Prophylactic uterine artery embolization in placenta accreta spectrum - an active intervention to reduce morbidity and promote uterine preservation.

PURPOSE: To 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 caesarean operation and prophylactic uterine artery embolization in the IR angiography suite as a combined procedure.

MATERIALS AND METHODS: This study evaluates the efficacy and safety of prophylactic uterine artery embolization prior to placental separation in cases of antenatally proven or suspected abnormal placentation. Over a five year period sixteen consecutive patients with PAS underwent combined IR and obstetric intervention. In all cases, caesarean 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 (14/16) if there was evidence of active postpartum bleeding or inability to deliver the placenta.

RESULTS: There 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.

CONCLUSION: In patients with PAS, caesarean section in the angiography suite preceded by prophylactic balloon placement and followed by uterine artery embolization is feasible, safe, and effective in preventing massive blood loss, with 56% uterine sparing rate.