North Texas Research Forum 2025
Files
Download Full Text (542 KB)
Division
North Texas
Hospital
Medical City Arlington
Specialty
Obstetrics & Gynecology
Document Type
Poster
Publication Date
2025
Keywords
placenta accreta spectrum disorder, PASD, placenta percreta, balloon occlusion
Disciplines
Female Urogenital Diseases and Pregnancy Complications | Medicine and Health Sciences | Obstetrics and Gynecology
Abstract
Introduction: Placenta accreta spectrum disorders (PASD) are associated with severe maternal morbidity, including hemorrhage requiring massive transfusion, intensive care unit (ICU) admission, coagulopathy, organ ischemia or failure, and death. The adherent placenta results in continuous mixed arterial and venous bleeding, preventing the uterus from adequately contracting. This can result in a blood loss rate of 600 mL or more per minute, posing a risk of exsanguination in less than five minutes. Few reports exist on the prophylactic use of resuscitative endovascular balloon occlusion of the aorta (REBOA) to reduce obstetric hemorrhage and its application for prolonged occlusion times exceeding 60 minutes. Using the REBOA catheter to manage PASD can potentially improve hemorrhage-related maternal outcomes by minimizing blood loss, facilitating improved operative field visualization, minimizing transfusion volume needs, and shortening surgery duration. Case: The patient was diagnosed with suspected placenta percreta and scheduled for a cesarean hysterectomy at thirty-four weeks gestation. The case was managed by an interdisciplinary team at an Accreta Center of Excellence. Prior to the delivery, interventional radiology placed the REBOA under fluoroscopic guidance at distal zone 3 of the aorta. Central aortic pressure was monitored through the catheter's pressure transducer and compared with the contralateral femoral and radial arterial lines placed preoperatively. Following the delivery and hysterotomy closure, severe hemorrhage secondary to suspected abruption was found after the patient had complete loss of arterial pressure. Inflation of the pre-positioned catheter was able to redirect blood to vital organs, rapidly achieving ROSC and hemodynamic stability. Intraoperatively, the placenta percreta was found to extend from both uterine sidewalls down the entire length of the lower uterine segment involving the bladder and the left ureter. The cesarean hysterectomy with the placenta left in situ was completed with partial and complete occlusion techniques to provide prolonged occlusion for a total of 166 minutes without complications associated with the REBOA. Conclusion: Prophylactic placement of the REBOA catheter has the potential to significantly improve the management of obstetric hemorrhage. This case highlights the efficacy of prolonged endovascular occlusion, utilizing partial and complete aortic occlusion with core aortic blood pressure monitoring to assess hemodynamic status. In cases of acute trauma, REBOA placement is reactive, addressing immediate hemorrhage. However, proactive approaches to obstetric hemorrhage create a unique opportunity, enabling physicians to mitigate complications more efficiently and potentially save lives.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Rodriguez, Monica; Tenzel, Nicole; Russo, Rachel; and Cohen, Robert, "Prophylactic Resuscitative Endovascular Balloon Occlusion in the Management of Placenta Percreta: A Case Report" (2025). North Texas Research Forum 2025. 62.
https://scholarlycommons.hcahealthcare.com/northtexas2025/62
Included in
Female Urogenital Diseases and Pregnancy Complications Commons, Obstetrics and Gynecology Commons