With the global increase in the cesarean delivery rate, the incidence of placenta accreta spectrum (PAS) during second pregnancy has increased. Hysterectomy, which would permanently affect fertility, has been the major therapeutic choice, when life-threatening bleeding occurred with PAS subsequent to cesarean delivery. In the past few decades, prophylactic aortic balloon oc-clusion for PAS has been employed to prevent intraoperative and postoperative hemorrhage. However, its use remains controversial. There is no consensus about which artery is most effective for prophylactic aortic balloon occlusion (internal iliac, common iliac or aorta). Furthermore, the timing of balloon inflation before cesarean delivery or after fetal delivery and what type of balloon to use are also controversial.
In this paper, we present the contents, procedures, advantages, disadvantages, safety, and efficacy of prophylactic aortic balloon oc-clusion for PAS. In addition, inter-professional work is important in high-risk pregnancy, and we will discuss our approach and the role of IVR physicians. Large-scale prospective studies are needed to evaluate the efficacy and safety of prophylactic aortic balloon occlusion for PAS.
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