Prophylactic Uterine Artery Embolization Research Articles

Emergency and prophylactic uterine artery embolization in gynecology and obstetrics - a retrospective analysis.

This study aimed to evaluate the safety and efficacy of emergency and prophylactic uterine artery embolization (UAE) in our clinical practice, including technical success, clinical success, and associated complications. In this retrospective study, we analyzed 64 women who underwent emergency (n =18) and prophylactic (n = 46) UAE. Indications for emergency UAE included postpartum hemorrhage or severe hemorrhage during pregnancy termination, while prophylactic UAE was performed prior to surgical removal of retained products of conception (RPOC), delivery with abnormal placental implantation, or pregnancy termination (cervical pregnancy or fetal anomalies accompanied by abnormal placental implantation). Technical success of UAE was defined as complete exclusion of the vascular lesion and contrast stasis on the final angiogram, while clinical success was defined as cessation of bleeding after UAE Termination without a hysterectomy. The overall clinical success of UAE in our study was 97% (62/64). All embolization procedures were technically and clinically successful in the prophylactic group without life-threatening hemorrhages or hysterectomies (100% success rate, 46/46). However, while 100% technical success was similarly attained in the emergency group, bleeding was successfully controlled in 89% of cases (16/18). In two patients with significant blood loss (over 2000 mL), embolization failed to achieve hemostasis, resulting in persistent bleeding and subsequent hysterectomy. UAE is a safe and effective procedure for managing primary postpartum hemorrhage or severe hemorrhage during pregnancy termination and for decreasing the risk of severe hemorrhage during surgical removal of RPOC, delivery with abnormal placental implantation, or pregnancy.

Clinical analysis of prophylactic uterine artery embolization combined with double balloon catheter for second-trimester pregnancy termination in cases of complete placenta previa: A retrospective study.

Complete placenta previa often causes significant bleeding in a short period during second-trimester pregnancy termination. This can destabilize the mother's circulation, threatening her life. Furthermore, the condition is complicated by an immature cervix, making it a challenging clinical problem. The aim of this study was to investigate the effect of prophylactic uterine artery embolization (UAE) combined with double balloon catheter (DBC) deal with those cases. A total of 7 patients who underwent pregnancy termination in the second-trimester in Maternal and Child Health Hospital of Hubei Province between March 1st, 2021 and August 31st, 2023 were retrospectively analyzed in this study. All patients were diagnosed with complete placenta previa status and placenta accreta spectrum, and were treated with prophylactic UAE combined with DBC, and/or dilation and evacuation. All the patients received mifepristone, and 5 of them underwent medical termination with ethacridine lactate. Following prophylactic UAE combined with DBC, 6 patients underwent dilation and evacuation, which was monitored by ultrasound. And one patient experienced natural delivery of their fetus and placenta. Only one patient (patient 3) developed an intrapartum fever after prolonged duration of 18 hours from ethacridine to UAE and 56 hours from UAE to DBC. The amount of intrapartum hemorrhage ranged from 20 mL to 300 mL. The combined therapy of prophylactic UAE and DBC is a preferred option for patients with complete placenta previa undergoing second-trimester pregnancy termination. The use of dilation and evacuation may depend on the cervical condition, bleeding, or infection.

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

PurposeTo 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 MethodsThis 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. ResultsThere 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. ConclusionsIn 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.

The effect of prophylactic uterine artery embolization on reproductive outcomes in patients with cesarean scar pregnancy: a propensity score-matched study.

This study aimed to investigate the effect of prophylactic uterine artery embolization (UAE) on reproductive outcomes in patients with cesarean scar pregnancy (CSP). A retrospective case-control study was conducted using the hospital records of all women diagnosed with CSP during a period of 6years, between January 2014 and December 2019, at Shengjing Hospital of China Medical University. The clinical characteristics and different treatment modalities were analyzed. According to the inclusion and exclusion criteria, 181 patients with reproductive needs were selected and divided into a UAE group (n = 51) and a non-UAE group (n = 130) according to whether they received preventive UAE before their hysteroscopic or laparoscopic operation. The basic characteristics and pregnancy outcomes of patients in each group were compared, and a propensity score-matched (PSM) analysis was used to produce 37 matched pairs. Before PSM, the UAE group had a thinner muscle layer, larger mass size, and higher serum human chorionic gonadotropin level than the non-UAE group. The pregnancy rate and live birth rate of the UAE group were 54.9% and 61.9%, respectively, which were lower than those of the non-UAE group (61.5% and 66.7%), but no statistical differences were observed. Post-PSM, no significant differences between basic characteristics of the groups were observed. The pregnancy rate of the UAE group was 51.4%, which was lower than that of the non-UAE group (73.0%); the live birth rate of the UAE group was 64.3%, which was also lower than that of the non-UAE group (72.7%); however, the differences were not statistically significant with the P value of 0.077 and 0.716. Prophylactic UAE did not induce a significant difference in pregnancy rate and live birth rate between the UAE group and the non-UAE group.

