Uterine Artery Embolization following Cesarean Delivery but prior to Hysterectomy in the Management of Patients with Invasive Placenta.

Abstract

PURPOSE:

To evaluate outcomes of patients with placenta accreta spectrum (PAS) disorders who underwent uterine artery embolization (UAE) following cesarean delivery but before hysterectomy.

MATERIALS AND METHODS:

A retrospective review of patients with PAS treated with cesarean-hysterectomy (C-hyst) was performed. Patients in the UAE group underwent UAE after cesarean delivery but before hysterectomy; patients in the control group underwent C-hyst alone. Estimated blood loss (EBL), transfusion requirements, length of intensive care unit (ICU) stay, and adverse events were evaluated.

RESULTS:

The study included 31 patients, 7 in the UAE group and 24 in the control group. Median EBL, transfusion requirements, and length of ICU stay in the UAE group compared with control group were 1,500 mL (range, 500-2,000 mL) vs 2,000 mL (range, 1,000-4,500 mL) (P = .04), 150 mL (range, 0-650 mL) vs 550 mL (range, 0-3,125 mL) (P = .10), and 0 d (range, 0-1 d) vs 0.5 d (range, 0-2 d) (P = .07). All patients in the UAE group had placenta increta; patients in the control group had placenta accreta (29%), increta (54%), and percreta (17%) (P = .10). Subgroup analysis of patients with placenta increta demonstrated that the UAE group had a significant decrease in median EBL (P = .004), transfusion requirements (P = .009), and length of ICU stay (P = .04). No adverse events following UAE were noted.

CONCLUSIONS:

UAE following cesarean delivery but before hysterectomy in patients with placenta increta appears to be safe and effective in decreasing EBL, transfusion requirements, and length of ICU stay compared with C-hyst alone.

• Authors: Melinda Wang, Deddeh Ballah, Alana Wade, Andrew G Taylor, Gabrielle Rizzuto, Benjamin Li, Jennifer Lucero, Lee-May Chen, Maureen P Kohi
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 30 Issue 5 Pg. 687-691 (May 2019) ISSN: 1535-7732 [Electronic] United States
• PMID: 30922797 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Blood Loss, Surgical (prevention & control)
• Blood Transfusion
• Cesarean Section (adverse effects)
• Female
• Humans
• Hysterectomy (adverse effects)
• Length of Stay
• Placenta Accreta (diagnostic imaging, therapy)
• Pregnancy
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Uterine Artery Embolization (adverse effects)