{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:43:37Z","timestamp":1788536617149,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T00:00:00Z","timestamp":1744070400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Preoperative prophylactic balloon occlusion (PPBO) of internal iliac arteries (IIAs) in placenta previa and placenta accreta spectrum (PAS) has been widely used as a preventive adjuvant technique to reduce blood loss and to preserve fertility. Nevertheless, the efficacy of PPBO is based primarily on retrospective studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the effectiveness of PPBO of the IIAs in placenta previa and PAS in reducing perioperative bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>MEDLINE, EMBASE, Web\u2010of\u2010Science, Scopus, the Cochrane Library, and <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link> were searched from their inception to July 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p>Randomized controlled trial (RCT) in which the use of PPBO on the IIAs was compared to non\u2010use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>The primary outcome was number of packed red blood cell (RBC) units transfused. We executed meta\u2010analysis using a random\u2010effects model. Quality of the studies was assessed using the Cochrane Risk\u2010of\u2010Bias tool. The GRADE criteria were used to assess evidence certainty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>Of 164 reports identified, three RCTs representing 167 women (83 and 84 in the intervention and control groups, respectively) were eligible. Mean number of RBC units transfused was 4.52\u2009\u00b1\u20091.70 and 3.70\u2009\u00b1\u20091.88 in the intervention and control groups, respectively (weighted mean difference, 1.04; 95% CI: 0.52\u20131.55; <jats:italic>P<\/jats:italic>\u2009=\u20090.001; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>, 0%; low certainty evidence). Transfusion of other blood products was comparable. Incidence of postoperative fever was higher (<jats:italic>P<\/jats:italic>\u2009=\u2009 0.024) and hospitalization duration was longer (<jats:italic>P<\/jats:italic>\u2009=\u20090.001) in the intervention group compared to the control group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Use of PPBO of the IIAs in placenta previa and PAS was associated with increase in number of RBC units transfused.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.70118","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T12:46:39Z","timestamp":1744116399000},"page":"1061-1070","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A systematic review and meta\u2010analysis of randomized controlled trials on the effects of internal iliac artery balloon occlusion in placenta previa and placenta accreta spectrum in reducing perioperative bleeding"],"prefix":"10.1002","volume":"170","author":[{"given":"Rula","family":"Iskander","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal","family":"Massalha","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"},{"name":"The Ruth and Bruce Rappaport Faculty of Medicine, Technion  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Remer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ido","family":"Izhaki","sequence":"additional","affiliation":[{"name":"Department of Evolutionary and Environmental Biology University of Haifa  Haifa 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