A study on the timing of uterine artery embolization followed by pregnancy excision for cesarean scar pregnancy: a prospective study in China

BackgroundCesarean scar pregnancy (CSP) remains a sporadic and special form of ectopic pregnancy in which the fertilized ovum is implanted on a previous cesarean scar within 12 weeks. This study aims to evaluate the optimal time interval between uterine artery embolization (UAE) and curettage modalities in order to provide the best clinical outcomes.MethodsFrom January 2018 to December 2020, we recruited 61 patients with CSP. They were randomly divided into two groups depending on whether the time interval between UAE and dilatation and curettage (D&C) requires additional hospitalization: 31 patients received prophylactic UAE followed by D&C on the same day (0–12 h; group A) and 30 patients need hospitalization (12–72 h; group B). The clinical characteristics, diagnostic data, and outcomes of the two groups were compared and analyzed.ResultsA total of 59 (96.72%) cases had responded well to the first treatment. One patient in each arm undergone retreatment, but none of the 61 patients needed additional hysterectomy. There was no considerable relationship between the two groups with respect to the intraoperative hemorrhage during D&C, serum index (containing β-hCG, hemoglobin, CRP, and D-dimer) on the first day after D&C, side effects (containing fever and abdominal pain), renal, hepatic, and coagulation function, time of CSP residual mass disappearance, and hospitalization cost. The time of serum β-hCG resolution after surgery was 41.22 ± 14.97 days in group A and 66.67 ± 36.64 days in group B (P = 0.027), and group A treatment resulted in a shorten hospital stay as compared with group B (4.81 ± 2.74 days vs. 6.80 ± 2.14 days, P < 0.001). However, the average hourly serum β-hCG decrease rate within 24 h and the leukocytes on the first day after D&C in group B were superior than in group A (P < 0.050).ConclusionFor patients with CSP, UAE followed by D&C on the same day (0–12 h) appears to have more advantages in hospitalization and recovery time, while the long time interval (12–72 h) may have a lower risk of inflammation and a more rapid decrease in serum β-hCG level within 24 h after D&C surgery. The treatment of CSP should be individualized based on the conditions of patients.

Risk factors for poor hemostasis of prophylactic uterine artery embolization before curettage in cesarean scar pregnancy.

ObjectiveTo observe the hemostatic effect of prophylactic uterine artery embolization (UAE) in patients with cesarean scar pregnancy (CSP) and to examine the risk factors for poor hemostasis.MethodsClinical data of 841 patients with CSP who underwent prophylactic UAE and curettage were retrospectively analyzed to evaluate the hemorrhage volume during curettage. A hemorrhage volume ≥200 mL was termed as poor hemostasis. The risk factors of poor hemostasis were analyzed and complications within 60 days postoperation were recorded.ResultsAmong the 841 patients, 6.30% (53/841) had poor postoperative hemostasis. The independent risk factors of poor hemostasis were gestational sac size, parity, embolic agent diameter (>1000 μm), multivessel blood supply, and incomplete embolization. The main postoperative complications within 60 days after UAE were abdominal pain, low fever, nausea and vomiting, and buttock pain, with incidence rates of 71.22% (599/841), 47.44% (399/841), 39.12% (329/841), and 36.39% (306/841), respectively.ConclusionsProphylactic UAE before curettage in patients with CSP is safe and effective in reducing intraoperative hemorrhage. Gestational sac size, parity, embolic agent diameter, multivessel blood supply, and incomplete embolization of all arteries supplying blood to the uterus are risk factors of poor hemostasis.

