Efficacy analysis of balloon hemostasis technologies in parturient with placenta previa: A hemodynamic numerical and clinical retrospective study

To determine the hemostatic values of internal iliac artery balloon (IIABO) occlusion and abdominal aorta balloon occlusion (AABO), 142 patients with pernicious placenta previa were divided into three groups: control (45), IIABO (40), and AABO (57) groups, respectively. The blood loss, operative duration, time-averaged hemorrhage velocity (TAHV), blood transfusion, time-averaged transfusion velocity (TATV), and hospitalization days of these groups were compared. Angiographies and a circulatory simulation were used to unveil the bleeding mechanisms. Although the AABO group's operative duration and hospitalization days are longer (p < 0.001) than those of the other groups, the AABO group has considerably reduced blood loss (p < 0.05) and TAHV (p < 0.001) than the other groups. No obvious difference in blood transfusion and TATV between these groups can be observed. Angiographies showed that there was a large amount of blood flow in the pelvic cavity during IIABO, but AABO did not. In our modeling, the cumulative blood loss is about 2000 ml without using the balloon, which is the same as that when IIABO is used with collateral pressure of 75 mm Hg. The main source of blood loss is uterine arterioles. However, the blood loss during AABO is about 300 ml, which is mainly from uterine venules. These results suggested that IIABO failed to control bleeding, which may be related to collateral circulation, while AABO has a better prospect and may be more effective if the blood pressure of uterine venules is also isolated. These findings may guide technology selections for obstetricians and the improvement of hemostasis technology.