Resuscitative endovascular balloon occlusion of the aorta for placenta percreta/previa

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A 39-year-old woman, gravida, 7; para term, 4; cesarean sections, 4; para preterm, 0; para abortions, 2; para living, 4 with a gestational age of 37 weeks and 2 days. Her prenatal care had been erratic but was worked up with an ultrasound and magnetic resonance imaging with findings suggestive of a placenta accreta/previa (Fig. 1). Operative plan was to perform a midline infraumbilical delivery of the fetus in the hybrid room, prior placement of bilateral internal iliac artery occlusion balloons by the interventional radiologist and bilateral utereral stents by the urologist, followed by a hysterectomy to manage the placenta. The baby was delivered with good Apgar scores, and upon completion of the hysterectomy, the placenta revealed to be a percreta, which was confirmed by our histopathologist, and massive pelvic bleeding ensued, which required the activation of the institutions massive transfusion protocol and the urgent intraoperative consultation to the trauma service.
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