Prophylactic intraoperative uterine artery embolization for the management of major placenta previa

Purpose Placenta previa is a major cause of maternal morbidity and mortality, associated to a high risk of peripartum hemorrhage and hysterectomy. We aimed to verify if prophylactic intraoperative uterine artery embolization in patients with placenta previa and at least one additional risk of bleeding (major placenta previa), can reduce hemorrhage, need for blood transfusions, peripartum hysterectomy and maternal morbidity. Materials and methods We enrolled 76 patients with major placenta previa; a specific multidisciplinary protocol was designed for management, including ultrasound evaluation, hospitalization at 34 weeks, antenatal corticosteroids and scheduled cesarean section at 35–36 weeks. 44 patients (control group or CTR) were treated with elective cesarean section, 32 patients (embolized group or EMB) underwent selective catheterization of bilateral uterine arteries before cesarean section and subsequent uterine embolization. In both cases cesarean section was performed by a senior surgeon. Results Significant differences were found in term of intraoperative blood loss (CTR: 1431 ml; EMB: 693 ml); despite an high percentage of CTR patients had a bleeding greater than 1000 ml (56%), the need for blood transfusion was not significantly different between the two groups. Time of surgery was higher in the EMB group, considering that embolization procedure required approximatively 30 min. Three patients from the CTR group needed hysterectomy and ICU admission, compared to none in the EMB group. Duration of hospitalization and neonatal outcome were similar. Uterine embolization was not related to any short or long-term complications; return to normal menses and preservation of fertility were confirmed at follow up. Conclusions Our results are promising, although we believe that a major contribution is referable to the multidisciplinary approach rather than the procedure itself. Nevertheless, we demonstrated the feasibility and safety of preventive uterine embolization in patients with placenta previa; in order to establish its prophylactic role in the prevention of peripartum hemorrhage, randomized trial should be carried out, on a larger population.

Uterine Artery Embolization Prior to Induced Second-Trimester Abortion With Placenta Previa: Report of a Series of Cases

Due to the higher prevalence of placenta previa in induced second-trimester abortions, prophylactic uterine artery embolization prior to induction of labor is a safe and effective technique to reduce maternal blood loss and morbidity. J Clin Gynecol Obstet. 2020;9(1-2):25-28 doi: https://doi.org/10.14740/jcgo511

Clinical investigation in the methods for complete placenta previa labor induction in the second trimester

Objective: To investigate the appropriate method of labor induction in the second trimester for complete placenta previa patients. Methods: The labor induction outcomes of 85 cases with complete placenta previa in the second trimester were retrospectively analyzed. Twenty patients in group A were treated with cesarean section, 30 patients in group B were treated with ethacridine and mifepristone combined with uterine artery embolization (UAE), and 35 patients in group C were induced by using ethacridine and mifepristone. The clinical features and induction outcomes of three groups were compared. Results: The total duration of labor in group B [(28.7±30.1) hours] was significantly longer than that of group C [(24.3±21.9) hours; P<0.05]. The total amount of blood loss during induction and labor in group B [(302±271) ml] was significantly lower than those of group C [(393±523) ml] and group A [(626±487) ml; P<0.05]. The incidence of fever in group B (13%, 4/30) was significantly higher than those of group C (11%, 4/35) and group A (10%, 2/20; P<0.05). In group C, 13 patients (37%, 13/35) underwent emergency UAE, and 2 patients (6%, 2/35) underwent emergency cesarean section. As to average hemoglobin level and blood transfusion rate, there were no difference among the three groups (all P>0.05). Conclusion: Prophylactic UAE combined with drug induction in patients with complete placenta previa in the second trimester could significantly reduce the amount of bleeding during induction and reduce the risk of emergency procedures.

Prophylactic uterine artery embolization during cesarean delivery for placenta previa complicated by placenta accreta.

