Abstract
Objectives: The purpose of this article is to investigate the estimated blood loss in pregnant women undergoing cesarean section and placental extirpation to treat abnormal placentation and compare the outcomes of those who underwent prophylactic transcatheter arterial embolization (TAE) with those who did not. Methods: A retrospective study was conducted on 17 pregnant women diagnosed with abnormal placentation in 2001–2018 in a single tertiary center. The patients were diagnosed by surgical finding, ultrasound, or magnetic resonance imaging (MRI). These patients were divided into two groups: a prophylactic TAE group (11 patients) and a control group (6 patients). In the former group, prophylactic TAE of the bilateral uterine artery (UA) and/or internal iliac artery (IIA) was performed immediately after delivery of the infant. The placenta was removed in both groups. The primary outcomes were estimated blood loss (EBL), units of packed red blood cell (pRBC) transfusion, operative time, whether hysterectomy was performed, whether the patient was transferred to the intensive care unit (ICU), and hospitalization days. The secondary outcome was maternal complications. Results: Patients who received prophylactic TAE had significantly reduced intraoperative blood loss (990.9 ± 701.7 mL vs. 3448.3 ± 1767.4 mL, p = 0.018). Units of pRBC transfusion, operative time, hysterectomy, transfer to the ICU, and postoperative hospitalization days were not significantly different between the two groups. Thirteen patients (9 in the TAE group and 4 in the control group) received a blood transfusion during the operation. Three patients underwent a hysterectomy (1 in the TAE group and 2 in the control group). Five patients were transferred to the ICU (3 in the TAE group and 2 in the control group) for maternal complications or monitoring. In the prophylactic TAE group, 3 patients (27%) had a subsequent pregnancy within the next 5 years. Conclusions: Prophylactic TAE was safe and effective for reducing intraoperative hemorrhage from removing an invasive placenta in patients with abnormal placentation.
Highlights
In recent decades, the incidence of placenta accreta has risen from 1 in 4027 to 1 in 533 deliveries in the US due to the increased number of patients receiving cesarean sections [1]
Due to the limited number of studies focusing on placenta expulsion in patients with an invasive placenta, the aim of this study is to investigate the efficacy and safety of prophylactic transcatheter arterial embolization (TAE) in patients with abnormal placentation who undergo placenta extirpation
Eleven patients who were treated with prophylactic transcatheter arterial embolization (TAE) were in the prophylactic TAE group, and six patients who did not receive this intervention were in the control group
Summary
The incidence of placenta accreta has risen from 1 in 4027 to 1 in 533 deliveries in the US due to the increased number of patients receiving cesarean sections [1]. According to the invasion depth of chorionic villi, abnormal placental implantations are classified as accreta, increta, and percreta. The pathogenesis of abnormal placentation is not yet clearly understood, the most accepted theory is that it results from an imbalance between decidualization and trophoblast invasion. Dysfunctional decidua in a scarred area caused by previous uterine surgery leads to invasion of the myometrium by the placenta [2]. The most common risk factors for invasive placenta are placenta previa and previous cesarean surgery [3]. Placenta accreta is much more common than increta and percreta [4]
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