Management of High-Risk Obstetrical Patients with Morbidly Adherent Placenta in the Age of Resuscitative Endovascular Balloon Occlusion of the Aorta

Abstract

Obstetric hemorrhage is the leading cause of maternal morbidity and mortality worldwide. At highest risk of massive obstetric hemorrhage, are women with morbidly adherent placenta (MAP). The complications associated with MAP are even more devastating in very high-risk obstetrical patients, where blood transfusion is not an option, either due to lack of resources or patient refusal, such as for Jehovah's Witnesses. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally-invasive technique used in trauma surgery to control non-compressible hemorrhage. REBOA is emerging as useful tool for managing high-risk obstetric surgery for MAP. This review aims to provide a framework for use of REBOA in obstetric care in challenging circumstances.