To evaluate the efficacy and safety of prophylactic uterine artery embolization (UAE) during cesarean delivery for women with placenta previa complicated by placenta accreta. A retrospective analysis of women with placenta previa admitted to The Second Affiliated Hospital of Soochow University, Suzhou, China, for elective cesarean between February 2003 and July 2016. Postpartum estimated blood loss, blood transfusion, hysterectomy, disseminated intravascular coagulation (DIC) incidence, intensive care unit (ICU) duration, and postoperative stay were compared between control women who underwent cesarean delivery only and women who underwent prophylactic intraoperative UAE during cesarean. There were 28 and 26 women in the UAE and control group, respectively. There were no differences in hysterectomy incidence (P=0.291), or duration of ICU stay (P=0.085), or postoperative hospitalization (P=0.668) between the groups; however, the incidence of DIC was lower in the UAE group (P=0.035). Mean estimated blood loss (P=0.018) and blood transfusion (P=0.011) were also lower in the UAE group. No serious complications were associated with the endovascular procedures. Prophylactic intraoperative UAE seemed to effectively reduce blood loss, need for blood transfusion, and incidence of DIC among women with placenta previa complicated by placenta accreta.

Observation on the Effect of Uterine Artery Embolization Combined with Hysteroscopy in the Treatment of Cesarean Scar Pregnancy

Objective To study the effect of uterine artery embolization (UAE) and methotrexate (MTX) combined with hysteroscopy in the treatment of cesarean scar pregnancy(CSP). Methods:82 cases of cesarean scar pregnancy in the China-Japan Union Hospital of Jilin University were retrospectively studied between January, 2010 and January, 2016.They were divided into the two groups on the treatment method. The group A was offered prophylactic uterine artery embolization (UAE) and methotrexate (MTX) prior to uterine curettage with hysteroscopy method. The group B was treated with mifepristone prior to uterine curettage with hysteroscopy as routine therapy. The effect of the two groups after treatment was analyzed and compared. Results: The blood loss of the group A (27.42 ± 15.31)mL was significantly lower than that of the group B, P<0.05.The total effective rate of the group A was 97.24%,which was significantly higher than that of the group B of 69.86%, P <0.05. The bleeding days in the group A were significantly shorter than those in the group B, P <0.05. The surgical time of group A was significantly shorter than the group B. Conclusion: Uterine artery embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy can significantly improve the bleeding situation and prognosis.

Prophylactic uterine artery embolization in second-trimester pregnancy termination with complete placenta previa.

ObjectiveThis study was performed to assess whether prophylactic uterine artery embolization (UAE) is beneficial for second-trimester abortion with complete placenta previa (CPP).MethodsPatients with CPP who underwent second-trimester pregnancy termination by labor induction with or without UAE from January 2010 to January 2018 were retrospectively reviewed. In total, 25 patients were eligible for analysis. The primary outcomes were the abortion success rate and bleeding volume, and the secondary outcomes were the induction-to-abortion time, length of hospital stay, and complications.ResultsCPP occurred in all 25 patients. Fifteen patients underwent prophylactic UAE (UAE group) and 10 did not (control group). Abortion was successful in 13 of 15 (86.7%) women in the UAE group and in 9 of 10 (90.0%) women in the control group. There was no significant difference in the bleeding volume or induction-to-abortion time between the two groups. The hospital stay was longer and pyrexia was more common in the UAE than control group.ConclusionProphylactic UAE did not markedly improve the outcomes of second-trimester abortion in patients with CPP. Conversely, it may increase the risk of complications and prolong the hospital stay.

Effects of prophylactic uterine artery embolization on second-trimester induced abortions in patients with placenta previa.

To evaluate the effects of prophylactic uterine artery embolization (UAE) on second-trimester induced abortions in patients with placenta previa. The present study was a retrospective review of second-trimester induced abortions in the presence of placenta previa that conducted between January 1, 2008, and October 31, 2017, at a university hospital in Hangzhou, China. Pregnancy outcomes including intraoperative blood loss, transfusion, dilatation and evacuation, hysterotomy delivery, and hysterectomy were compared between patients with and without prophylactic UAE. There were 54 patients included in the study. In patients with partial placenta previa (n=15), the volume of intraoperative blood loss and the frequency of dilatation and evacuation were not significantly different between the UAE and non-UAE groups (P>0.05). No patient had a transfusion, hysterotomy delivery, or hysterectomy. Among patients with complete placenta previa (n=39), the volumes of intraoperative blood loss (P=0.014) and transfusion (P=0.046) were significantly lower in the UAE group compared with the non-UAE group. The rates of dilatation and evacuation, and hysterotomy delivery did not differ between the groups (P>0.05), but were numerically higher in the non-UAE group. No patient was treated with hysterectomy. Prophylactic UAE before a second-trimester induced abortion had significant advantages in women with complete placenta previa, but it did not improve the pregnancy outcome in patients with partial placenta previa. ChiCTR-OPC-14005334.

