Object: This systematic review and meta-analysis aim to examine evidence on the effectiveness and safety of aortic balloon occlusion (ABO) during caesarean deliveries in placenta accreta spectrum (PAS) disorders. Methods: MEDLINE, Science Citation Index, Elsevier, clinicaltrials.gov, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for articles dated from database inception to February 2020. The primary outcomes were intraoperative blood loss volume (BLV) and hysterectomy rate. Results: Of the 793 articles, 11 were included in this study, with a total of 915 patients. Of the 535 patients who underwent ABO, 48 (9%) had placenta creta; 309 (57%), placenta increta; and 124 (23%), placenta percreta. Meta-analysis showed that ABO significantly reduced BLV and blood transfused volume (P 0.001), and reduced the rate of hysterectomy (P 0.001). The overall catheter-related complication rate was 3.36%. The primary outcomes were available for 60 patients with placenta percreta. Meta-analysis of these patients showed ABO was associated with a decrease in BLV (P 0.001), but not a statistically significant reduction in hysterectomy (P = 0.48). Conclusions: ABO is effective at controlling haemorrhage and reducing the need for hysterectomy in PAS disorders, but it did not appear to be effective for uterine preservation in patients with placenta percreta.