Intraoperative Contact Duplex Ultrasonography in Navigation of Prophylactic Balloon Occlusion of the Abdominal Aorta in Patients With Placenta Percreta

Background Prophylactic balloon occlusion of the abdominal aorta (PBOAA) is the most effective vascular control strategy in surgical treatment of patients with placenta accreta spectrum (PAS) disorders. Intraoperative contact duplex ultrasonography (ICDUS) can be used for PBOAA navigation in the absence of opportunities for traditional X-ray imaging. Methods This retrospective observational study was conducted using medical records of patients with PAS who gave birth from January 1st, 2020, to October 30th, 2025. Inclusion criteria : singleton pregnancy; cesarean delivery; PAS types T3 or T4. Exclusion criteria : multiple pregnancy; vaginal delivery; no clinical signs of PAS at delivery; PAS types T0, T1, T2, and T5. The study cohort was divided into two groups based on the primary method of bleeding prevention. Group 1 – using distal complex compression hemostasis. Group 2 – using PBOAA under ICDUS navigation. The primary outcome was total blood loss of ≥ 2500 ml. The secondary outcomes were: operation time ≥ 120 minutes, bladder injury, need for additional intraoperative methods of hemostasis, postpartum hemorrhage, relaparotomy, hysterectomy, and PBOAA-related complications. Results Of the total cohort, 62 (80.5%) patients were assigned to Group 1 and 15 (19.5%) patients to Group 2; in all cases, ICDUS allowed direct real-time control of the introducer movement and precise positioning of the balloon in zone 3 of the abdominal aorta. The only PBOAA-associated complications were hematomas at the site of femoral artery puncture, which were reported in 2 (13.3%) patients and did not require surgical intervention. A total blood loss volume of ≥ 2500 ml. was seen in 25 cases (40.3%) in Group 1 but in only 1 case (6.7%) in Group 2 (p=0.014). In Group 1, additional methods of blood flow reduction were used in almost all (95.1%) cases, while in Group 2 they were not required (p<0.0001). Average total blood loss (1850 ml vs 980 ml), duration of the operation (126.5 min vs 112 min), and postoperative hospitalization (7 vs 5 days) of women were also significantly higher in Group 1 in comparison to Group 2 (p<0.05). Conclusion ICDUSappears to be a safe and effective form of navigation for PBOAA during Caesarean section in placenta percreta cases.