The Role of Interventional Radiology in the Management of Placenta Accreta Spectrum Disorders

Abstract

Placenta accreta spectrum disorders encompass a heterogeneous group of conditions classified according to the degree of invasion of the trophoblastic tissue trough the myometrium and uterine serosa with a detrimental effect on maternal outcomes, including life-threatening hemorrhage, need for blood transfusion, damage to adjacent organs, and eventually death, and this highlights the need of additional procedures to improve surgery. The present review aims to provide an up to date on the role of interventional radiology procedures in affecting the outcome of women undergoing surgery for PAS disorders. Endovascular interventional radiology, including balloon catheterization and arterial embolization of pelvic vessels or abdominal aorta, has been proposed as an effective method for the prevention and control of postpartum hemorrhage caused by different obstetrical conditions, but there is no robust evidence on its role in optimizing perioperative outcomes of women affected by PAS. The current evidence from the available literature shows that abdominal aorta and internal iliac arteries balloon occlusion are both effective methods to reduce maternal morbidity in case of PAS, with a low incidence of procedure-related complications. Further large RCT adequately powered for the most severe surgical adverse outcomes are needed in order to estimate the effect of IR procedures in improving the outcome of women undergoing surgery for PAS disorders.