**Author details**

hemodynamic and metabolic changes associated with balloon inflation and deflation is paramount and requires frequent communication between the operating and anesthesia teams to

• Plan risks and benefits discussion comparing available hemorrhage control adjuncts available at the institution

• Provide post-operative intensive care, anticipating fluid shifts and electrolyte abnormalities associated with

Finally, providing supportive care for profound anemia and limiting unnecessary lab draws can improve postoperative outcomes. Careful consideration must be given to the use and timing of anticoagulation in setting where further hemorrhage could be detrimental to patients.

In conclusion, women undergoing planned operations for MAP are among those at highest risk for catastrophic obstetric hemorrhage, especially those for whom blood products are not an option. A multidisciplinary approach to management is the key to patient survival. Goals include limiting blood loss, maintaining hemodynamic stability, and reducing postoperative morbidity. In addition to the obstetric and anesthesia teams, assistance by general, acute care, trauma, or vascular surgeons may be required for hemorrhage control. REBOA is an emerging hemorrhage-control technique with benefits for obstetric applications and represents a

tool that should be in the armamentarium of obstetric/gynecologic surgeons.

time the administration of medications and fluids.

**7. Conclusions**

**Acknowledgements**

**Conflict of interest**

The authors report no conflict of interest.

**Notes/thanks/other declarations**

None.

None.

A summary of the recommendations can be found in **Table 5**.

• Assemble multidisciplinary team including all perioperative stakeholders

• Consider REBOA as an adjunct to temporary hemorrhage control

• Optimize preoperative blood volume and hemoglobin

• Expeditiously achieve definitive hemorrhage control

severe anemia and ischemia–reperfusion

**Table 5.** Summary recommendations.

106 Placenta

Rachel M. Russo1 , Eugenia Girda2 , Hui Chen3 \*, Nina Schloemerkemper4 , Misty D. Humphries5 and Vanessa Kennedy3

\*Address all correspondence to: hachen@ucdavis.edu

1 Department of Surgery, University of California Davis, Sacramento, CA, USA

2 Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

3 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA, USA

4 Department of Anesthesiology, University of California Davis, Sacramento, CA, USA

5 Division of Vascular Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
