Something old, something new and something borrowed

Surgical management of placenta accreta spectrum (PAS) is, if anything, wrought with complexity. Placental invasion can be confined and relatively easy to manage or as surgically challenging a stage-IV ovarian tumour. In the most extensive cases, is equally capable encasing not only ureter but also femoral vessels obturator nerve, instead solid tumour surgeon faced mixed solid–cystic structure that behaves like large arteriovenous fistula until blood supply from uterine arteries collaterals bladder controlled. Even well-intended, experienced vascular who has never encountered PAS risks inadvertently inciting haemorrhage, should he she attempt move gain better exposure underlying structures. We surgical veterans will, therefore, always welcome effective tools techniques targeted against massive haemorrhage. this edition BJOG, MM Chou colleagues report outcomes their case series 32 women in whom they prophylactically isolate cross-clamp aorta (BJOG 2021; https://doi.org/10.1111/1471-0528.16605). Aortic occlusion been an essential step cardiovascular trauma surgery for decades. Without it, abdominal aortic aneurysm repair heart transplants would impossible. Although technique itself may entirely novel, article adds growing body evidence patients benefit when we learn expertise outside our own disciplines. The complexity heterogeneity demands multidisciplinary collaborative approach, advance understanding ultimately save women’s lives. Recently, there evidence-based shift away prophylactic internal iliac towards interest more proximal arteries. Within communities, significant debate continues between experts trust under direct vision those prefer intravascular techniques. purpose mini commentary espouse one method over another, rather highlight what remains unknown, questions must strive answer. Is superior other? What accompany each approach how do avoid iatrogenic harm? If median loss at being driven downwards meticulous techniques, risk harm than good occlusion? Fortunately, had few complications technique. caution eager adoption without forethought, however: novel approaches are readily published often surgeons need most, i.e., details about challenges pitfalls authors perfected these obstacles. Specifically, encourage obstetricians rely upon wisdom dissecting out aorta. A rent adjacent thin-walled inferior vena cava (IVC) difficult muscular Similarly, wise heed obstetrician asks them disturb sake exposure, removing it open haemorrhagic floodgates. There no doubt, however, face haemorrhage temporary aorta, either digitally ‘swab on stick’, lifesaving. Importantly, whatever favoured, desperately objective data help reduce potential ischaemic/reperfusion injuries postoperative thromboembolism. hope serves merely single springboard foster collaboration innovation, launch well-designed, high-quality, comparative studies specific complex obstetrical peripartum SC nothing disclose. KF reports grants Eunice Kennedy Shriver National Institute Child Health Human Development, submitted work. addition, local principal investigator multicentre database review efficacy REBOA (resuscitative endovascular balloon aorta) catheter. Completed disclosure forms available view online supporting information. Please note: publisher responsible content functionality any information supplied by authors. Any queries (other missing content) directed corresponding author article.