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

https://doi.org/10.1016/j.jvir.2014.10.013Get rights and content

Abstract

Purpose

To evaluate the feasibility and safety of prophylactic uterine artery catheterization and embolization in the management of placenta accreta (PA).

Materials and Methods

Retrospective 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).

Results

PA 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.

Conclusions

Prophylactic uterine artery catheterization and embolization in the management of PA appeared to be feasible and safe in this consecutive series of patients.

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

References (30)

  • C.H. Meller et al.

    Timing of delivery in placenta accreta

    Am J Obstet Gynecol

    (2014)
  • A.G. Eller et al.

    Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care

    Obstet Gynecol.

    (2011)
  • A. Hull et al.

    Placenta Accreta and Postpartum Hemorrhage

    Clin Obstet Gynecol.

    (2010)
  • C. Warshak et al.

    Effect of Predelivery Diagnosis in 99 Consecutive Cases of Placenta Accreta

    Obstet Gynecol

    (2010)
  • Publications Committee, Society for Maternal-Fetal Medicine, Belfort MA. Placenta accreta. Am J Obstet Gynecol...
  • Cited by (0)

    None of the authors have identified a conflict of interest.

    View full text