Comparative analysis of the effectiveness of different methods of surgical hemostasis in patients with placenta accreta spectrum disorders

Abstract

Currently, the medical community has accumulated significant experience in the use of endovascular methods in obstetric practice to achieve hemostasis and prevent massive hemorrhage, including in patients with placenta accreta spectrum (PAS) disorders. Objective — to evaluate the effectiveness of various methods of uterine devascularization in reducing blood loss during caesarean section in patients with PAS. In this review, we analyzed relevant literature and assessed the quality of clinical trials based on a systematic search in the Embase, PubMed, Web of Science, and Cochrane Library databases. The review presents an overview of modern methods of uterine devascularization aimed at reducing intraoperative blood loss in patients with PAS. A comparative analysis of the effectiveness of such methods of uterine devascularization as temporary balloon occlusion of the internal iliac arteries, common iliac arteries, abdominal aorta, as well as arterial compression using distal hemostasis was carried out. We evaluated effectiveness of the methods by such indicators as the mean amount of blood loss and the frequency of hysterectomy. The most effective methods of hemostasis in patients with PAS are temporary balloon occlusion of the abdominal aorta and the method of distal hemostasis. At the same time, there is still no ideal method for uterine devascularization in PAS, and clinical research in this direction should be continued.

Keywords

• placenta previa and accreta
• postpartum hemorrhage
• endovascular methods of hemostasis
• uterine devascularization