Table 3. Main characteristics of studies included for analysis.
| First author, year, Ref | Number of AIP patients | AIP type A/I/P |
Type of intervention | Rate of hysterectomy (%) | Estimated blood loss (mL) | Complication rate (%) | Radiation dose | Major points |
|---|---|---|---|---|---|---|---|---|
| Shrivastava et al. 2007 (21) | 19 | 13/4/2 | PBO IIA (19/19) | 100 (19/19) | 2,700 (up to 8,000) | 16 (3/19) | NR | No differences in EBL and hysterectomy compared to no PBO |
| Tan et al. 2007 (22) | 11 | 3/1/7 | PBO IIA | 64 (7/11) | 2,011 (up to 5,000) | 0 (0/11) | N.R | Lower EBL with PBO (P=0.042) |
| Mok et al. 2008 (23) | 12 | 4/0/0 | PBO IIA (6/12) | 33 (4/12) | 6,415 (up to 14,000 | 0 (0/12) | NR | – |
| Yu et al. 2009 (24) |
11 | 4/3/4 | PUAE | 27 (3/11) | 3,190 (up to 13,000) | 0 (0/11) | N.R | – |
| Diop et al. 2010 (25) | 17 | Accreta* | UAE | 6 (1/17) | 1,929 | 0 (0/17) | NR | – |
| Sivan et al. 2010 (26) | 25 | 25/0/0 | PCIIA (25/25) + UAE (23/25) | 8 (2/25) | 2,000 (up to 9,000) | 0 (0/25) | NR | – |
| Carnevale et al. 2011 (27) | 21 | 18/0/3 | PBO IIA | 100 (21/21) | 1,671 (up to 4,000) | 10 (2/21) | NR | Thromboembolectomy in two women |
| Amsellem et al. 2011 (28) | 10 | Accreta* | PBO IIA | 40 (4/10) | 900±754 | 0 (0/10) | NR | The endpoint was a conservative approach |
| Jung et al. 2011 (29) | 17 | Accreta* | UAE | 18 (3/17) | 1,823 (up to 4,500) | 0 (0/17) | NR | – |
| Soyer et al. 2011 (9) | 12 | 4/2/6 | UAE | 18 (2/11) | > 1,000 | 8 (1/12) | Skin dose 175.89 cGy (range, 90.21–351.78) | Clinical success of UAE in 82% of women |
| Ballas et al. 2012 (30) | 59 | 24/0/35 | PBO IIA | NR | 2,165 | 3.4 (2/59) | NR | Case control study; EBL was greater in women with inflated balloons |
| Bouvier et al. 2012 (31) | 14 | 10/0/4 | UAE | 43 (6/14) | 2,242 (up to 3,500) | 0 (0/14) | NR | – |
| Li et al. 2012 (32) |
10 | 6/4/0 | UAE | 0 (0/10) | >500 | 10 (1/10) | NR | Secondary PPH conservative treatment |
| Panici et al. 2012 (33) | 15 | 13/2/0 | PBO AA | 13 (2/15) | 950 | 0 (0/15) | 0.1 mGy | Case control study; greater EBL without PBOAA (3,375 mL) |
| Claussen et al. 2013 (34) | 15 | 15/0/0 | PBO IIA | 53 (8/15) | 4,150 (up to 16,000) | 0 (0/15) | NR | EBL > 6,000 mL in 5 women |
| Hwang et al. 2013 (14) | 40 | Accreta* | UAE | 7.5 (3/40) | NR | 0 (0/40) | NR | Clinical success of UAE in 92.5% of women; one death due to DIC |
| Teixidor Viñas et al. 2014 (35) | 27 | 8/2/17 | PBO IIA [27]; PBO IIA + UAE [8] | 11 (3/27) | 1,920 (up to 12,000) | 4 (1/27) | FRD 4.4 mGy (range, 0.4–15.1) | Balloon rupture in one woman; resolutive IIA thrombosis in one woman |
| Cali et al. 2014 (36) | 30 | 12/0/18 | PBO IIA | 100 (30/30) | 846 (up to 1,700) | 0 (0/30) | NR | Lower EBL in women with placenta percreta by comparison with historical control group |
| Darwish et al. 2014 (37) | 32 | Accreta* | PBO IIA | 12.5 (4/32) | 1,9000 | NR | NR | Lower EBL with PBO by comparison with retrospective group |
| Chou et al. 2015 (38) | 12 | 1/6/5 | PBO IIA | 75 (9/12) | 1,902 (up to 8,000) | 17 (2/12) | NR | Popliteal thrombosis and EIA thrombosis (one woman each) |
| D’Souza et al. 2015 (39) | 10 | 0/4/6 | PBO IIA + UAE | 33 (3/10) | 1,200 (up to 4,000) | 0 (0/10) | NR | |
| Duan et al. 2015 (40) | 42 | 37/0/5 | PBO AA + UAE | 2.4 (1/42) | 586 | 0 (0/42) | FRD 4.2 mGy, | |
| Izbizki et al. 2015 (41) | 79 | 25/18/36 | PCUA + UAE | 94 (74/79) | NR | 0 (0/79) | NR | Resolving decreased temperature of right lower limb in one woman |
