the associated risk
of massive haemorrhage. Currently prophylactic interventional radiology (IR) arterial
occlusion is being performed occluding either the internal iliac artery (IIA), abdominal
aorta (AA) or uterine artery (UA) in order to prevent this blood loss. The aim of
this meta-analysis is to identify whether these IR procedures are effective in reducing
estimated blood loss (EBL) and hysterectomy rates and if so which method achieves
the optimal results
Methods
A literature search was conducted to acquire case-control studies assessing EBL and
hysterectomies performed following IR arterial occlusion in PAS patients, yielding
16 results. Studies were analyzed together and later split into groups dependent on
the artery occluded. The results of these were then inputted into forest plots to
identify their overall estimated effect with confidence intervals.
Results
Prophylactic IR arterial occlusion was proven to reduce both EBL and hysterectomies.
When separated by artery, IIA achieved the worst outcomes with no proven effect on
EBL and a minimal reduction in hysterectomies. UA scored in the middle with a modest
reduction in both outcomes, whilst AA occlusion had the most significant reduction
in both EBL and hysterectomies.
Conclusion
Prophylactic IR arterial occlusion should be routinely considered in PAS patients
to reduce both EBL and rates of hysterectomies. Current literature promotes the use
of IIA occlusion; however the findings of this analysis propose that AA and UA occlusion
should be favoured
Key Words
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Article info
Publication history
Published online: November 12, 2022
Accepted:
October 19,
2022
Received in revised form:
October 5,
2022
Received:
August 28,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
