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 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. (Fertil Steril (R) 2009;91:1951-5. (C) 2009 by American Society for Reproductive Medicine.)