Clinical StudyFeasibility and Safety of Prophylactic Uterine Artery Catheterization and Embolization in the Management of Placenta Accreta
Section snippets
Materials and methods
The present study was a retrospective chart review of a series of 95 consecutive patients who were suspected prenatally to have PA and were managed with the same multidisciplinary strategy between February 2002 and July 2012 at a university hospital. Inclusion criteria were suspicion of PA based on the presence of ultrasound (US) and/or magnetic resonance (MR) imaging findings and/or the presence of high risk factors such as previous cesarean delivery and placenta previa in the index pregnancy.
Results
PA was confirmed in 79 of 95 patients (83%), 74 based on histopathology (hysterectomies) and five based on intraoperative clinical assessment. Among the 74 patients with a pathologic diagnosis of abnormal placental adherence, 20 (27%) were accreta, 18 (24%) increta, and 36 (49%) percreta (Table 2). The five patients with clinical diagnosis of PA were managed without hysterectomy at the discretion of the attending physician because only a focal area of PA was suspected, the placenta could be
Discussion
The present large series reports the use of prophylactic uterine artery catheterization and embolization together with the surgical management of PA at a single institution. In this multidisciplinary approach, prophylactic uterine artery catheterization proved to be feasible in 97% of patients, with no major complications directly attributable to the endovascular procedures.
The literature describes two different types of endovascular interventions to diminish bleeding before hysterectomy in the
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None of the authors have identified a conflict of interest.