| Salim et al. 2015 (42) | 27 | Accreta* | PBO IAI [13]; Control [14] | 46 (6/13); 50 (7/14) | 4,950; 4,709 | 15 (2/13) | NR | Randomized trial; PBO IIA vs. control; no benefit with PBOIIA for EBL (P=0.72) |
| Omar et al. 2016 (43) | 14 | 5/4/5 | PBO IIA [11]; PBP CIA [3] | NR | 43,000±70,000 | 7 (1/14) | NR | No differences in EBL with control group |
| Wei et al. 2016 (18) | 45 | 22/20/3 | PBO AA | 9 (4/45) | 835 (up to 6,000) | 4 (2/45) | NR | Arterial thrombosis and ischemic injury of femoral nerve (one woman each) |
| Niola et al. 2016 (44) | 27 | A [21] P [6] | PUAE | 37 (10/27) | NR | 0 (0/27) | Skin dose 70.37 mGy (range, 18.53–234.27) | UAE was performed before delivery with the fetus in the uterus |
| Wu et al. 2016 (45) | 230 | 30/112/88 | PBO AA [203] + UAE [2] | 0 (0/230) | 921 | 0 (0/230) | FRD 5.1±3.0 mGy | – |
| Wang et al. 2016 (46) | 18 | 10/5/3 | UAE | 6 (1/18) | 1,372 | 0 (0/18) | NR | – |
| Angileri et al. 2017 (47) | 37 | 14/3/20 | PBO IIA | 0 (0/37) | 2,052 | 11 (4/37) | NR | Arterial thrombosis in 4 women |
| Cui et al. 2017 (48) | 38; 31 | 13/12/13; 11/14/6 | PBO AA [38] + UAE [12]; control group [31] | 5 (2/38); 10 (3/31) | 1,560±1,279; 2,145±1,160 | 8 (3/38) | FRD 3.3±1.1 mGy | No differences in EBL and hysterectomy rate. Arterial thrombosis (two women). UAE was needed in 12 women with PBO AA |
| Feng et al. 2017 (49) | 30 | 9/17/4 | PBO IIA (inflated in 27/30) | 43 (13/27) | 1,000 (up to 15,000) | 0 (0/30) | NR | No benefit of PBO IIA compared to historical control group |
| Pan et al. 2017 (50) | 26 19 |
18/7/1; 11/7/1 | PUA [26]; control group [19] | 23 (6/26); 37 (7/19) | 2,080; 2,800 | 4 (1/26) | FRD 30.6 mGy (range: 5.5-104) | No differences in EBL and hysterectomy rate; uterine necrosis with PUA in one woman |
| Wang et al. 2017 (51) | 57; 48 | Accreta*; Accreta* | PBO AA [57] + UAE [16]; PBO IIA [48] + UAE [14] | NR | 450; 619 | NR | NR | Prospective study comparing PBOIAI vs. PBOAA; EBL and FRD were lower with PBOAA |
| Wang et al. 2017 (52) | 10; 33 | Increta*; Increta* | PBO AA; control | 70 (7/10); 64 (21/33) | 1,000 2,000 |
NR | NR | Lower EBL with PBO AA |
| Xie et al. 2017 (53) | 30; 41 | 25/5 | PBO AA [30]; Control group [41] | 17 (5/30); 24 (10/41) | 961±784; 1,560±1,353 | 3.3 (1/30) | NR | Lower EBL with PBO AA. No differences in hysterectomy rates |
| Al-Hadethi et al. 2017 (54) | 25; 27 | PBO IIA; control group | 59 (16/25); 85 (23/27) | 2,455±1,444; 1,992±1,498 | 8 (2/25) | NR | Dissection of CFA and bilateral CIA dissection (one woman each) | |
| Luo et al. 2017 (55) | 29 | 25/0/4 | PBO AA [29] + UAE [2] | 17 (5/29) | 750 (up to 3,000) | 0 (0/29) | NR | Hysterectomy in 5 women with percreta |
| Dai et al. 2018 (56) | 20; 22 | Accreta*; Accreta* | PBO IIA [20] + UAE [2]; control group [20] + UAE [14] | 5 (1/22); 32 (7/22) | 2,900±2,352; 4,550±2,367 | 5 (1/20) | – | Thrombosis of EIA in one woman. Lower EBL with PBO |
| Mei et al. 2018 (57) | 20; 20 | 16/4/0; 16/4/0 | PBO IIA [20]; control group [20] | 0(0/20); 5 (1/20) | 800±359 (up to 1,800); 1,875±1,904 (up to 7,600) | 0 (0/20) | NR | Lower EBL with PBP IIA ± UAE; UAE was used when needed but no numbers were reported; no accreta in the study |
| Picel et al. 2018 (58) | 90; 61 | 20/20/50; 32/14/15 | PBO IIA; control group | 100 (90/90); 100 (61/61) | 2,360 (up to 2,500); 3,290 (up to 4,000) | 9 (8/80) | DAP 32.8 ìGym2 | Lower EBL with PBO IIA Dissection of oCIA; two pseudoaneurysms; acute limb ischemia |