Conservative management of placenta percreta.

Maternal outcomes after conservative management of placenta percreta are poorly understood. To assess the success and complication rates of conservative management of placenta percreta. The PubMed, MEDLINE, and Scopus databases were searched for English-language articles published between January 1990 and December 2016, using combinations of search terms related to conservative management of placenta percreta. Only studies describing conservative treatment for placenta percreta (without placental removal) were included in the systematic review. There were 44 studies included and maternal outcomes were reviewed and categorized among 72 patients. The uterus was preserved among 42 (58%) patients and severe complications developed among 40 (56%). Prophylactic uterine artery embolization (UAE) did not improve success rates (P=0.807); however, the mean time for complete placental resorption was lower in the UAE group than in the non-UAE group (22.4weeks vs 35.3weeks; P=0.014). Hysterectomy was performed at a mean of 44.6days after cesarean delivery. Among the 23 patients with hysterectomy-related complications, 18 (78%) experienced bladder injury, intraoperative bleeding (>2000mL), or both. The use of chemotherapy did not improve success rates (P=0.064). The present systematic review revealed high maternal morbidity during conservative management of placenta percreta.

Efficacy of Prophylactic Uterine Artery Embolization before Obstetrical Procedures with High Risk for Massive Bleeding.

ObjectiveTo evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding.Materials and MethodsA retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D&C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D&C for retained placenta with vascularity (n = 5), and D&C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE.ResultsAll women received successful bilateral prophylactic UAE followed by D&C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester.ConclusionProphylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.

Prophylactic Uterine Artery Embolization in Mid-trimester Pregnancy Termination for Placenta Previa: Required for All Patients?

Prophylactic Uterine Artery Embolization in Mid-trimester Pregnancy Termination for Placenta Previa: Required for All Patients?

Efficacy and Safety of Prophylactic Uterine Artery Embolization in Pregnancy Termination with Placenta Previa.

To appraise the efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa. A cohort of 54 consecutive patients with placenta previa underwent prophylactic uterine artery embolization before vaginal delivery from February 2012 to March 2015. Vaginal delivery was attempted in all patients. Cesarean section or hysterectomy was introduced when vaginal delivery failed. Vaginal delivery succeeded in 50 patients (93.6%) and failed in 4 patients (6.4%), thereupon converted to cesarean delivery. No patients resorted to hysterectomy. Six patients (11.1%) underwent blood transfusion. None of clinical characteristics, including maternal age, gestational age, history of abortion, history of cesarean delivery, and volume of vaginal bleeding, was significantly associated with complete placenta previa (P>0.05). However, patients with complete placenta previa had a significantly lower successful rate of vaginal delivery than did patients without complete placenta previa (81 vs 100%, P=0.038). The rate of complications was 3.7%. No major complications were observed. Uterine artery embolization is an effective and safe technique to assist pregnancy termination with placenta previa, which may lower the risk of cesarean section, hysterectomy, and blood transfusion.

Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy.

In the present study, we evaluated the diagnosis and management modalities of caesarean scar pregnancy (CSP). Thirty patients diagnosed with CSP were retrospectively studied between February, 2010 and February, 2012. Twenty-five patients were offered prophylactic uterine artery embolization (UAE) and methotrexate (MTX) prior to uterine suction curettage. Five cases were referred from other hospitals where the initial management with uterine suction curettage had resulted in uncontrollable massive haemorrhage, 4 of the cases had UAE and one proceeded immediately to hysterectomy. In the 25 patients treated with prophylactic UAE and MTX, 12 had laparoscopy-guided curettage and 13 had ultrasound-guided curettage without complication. The results showed that the 25 patients with CSP, who received prophylactic UAE and MTX prior to uterine curettage, recovered without complications. Five patients referred from other hospitals, where uterine curettage was the primary procedure, had severe complications including uncontrolled vaginal bleeding and uterine rupture. Four of the five patients were treated successfully with emergency UAE and the remaining patient underwent emergency hysterectomy as ultrasound examination detected significant haemorrhage between the uterus and the bladder. Of the 25 patients who received prophylactic UAE combined with MTX, there were no reports of irregular menstruation or serious adverse effects. Notably, the decrease in serum human chorionic gonadotropin (HCG) levels 3 days post-surgery was greater with ultrasound-guided curettage (84.3±5.5%) than with laparoscopy-guided curettage (76.3±10.2%). In summary, the data suggested that prophylactic UAE with MTX followed by ultrasound-guided curettage is the most effective therapeutic approach in CSP.

