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Preoperative placement of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter for dilation and evacuation with invasive placentation
Abstract Number: F4C-1
Abstract Type: Case Report/Case Series
CASE SYNOPOSIS: A 37 yo G6P4104 with an obstetric history notable for five prior cesarean deliveries presented for an elective termination at 16w5d due to concerns for maternal morbidity in the setting of placenta increta. Her most recent delivery was complicated by placental abruption resulting in an intrauterine fetal demise, disseminated intravascular coagulopathy, massive blood transfusion, prolonged ICU care, and multiple operative repairs of internal injuries. Two years following, the patient became unexpectedly pregnant and was diagnosed with invasive placentation. She subsequently presented for dilation and evacuation.
Precautionary measures were taken to minimize her risk of hemorrhage. Preoperatively, she underwent prophylactic placement of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter and vascular sheath by interventional radiology. She was transitioned to the operating room where general anesthesia was induced and the trachea was intubated. A radial arterial line was placed for hemodynamic monitoring. Large-bore IV access was obtained, and a 7-french Rapid Infusion Catheter was placed in the left antecubital vein. Four units of blood were kept in a cooler and were immediately available for administration. Additionally, an interventional radiologist was present in the operating room during the procedure and was available to inflate the REBOA balloon in the event of massive hemorrhage. Her procedure was complicated by EBL 1650ml requiring oxytocin, methylergonovine maleate, misoprostol, and intrauterine tamponade via a foley balloon. She was admitted to the ICU postoperatively for close monitoring. On POD 1, the intrauterine foley balloon was sequentially deflated and removed with minimal bleeding, and the REBOA balloon catheter was subsequently removed. The patient met appropriate postoperative milestones and was discharged from the hospital later that day.
KEY LEARNING POINTS FOR DISCUSSION:
1) What is the REBOA and how is it used?
2) What evidence is available in the literature supporting its use?
3) What are the advantages of the REBOA catheter versus uterine artery embolization?
4) Does placement of the REBOA require anticoagulation?
5) What precautions must be taken when a REBOA is in place?