69: Prophylactic arterial catheterization may improve operative morbidity in suspected placenta accreta and reduce the need for hysterectomy

Abstract

operative morbidity in suspected placenta accreta and reduce the need for hysterectomy Neeraj Desai, Hima Tam Tam, Adiel Fleischer Hofstra North Shore-LIJ School of Medicine, Division of Maternal-Fetal Medicine, Manhasset, NY OBJECTIVE: The optimal operative approach to placenta accreta (PA) is not well defined. We evaluated whether prophylactic arterial occlusion (CATH) techniques can decrease the need for routine cesareanhysterectomy and improve operative outcomes in patients with suspected PA. STUDY DESIGN: Retrospective study of all antenatally diagnosed PA at our institution from 1995-2011. Data regarding maternal demographics, operative procedure, EBL, PRBC, use of other blood products (FFP, cryo, or platelets), OR time, length of stay (LOS), and need for hysterectomy were collected. Cases with CATH, either Avitene embolization(UAE) or hypogastric balloon(BAL) were compared to controls without CATH. Data were analyzed using Fisher’s-exact and t-test. RESULTS: Of 78 identified PA, 63 had an antenatal diagnosis (Mean GA del 36wks); of these 39 had CATH, and 24 had no arterial occlusion. Maternal demographics were similar in both groups. CATH had significantly less EBL (2.0 vs.3.6l; p 0.0012), less PRBC (2.5 vs. 4.5U; p 0.0006), less need for additional blood products (15% vs. 42%; OR 0.25 [CI 0.07-0.84]; p 0.04) with no difference in OR time or LOS. In a subgroup analysis of CATH, 26 had intraoperative UAE immediately post delivery of infant while 13 had BAL. UAE vs. no occlusion also had decreased EBL and less PRBC transfusion (p 0.01). However, this reduction was not seen with BAL. 56 of 63 had attempt at uterine preservation; 35% in the CATH group required a hysterectomy vs. 88% without CATH (p 0.001). When the patient did have a hysterectomy, those that had CATH had similar EBL (3.0 vs.3.8l; p 0.41), and no significant differences in PRBC, use of other blood products, OR time,or LOS. When analyzed by type of CATH, there was a trend for lower EBL and PRBC vs. BAL, but this was nonsignificant. In the CATH group, only one complication (axillary hematoma) was observed. CONCLUSION: This is one of the largest series to date in the US that looks at the management of PA. Our findings suggest that a protocol that includes CATH may improve the likelihood of uterine conservation and reduces operative morbidity.