(241) Antenatal Factors Associated with Inflation of 4 French Aortic Occlusion Balloon in Placenta Accreta Surgery

Objective: Aortic balloon occlusion is a technique used to reduce blood loss in cases of placenta accreta spectrum (PAS). Currently, there is no consensus on which patients would most benefit from aortic balloon device placement. We evaluated differences in antenatal clinical factors between patients who had the device inflated from those who had the device placed but not inflated.

Study Design: This was a retrospective case-control study of patients with ultrasound findings consistent with PAS who were delivered at a single tertiary care center from March 2022 through June 2024 and had a 4 French aortic occlusion balloon placed prior to surgery. Patients who had the balloon inflated intraoperatively were compared to patients who had the device inserted but not inflated. Uni- and multivariate analyses were performed for outcomes and confounding variables.

Results: There were 59 patients who had the 4 French aortic occlusion balloon placed during the study period, 28 of which had the balloon inflated during surgery. The average duration of balloon inflation was 35 minutes. There were no differences in demographic factors and medical histories between groups, including number of uterine surgeries (2.7 vs 2.8, p=0.80) or timing of delivery (32.4 vs 33.0 weeks, p=0.40). Additionally, there was no significant difference in the number or type of PAS ultrasound findings between groups. The suspected PAS diagnoses were similar in each group. Patients who had balloon inflated were more likely to have greater than two episodes of antenatal bleeding episodes though this did not reach statistical significance (18% vs 3%, p=0.08). Antepartum complications were similar between both groups.

Conclusion: In our cohort we were unable to identify demographic, ultrasonographic, or antepartum factors that were associated with inflation of 4 French aortic occlusion balloon. These findings highlight the challenge in identifying patients who would most benefit from this device. Further research is needed to stratify patients for use of aortic occlusion balloon in PAS surgery.