title: Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage.
abstract: BACKGROUND
  Severe postpartum hemorrhage occurs in 1/1000 women giving birth. This condition is often dramatic and may be life threatening. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has in recent years been introduced as a novel treatment for hemorrhagic shock. We present a series of fluoroscopy-free REBOA for controlling life threatening postpartum hemorrhage.
  
  
  METHODS
  In 2008 an 'aortic occlusion kit' was assembled and used in three Norwegian university hospitals. The on-call interventional radiologist (IR) was to be contacted with a response time < 30 minutes in case of life threatening PPH. Demographics and characteristics were noted from the medical records.
  
  
  RESULTS
  This retrospective study includes 36 patients treated with fluoroscopy-free REBOA for controlling severe postpartum hemorrhage in the years 2008-2015. The REBOA success rate was 100% and no patients died from REBOA related complications. Uterine artery embolization was performed in 17 (47%) patients and a hysterectomy in 16 (44%) patients. A short (11cm) introducer length was strongly associated with iliac artery thrombus formation (ρ = 0.50, P = 0.002). In addition, there was a strong negative correlation between uterine artery embolization and hysterectomy (ρ = -0.50, P = 0.002).
  
  
  CONCLUSIONS
  Our Norwegian experience indicates the clinical safety and feasibility of REBOA in life threatening PPH. Also, REBOA can be used in an emergency situation without the use of fluoroscopy with a high degree of technical success. It is important that safety implementation of REBOA is established, especially through limited aortic balloon occlusion time and a thorough balloon deflation regime.
authors.affiliation: Dept of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway.|Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Knut Haakon
authors.initials: KH
authors.lastname: Stensaeth
authors.affiliation: Dept of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway.
authors.forename: Edmund
authors.initials: E
authors.lastname: Sovik
authors.affiliation: Dept of Radiology and Nuclear Medicine, Oslo University Hospital Ullevaal, Oslo, Norway.
authors.forename: Ingrid Natasha Ylva
authors.initials: IN
authors.lastname: Haig
authors.affiliation: Dept of Radiology and Nuclear Medicine, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Erna
authors.initials: E
authors.lastname: Skomedal
authors.affiliation: Dept of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway.|Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Arve
authors.initials: A
authors.lastname: Jorgensen
mesh_terms: D000328:Adult; D001011:Aorta / Q000473:pathology*; D021721:Balloon Occlusion; D057510:Endovascular Procedures; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome