Onitorinvasive arterial blood pressure (ABP), electrocardiogram (ECG), SPO2, PetCO2, temperature (T), arterial blood gas (ABG), and thrombelastograph (TEG) in the individuals for the duration of the operation. Immediately after fetal delivery and umbilical cord clamping, in line with the PA location and depth, individuals are provided nearby excision with the uterine wall, placenta evacuation, partial cystectomy, and bladder repair. 20 U of oxytocin and 250 g of tromethamine are injected within the myometrium. Within the traditional group, patients are given a cesarean section without AABO. In this group, conservative therapies for PA, like oversewing of your placental bed, a uterine tamponade, and bilateral uterine artery, ligation are utilised. Hysterectomy is performed when enormous hemorrhage can not be controlled. In the interventional group, the cesarean section and all endovascular procedures will be performed in a hybrid operation room equipped having a digital subtraction angiography (DSA) machine (Allura Xper FD20, Philips, Finest, the Netherlands). Interventional radiologists will pick the proper diameter of the balloon, which is measured by MRI, and insert a 5 F pigtail catheter (Cook, Bloomington, IN, USA) into the abdominal aorta at the degree of T12 with an 8-F sheath (Cook) in the ideal femoral artery at the groin, together with the patient beneath nearby CP-456773 sodium anesthesia. Subsequent, five ml iodixanol 
(Visipaque-320, Nycomed, Oslo, Norway) will probably be injected to find theChu et al. Trials (2017) 18:Page four oforigin of your renal arteries. An 8-F, 40 14 mm, 40 16 mm, or 40 18 mm balloon catheter (Bard Peripheral Vascular, Tempe, AZ, USA) will likely be inserted in to the infrarenal abdominal aorta and fixed carefully. Each patient will have peripheral oxygen saturation placed on the good toes from the left foot to enable the interventional radiologist to establish when balloon catheter occlusion in the aorta has occurred for the duration of the endovascular procedures. Indirectly confirmed balloon block effective indicators are as follows: the digit blood oxygen is reduced to zero, the blood oxygen curve is at a flat state, along with the bipedal arterial blood pressure drops to zero [13, 21]. A sketch drawing with the abdominal aortic balloon position and related monitoring of physiological parameters during the operation is shown in Fig. two. Short-term aortic balloon occlusion will probably be implemented by utilizing 106 ml of saline resolution straight away immediately after fetal delivery and umbilical cord clamping. The balloons are inflated for 125 min, and also the inflations are alternated with deflations of 1 min. Asreported, it really is secure to block the pelvic organs and reduce limbs for 30 min [22]. Soon after the operation, a pelvic angiography is performed again. If there is active bleeding, uterine artery embolization (UAE) is supplemented. The fluoroscopy time is recorded in all instances. When the operation is completed, the catheter is pulled out and compression bandaging of your femoral artery puncture sites is performed. The lower limbs in the individuals are massaged soon after the operation. Low-molecular-weight heparin is offered for the patients after 24 h to stop vein thrombosis in the reduce limbs.Information collection Main outcomeThe major outcome is estimated blood loss (EBL). EBL is measured with reference PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/2129546 for the collected blood within the suction bottle in the operating space and to the weight of the surgical swabs, excluding the volume of amniotic fluid.Fig. two Sketch of abdominal aortic balloon position and connected physiological parameter monitoringChu et al. Tria.