Prophylactic Uterine Artery Embolization in Placenta Accreta Spectrum-An Active Intervention to Reduce Morbidity and Promote Uterine Preservation.

Abstract

PURPOSE:

To evaluate the feasibility and safety of early and proactive involvement of interventional radiology (IR) in the management of placenta accreta spectrum (PAS) by performing the cesarean operation and prophylactic uterine artery embolization in the IR angiography suite as a combined procedure.

MATERIALS AND METHODS:

This study evaluated the effectiveness and safety of prophylactic uterine artery embolization prior to placental separation in cases of antenatally proven or suspected abnormal placentation. Over a 5-year period, 16 consecutive patients with PAS underwent combined IR and obstetric intervention. In all cases, cesarean delivery was performed in the IR angiography suite. Vascular access was obtained prior to surgery with balloon placement into both internal iliac arteries. These balloons were inflated after delivery, followed by uterine artery embolization (14 of 16) if there was evidence of active postpartum bleeding or inability to deliver the placenta.

RESULTS:

There was no fetal or maternal mortality and no significant IR or surgical adverse events. Mean blood loss was 1900 mL. Seven patients (44%) underwent hysterectomy.

CONCLUSIONS:

In patients with PAS, cesarean section in the angiography suite preceded by prophylactic balloon placement and followed by uterine artery embolization was feasible, safe, and effective in preventing massive blood loss, with a 56% uterine sparing rate.

• Authors: Bibin Sebastian, Uma Rajesh, Paul M Scott, Saira Sayeed, Graham J Robinson, Duncan F Ettles, Vivek Shrivastava, Raghuram Lakshminarayan
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 34 Issue 11 Pg. 1922-1928 (11 2023) ISSN: 1535-7732 [Electronic] United States
• PMID: 37517463 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 SIR. Published by Elsevier Inc. All rights reserved.

Topics

• Pregnancy
• Humans
• Female
• Placenta Accreta (therapy, surgery)
• Uterine Artery Embolization (adverse effects)
• Cesarean Section (adverse effects)
• Placenta
• Balloon Occlusion (adverse effects, methods)
• Hysterectomy
• Iliac Artery
• Postpartum Hemorrhage (etiology, prevention & control)
• Morbidity
• Retrospective Studies
• Blood Loss, Surgical (prevention & control)