Perioperative Prophylactic Internal Iliac Artery Balloon Occlusion in the Prevention of Postpartum Hemorrhage in Placenta Previa: a Randomized Controlled Trial

(Am J Obstet Gynecol. 2020;223:117.e1–13) Placenta previa is a major cause of postpartum hemorrhage (PPH) and maternal death worldwide. As cesarean delivery rates have increased, so has the prevalence of placenta previa. Internal iliac artery balloon occlusion has been suggested as a preventive measure to reduce blood loss during cesarean delivery in these cases. This approach has been investigated in only one randomized controlled trial (RCT) for placenta accreta spectrum. This RCT found no benefit from this approach but observed adverse effects due to the procedure in 15.4% of cases. No RCTs have investigated prophylactic internal iliac artery balloon occlusion for placenta previa. The aim of this study was to determine whether this approach for placenta previa reduces postpartum hemorrhage and demonstrates greater clinical benefit over the risks.