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Prophylactic Radiological Interventions to Reduce Postpartum Haemorrhage in Patients with Placenta Accreta Spectrum Disorders

1Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands, 2Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands, 3Jon J. van Rood Centre for Clinical Transfusion Research, Sanquin Research, Leiden, Netherlands, 4Department of Obstetrics and Gynaecology, Erasmus University, Rotterdam, Netherlands, 5Department of Obstetrics, Birth Center, Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, Utrecht, Netherlands, 6Athena Institute, VU University, Amsterdam, Netherlands, 7Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands, 8Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, Netherlands, 9National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom

Abstract Number: PB1312

Meeting: ISTH 2021 Congress

Theme: Women Health » Pregnancy and Pregnancy Complications

Background: Placenta accreta spectrum disorder (PAS) has a high maternal morbidity and mortality rate caused by severe postpartum haemorrhage. The role of prophylactic endovascular interventions to reduce blood loss in these patients is controversial.

Aims: To quantify the association of prophylactic placement of balloon catheters or transcatheter internal iliac arterial sheaths with total blood loss in women at high risk of PAS.

Methods: We included women suspected to have PAS based on their medical history or on radiological imaging who had undergone a planned cesarean section. We selected these women from databases of two national registries and birth registries of 69 participating hospitals in The Netherlands. We determined the effect of the intervention on total blood loss from a linear regression model. Women without balloon catheters were the reference group. Results were adjusted for patient and PAS characteristics.

Results: We included 351 women with suspected PAS: 290 based on history of whom 21 had the intervention and 61 based on imaging of whom 22 had the intervention. 
Women with PAS based on history without intervention had median blood loss of 750 mL(interquartile range, IQR, 500-1500) vs 1000 mL(IQR, 550-1750) in women with intervention; adjusted blood loss by intervention: +2 mL, (95% CI, -251 – 377), p=0.99. 
Women with PAS based on imaging without intervention had median blood loss of 2500 mL(IQR, 1200-5000) vs 2000 mL(IQR, 850-4000); adjusted blood loss reduction by intervention:  -590 mL, (95% CI, -1018 – 130), p=0.09.
In women with confirmed PAS disorder the adjusted blood loss reduction by intervention was -872 mL, (95% CI, -1411 – 84), p=0.07.

Conclusions: Preoperative placement of balloon catheters in women with PAS might be associated with reduced blood loss. As the results of this study did not reach statistical significance and several previous studies have proven inconclusive as well, we will perform a meta-analysis.

To cite this abstract in AMA style:

Bonsen L, Harskamp V, Feddouli S, Duvekot J, Pors A, Bloemenkamp K, van Roosmalen J, van Kraaij M, Zwart J, van Lith J, van den Akker T, Henriquez D, van der Bom J, TeMpOH-3 study group . Prophylactic Radiological Interventions to Reduce Postpartum Haemorrhage in Patients with Placenta Accreta Spectrum Disorders [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/prophylactic-radiological-interventions-to-reduce-postpartum-haemorrhage-in-patients-with-placenta-accreta-spectrum-disorders/. Accessed October 1, 2023.

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