| Ono et al. 2018 (59) | 29 | 17/7/5 | PBO CIA [29] | 100 (29/29) | 2,027±1,638 | 7 (2/29) | Skin dose 29.4±25.0 mGy | Balloon rupture in two woman |
| Blumenthal et al. 2018 (60) | 16; 19 | 4/3/9; 11/3/5 | PBO AA; control | 94 (15/16); 89 (17/19) | 2,007 (up to 20,000); 2,112 (up to 8,664) | 6 (1/16) | NR | No differences in EBL |
| Li et al. 2018 (61) | 199 | 39/60/13/29/52/6 | PBO [112] (IIA 37; CIA 42; AA 33); control group [87] | 11.6 (13/112); 32.8 (28/87) | 1,550; 3,500 | 1.8 (2/112) | 19.01 ± 13.33 mGy | Lower EBL with PBO IIA thrombosis in 2 women. Lower EBL with PBO in CIA and IAA |
| Huang et al. 2018 (62) | 11; 6 | 10/1/0; 3/1/2 | PUAE [11]; control group [6] | 9 (1/11); 33 (2/6) | 991.9±702; 3,448±1,767 | – | NR | – |
| Rosner-Tenerowicz et al. 2018 (63) | 13; 8 | Perceta*; Percreta* | PBO IIA [13]; Control group [8] | 100 (13/13); 100 (8/8) | 1,492±1,239; 2,963 ± 1,534 | 8 (1/13) | NR | Lower EBL with PBO IIA |
| Sun et al. 2018 (64) | 19 | Increta* | PBO AA | 31 (6/19) | 1,200 (up to 9,000) | 5 (1/19) | Skin dose 4.20±1.49 mGy | Thrombosis of IIA in one woman |
| Chodraui-Filho et al. 2019 (65) | 35 | 9/11/15 | PBO IIA + UAE | 100 (35/35) | 1,193 (up to 2,967) | 11 (4/35) | NR | Arterial thrombosis in two women. Gluteal muscle necrosis in one woman |
| Liu et al. 2019 (66) | 31 | 8/14/9 | PBO AA [31] + UAE [3] + OAE [3] | 3 (1/31) | 1,906±1,118 | 6 (2/31) | FRD 4.33±0.79 mGy | Thrombosis of right femoral artery in two women favorably treated with thrombolysis |
| Mei et al. 2019 (67) | 74; 100 | Accreta*; Accreta* | PBO AA [74] + UAE [23]; PBO IIA [100] + UAE [47] | 0 (0/74); 0 (0/100) | 600 (up to 2,500); 600 (up to 2,500) | 0 (0/74); 0 (0/100) | FRD 1.85 mGy (range, 2.9); FRD 25 mGy (range, 8–31) | No differences in EBL between the two procedures |
| Tokue et al. 2019 (68) | 42 | 33/6/3 | PBO IIA | 36 (15/42) | 3,706±3,852 | 0 (0/42) | FRD 25.5±8.2 mGy | Visualization of round ligament artery is associated with failed PBO IIA |
| Chen et al. 2019 (69) | 83; 31 | 30/0/53; 28/0/3 | PBO IIA [83]; control group [31] | 100 (83/83); 100 (31/31) | 3,000; 3,700 | NR | NR | PBO IIA has not impact of maternal outcome using a propensity score |
| Yuan et al. 2020 (70) | 28; 26 | 16/10/2; 18/7/1 | UAE [28]; control group [26] | 29 (8/28); 42 (11/26) | 1,325±871; 4,483±2,295 | 0 (0/28) | NR | Lower EBL in UAE group |
| Lee et al. 2020 (71) | 28 | 7/10/11 | PBOAA [12] or PBO IIA [16] | 100 (28/28) | 1,826 | 0 (0/28) | NR | Lower EBL with PBO |
*, o subgroup information was given. Table shows studies with more than 10 women with AIP. Studies were analyzed for the actual numbers of AIP and those that included women with AIP and placenta praevia were included when the actual number of AIP was ≥10. DR, fetal radiation dose; NR, not reported; DAP, dose area product; AA, abdominal aorta; AIP, abnormally invasive placenta; CIA, common iliac artery; DAP, dose area product; DIC, disseminated intravascular coagulopathy; FRD, fetal radiation dose; IIA, internal iliac artery; OAE, ovarian artery embolization; PBOAA, prophylactic balloon occlusion of abdominal aorta; PBOCIA, prophylactic balloon occlusion of common iliac artery; PBOIIA, prophylactic balloon occlusion of internal iliac arteries; PPH, postpartum hemorrhage; PUAE, prophylactic uterine artery embolization; PCUA, prophylactic catheterization of uterine arteries; PCIIA, prophylactic catheterization of IIA; UAE, uterine artery embolization.