Cesarean delivery with and without uterine artery embolization for the management of placenta accreta spectrum disorder—A comparative study

Abstract

Introduction The aim of this study is to compare immediate and long‐term obstetrical outcomes of patients who underwent cesarean delivery with and without uterine artery embolization (UAE) for the management of placenta accreta spectrum disorder. Material and methods A retrospective case control study including all pregnant women admitted to a single tertiary medical center between December 2001 and May 2018 with a diagnosis of placenta accreta spectrum disorder, who underwent cesarean delivery with and without UAE. Groups were compared for maternal characteristics, operative management, postoperative complication rate and long‐term outcomes. Follow up on future obstetrical outcomes was conducted via telephone questionnaire. Non‐parametric statistics were used. Results During the study period, 272 women met the inclusion criteria: 64 (23.53%) and 208 (76.47%) underwent preservative cesarean section with and without UAE, respectively. UAE procedure was associated with a longer operative time (82.5 [68‐110] vs 50.5 [39‐77] minutes; P = .001), and higher blood loss (2000 (1500‐3000) vs 1000 (600‐2000) mL; P = .001). Hysterectomy rate was comparable between the groups (9 [14%] vs 35 [16.82%]; P = .88); however, multivariate logistic regression analysis found UAE to be an independent factor associated with lower hysterectomy rate (P = .02). Postoperative complications were more frequent in the UAE group. Follow up was achieved in 29 (59.18%) and 72 (51.79%) of the women with and without UAE, respectively (P = .36). No differences were found in rate of abortions, pregnancy and deliveries between the groups. Conclusions Cesarean delivery using UAE in placenta accreta spectrum disorder is associated with a higher rate of operative and postoperative complications. Nevertheless, in cases of severe adherence of the placenta, embolization reduces the need for hysterectomy, allowing future fertility.

Cesarean Hysterectomy in Abnormally Invasive Placenta: The Role of Prenatal Diagnosis

“…Prophylactic uterine artery embolization has been proposed to minimize blood loss during the surgery in this condition. However, literature results are contradictory, as some authors find a higher rate of operative and postoperative complications [23] whilst others describe better perinatal results with less blood loss [24]. This procedure was not performed in this case.…”

High‐intensity focused ultrasound in management of placenta accreta spectrum: A systematic review

“…Notably, conservative management was inconsistent among respondents 1 . Sixty‐one articles were retrieved from our CON‐PAS registry on conservative management using uterine artery embolization (23 studies), 27‐49 prophylactic balloon placement (15 studies), 2,50‐63 compression sutures (10 studies), 8,64‐72 leaving the placenta in situ (7 studies), 10,73‐78 and uterine wall excision and reconstruction (6 studies) 79‐84 . Despite the number of conducted studies (61 studies, 1979 patients), they have not yielded robust evidence‐based recommendations.…”

Placenta Accreta Spectrum: The Role of Interventional Radiology in Multidisciplinary Management

“…37 With respect to fertility, one retrospective study of women with PAS who underwent preservative cesarean delivery with (n ¼ 49) or without (n ¼ 139) UAE who completed long-term follow-up showed no difference in the rate of abortions, pregnancies, or deliv-eries between groups, and similar rates of PAS in future pregnancies. 38 Interestingly, a recent systemic review compared 483 pregnancies with prior UAE for PPH to 320,703 pregnancies without prior UAE. Using a patient backgroundmatched analysis based on previous PPH, the analysis showed that prior patients with prior PPH and UAE had higher rates of developing future PAS (odds ratio [OR]: 20.82; 95% confidence interval [CI]: 3.27-132.41) and PPH (OR: 5.32, 95% CI: 1.40-20.16) in future pregnancies, but not higher rates of hysterectomy (OR: 8.93, 95% CI: 0.43-187.06) or other complications such as placenta previa, fetal growth restriction, or preterm birth compared with those who did not undergo prior UAE.…”