4:51 PM, Abstract No. 305 - Prophylactic uterine artery embolization in patients with abnormal placental attachment: initial experience

Purpose: Placenta accreta/increta/percreta (AIP) is defined as abnormal attachment of all or part of the placenta to the myometrium and carries a high risk of hemorrhage and maternal mortality. The standard of care for management of placenta AIP has been cesarean-hysterectomy. In this series, we report an approach to the management of patients with abnormal placental attachment, in which patients underwent uterine artery embolization immediatley following delivery via cesarean section. Materials and Methods: Patients with suspected placenta AIP on both ultrasound and MRI underwent uterine artery catheterization prior to cesarean section, followed by cesarean section delivery. Patients who did not desire future fertility underwent cesarean section, uterine artery embolization with gelfoam, followed by hysterectomy. These patients were assessed post procedure for transfusions required as well as surgical complications. Patients who desired future fertility had the placenta left in situ, and underwent uterine artery embolization with gelfoam. Patients were followed and assessed for complications from angiography, postoperative complications and delayed passage of the placenta. Results: Over one year, 8 patients who were referred for suspected placenta AIP underwent uterine artery embolization. Four did not desire future fertility, and undwerwent cesarean section with hysterectomy. The remaining four patients desired future fertility and had the placenta left in situ. No angiographic complications were noted. Of the placentas left in situ, 3 either passed spontaneously or resorbed. 1 developed vaginal bleeding 7 weeks postoperatively, and underwent hysterectomy. Of those with no plans for future fertility, all successfully underwent hysterectomy. The number of units of red blood cells received per patient was 2, 1, 0 and 0 respectively. The only complication was a cystotomy due to the attachment of the placenta to the posterior bladder wall. Conclusion: Prophylactic uterine artery embolization allows for decreased blood loss and morbidity in patients undergoing cesearean hysterectomy and, when combined with nonremoval of the placenta, can provide an alernative to hysterectomy in patients desiring future fertility.

Feasibility and Safety of Prophylactic Uterine Artery Catheterization and Embolization in the Management of Placenta Accreta

PurposeTo evaluate the feasibility and safety of prophylactic uterine artery catheterization and embolization in the management of placenta accreta (PA). Materials and MethodsRetrospective chart review was performed of 95 consecutive patients with prenatal suspicion of PA managed in a 10-year period with a strategy that included prophylactic bilateral uterine artery catheterization, delivery of the baby, uterine artery embolization if indicated, and subsequent surgery. Feasibility was defined as catheterization being possible to perform, technical success as embolization being possible when indicated and complete stasis of the vessels achieved, and clinical success as no maternal death or major blood loss. Median gestational age at delivery was 36 weeks (interquartile range, 24–39 wk). ResultsPA was confirmed in 79 patients (83%). Feasibility was 97% (92 of 95); in three cases (3%), acute early massive hemorrhage forced emergency delivery without catheterization. Embolization was performed in 83 of 92 patients (87%) to the extent of complete stasis; in the remaining nine, it was unnecessary because spontaneous placental detachment was visualized after fetal delivery (technical success rate, 100%). There were several complications, including bleeding requiring blood transfusion (49%) and bladder surgery (37%), but there were no major complications attributable to the endovascular procedures. There was one minor complication presumably related to embolization (transient paresthesia and decreased temperature of lower limb), with uneventful follow-up. Clinical success rate was 86%, with no maternal deaths, but 14% of patients received large-volume blood transfusion. ConclusionsProphylactic uterine artery catheterization and embolization in the management of PA appeared to be feasible and safe in this consecutive series of patients.