Endovascular Strategy in Obstetrics

Postpartum hemorrhage (PPH) requires medical resources to resuscitate hemorrhagic shock patients. The concept of damage control surgery in obstetrics has become widespread, and resuscitative endovascular balloon occlusion of the aorta (REBOA) can be a means of resuscitation in PPH. However, the potential benefits of endovascular strategies in obstetrics are not fully understood. This review discusses surgical and endovascular strategies for perinatal resuscitation and hemostasis. The endovascular strategies include REBOA, arterial embolization, and common or internal iliac artery balloon occlusion (CIABO or IIABO). Uterine artery embolization achieves rapid definitive hemostasis while leaving fertility with a less invasive procedure. N-butyl-2-cyanoacrylat (NBCA) should be chosen as needed for coagulopathy. The obstetrics and resuscitation team would have to develop each command system, and control and cooperate in parallel. The consensus for the timing of arterial access and the patient’s positioning for pelvic examination and femoral arterial access should be established in advance.