Prophylactic intraoperative uterine artery embolization to control hemorrhage in abnormal placentation during late gestation

Objective To determine whether prophylactic intraoperative uterine artery embolization (UAE) reduces blood loss and minimizes morbidity and mortality in cases of placenta accreta, increta, and percreta. Design A prospective, nonrandomized clinical trial. Setting A university-based, high-risk pregnan...

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Bibliographic Details
Published in:Fertility and sterility 2009-05, Vol.91 (5), p.1951-1955
Main Authors: Yu, Pao-Chu, M.D, Ou, Hsin-You, M.D, Tsang, Leo Leung-Chit, M.D, Kung, Fu-Tsai, M.D, Hsu, Te-Yao, M.D, Cheng, Yu-Fan, M.D
Format: Article
Language:English
Subjects:
abnormal placentation
Adult
Biological and medical sciences
Birth Weight
cesarean hysterectomy
desired fertility
Female
Gynecology. Andrology. Obstetrics
Humans
Hysterectomy
Infant, Newborn
Internal Medicine
Medical sciences
Obstetrics and Gynecology
Placenta Accreta - diagnostic imaging
Placenta Accreta - surgery
postpartum hemorrhage
Postpartum Hemorrhage - prevention & control
Pregnancy
Prospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the genital tract and mammary gland
Ultrasonography, Prenatal
Uterine artery embolization
Uterine Artery Embolization - adverse effects
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Summary:Objective To determine whether prophylactic intraoperative uterine artery embolization (UAE) reduces blood loss and minimizes morbidity and mortality in cases of placenta accreta, increta, and percreta. Design A prospective, nonrandomized clinical trial. Setting A university-based, high-risk pregnancy unit and department of interventional radiology. Patient(s) Eleven patients who were diagnosed prenatally with placenta accreta, increta, and percreta. Intervention(s) Patients with suspected placenta accreta were treated with prophylactic, intraoperative UAE immediately after fetal delivery and before removal of the placenta. Patients with suspected placenta increta were treated with UAE; the placenta remained in situ, or a hysterectomy was performed. Patients with suspected placenta percreta were treated with UAE, and the placenta remained in situ. Main Outcome Measure(s) Intraoperative blood loss, maternal mortality, fetal mortality, need for hysterectomy. Result(s) Eleven viable fetuses were born with no radiation exposure. There were no maternal or fetal mortalities. Nine of 11 patients had an estimated blood loss between 500 and 2300 mL. Emergency hysterectomy was performed in two patients because of massive bleeding. The complications, including peritonitis and endometritis, occurred in another two patients after embolization. Conclusion(s) Prophylactic, intraoperative UAE before placental expulsion appears to reduce the risk of postpartum hemorrhage, decrease morbidity and mortality, and increase the chance of preservation of the uterus in patients with placenta accreta, increta, and percreta.
ISSN:0015-0282
1556-5653
DOI:10.1016/j.fertnstert.2008.02.170