The primary literature search yielded 3360 records, of which 2394 were unique. After reviewing titles and abstracts, we identified 70 articles that were eligible for full-text screening. Two studies were excluded because of missing data for the primary and secondary outcomes [33, 34], two studies reporting outcomes on women undergoing peripartum hysterectomy were also excluded, and one study was not included because did not quantitatively subgroup patients undergoing prophylactic placement of occlusive balloons [35]. Overall, 61 met eligibility criteria for qualitative and quantitative analysis. The flowchart of the study selection process is shown in Fig. 1.

Table 1 outlines demographic, clinical and operative data of the included studies. Overall, 6973 women with suspected or confirmed abnormal placentation undergoing prophylactic endovascular procedures or not were included. Of those, 2996 (42.9%) did not undergo any endovascular procedure, 1865 (26.7%) underwent REBOA, 1162 (16.6%) PBO-IIA, 406 (5.8%) PBO-CIA placement, and 544 (7.8%) underwent UAE. Three RCTs [36,37,38] included 95 women undergoing prophylactic PBO-IIA, and 92 controls. Fifty-eight observational studies included a total population of 3885 patients undergoing prophylactic endovascular procedures and 2904 controls; among those, there were forty-four were retrospective cohort studies [39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84], and fourteen prospective cohort studies [85,86,87,88,89,90,91,92,93,94,95,96]. Most studies came from Asia [36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65, 67,68,69,70,71,72,73,74,75,76,77,78, 80, 81, 84,85,86, 88, 90,91,92,93,94,