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Expanding the field of acute care surgery: a systematic review of the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in cases of morbidly adherent placenta



Prophylactic placement of endovascular balloon occlusion catheters has grown to be part of the surgical plans to control intraoperative hemorrhage in cases of abnormal placentation. We performed a systematic literature review to investigate the safety and effectiveness of the use of REBOA during cesarean delivery in pregnant woman with morbidly adherent placenta.


A systematic review was performed. Relevant case reports and nonrandomized studies were identified by the literature search in MEDLINE. We included studies involving pregnant woman with diagnosis of abnormal placentation who underwent cesarean delivery with REBOA placed for hemorrhage control. MINORS’ criteria were used to evaluate the risk of bias of included studies. A formal meta-analysis was not performed.


Eight studies were included in cumulative results. These studies included a total of 392 patients. Overall, REBOA was deployed in 336 patients. Six studies reported the use of REBOA as an adjunct for prophylactic hemorrhage control in pregnant woman with diagnosis of morbidly adherent placenta undergoing elective cesarean delivery. In two studies, REBOA was deployed in patients already in established hemorrhagic shock at the moment of cesarean delivery. REBOA was deployed primarily by interventional radiologists; however, one study reported a surgeon as the REBOA provider. The results from our qualitative synthesis indicate that the use of REBOA during cesarean delivery resulted in less blood loss with a low rate complications occurrence.


REBOA is a feasible, safe, and effective means of prophylactic and remedial hemorrhage control in pregnant women with abnormal placentation undergoing cesarean delivery.

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Correspondence to R. Manzano-Nunez.

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Ethical statement

RMN, MFE, MPN, FR, PF, JDC, and CAO comply with the ethical guidelines for authorship and publishing in the European Journal of Trauma and Emergency Surgery. This Systematic Review contains images of a patient with MAP that underwent prophylactic REBOA placement. Informed consent was obtained from the participant who appears in the pictures.

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The authors declare no conflict of interest relevant to this manuscript.

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Manzano-Nunez, R., Escobar-Vidarte, M.F., Naranjo, M.P. et al. Expanding the field of acute care surgery: a systematic review of the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in cases of morbidly adherent placenta. Eur J Trauma Emerg Surg 44, 519–526 (2018).

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  • Acute care surgery
  • Endovascular procedures
  • Placenta accreta
  • Abnormal placentation