REVIEW   

Minerva Obstetrics and Gynecology 2022 October;74(5):444-51

DOI: 10.23736/S2724-606X.22.05055-2

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Role of balloon tamponade during cesarean section in women with placenta previa: a systematic review and meta-analysis

Chiara CERRA ¹, Raffaella DI GIROLAMO ¹, Asma KHALIL ^{2, 3}, Filomena G. SILEO ^{4, 5}, Sara ALAMEDDINE ¹, Pantaleo GRECO ⁶, Marco LIBERATI ¹, Giuseppe CALI ⁷, Francesco D’ANTONIO ¹ ✉

¹ Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy; ² Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University, London, UK; ³ Fetal Medicine Unit, Division of Developmental Sciences, St. George’s University, London, UK; ⁴ Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy; ⁵ Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy; ⁶ Department of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy; ⁷ Department of Obstetrics and Gynecology, Azienda Ospedaliera Villa Sofia Cervello, Palermo, Italy

INTRODUCTION: To explore the role of balloon tamponade insertion in pregnancies complicated by placenta previa.
EVIDENCE ACQUISITION: Medline, Embase and ClinicalTrials.gov databases were searched electronically on October 17. Inclusion criteria were women with placenta previa undergoing, compared to those not undergoing, balloon tamponade insertion at the time of the cesarean section (CS). The outcomes observed were total, intra- and post-operative estimated blood loss (EBL), need for blood transfusion, admission to intensive care unit (ICU), hysterectomy and additional surgical or medical procedures to achieve hemostasis. Results were reported as pooled odd ratios (OR) or mean difference (MD) according to the outcome investigated.
EVIDENCE SYNTHESIS: Four studies (593 women) were included. Total EBL was significantly lower in women undergoing balloon tamponade insertion during CS compared to controls (MD: -556.3, 95% CI -496 to -617.0, P=0.001). Likewise, women undergoing balloon tamponade insertion had significantly lower intra- (MD: -699.8, 95% CI -766.1 to -633.5, P=0.001) and post-operative (MD: -1162 mL (95% CI -1211.1 to -1134.4, P<0.001) compared to women who did undergo such procedure. Furthermore, women undergoing balloon tamponade insertion had a significantly lower risk of requiring additional surgical (OR: 0.16, 95% CI 0.1-0.5, I²=0%; P=0.001) or medical (OR: 0.02, 95% CI 0.003-0.1, I²=0; P=0.001) procedures to achieve hemostasis. Conversely, there was no significant difference in either the need for blood transfusion (P=0.071), admission to ICU (P=0.459) or need for hysterectomy (P=0.312) between women undergoing, compared to those not undergoing, balloon tamponade insertion during CS for placenta previa.
CONCLUSIONS: Elective balloon tamponade insertion at the time of CS for placenta previa seems to be associated with a lower EBL and a reduced risk of additional medical and surgical procedures to control hemostasis. Large and adequately powered randomized controlled trials are needed to validate these results and introduce elective balloon tamponade insertion at the time of CS for placenta previa in clinical practice.

KEY WORDS: Placenta previa; Balloon occlusion; Pregnancy outcome