Uterine artery embolization for postpartum hemorrhage with placenta accreta spectrum

Acta Radiol. 2023 Jul;64(7):2321-2326. doi: 10.1177/02841851231154675. Epub 2023 Apr 24.

Abstract

Background: The reported success rate of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) differs by the cause of bleeding; in some reports, UAE shows less successful results in patients with placenta accreta spectrum (PAS).

Purpose: To evaluate the outcome of UAE for treating PPH associated with PAS.

Material and methods: From September 2011 to September 2021, 227 patients (mean age = 34.67±4.06 years; age range = 19-47 years) underwent UAE for managing intractable PPH. Patients were divided into two groups: those with PAS (n = 46) and those without PAS (n = 181). Delivery details, embolization details, and procedure-related outcomes were compared between the two groups. P values <0.05 were considered statistically significant.

Results: The technical success rate was 96.9% (n = 222) and the clinical success rate was 93.8% (n = 215). There were no significant differences in outcome of UAE between the two patient groups. The technical success rate was 95.7% (n = 44) in patients with PAS and 98.3% (n = 178) in patients without PAS (P = 0.267). The clinical success rate was 91.3% (n = 42) in patients with PAS and 95.6% (n = 173) in patients without PAS (P = 0.269). There were 24 cases of immediate complications, including pelvic pain (n = 20), urticaria (n = 3), and puncture site hematoma (n = 1). No major complication was reported.

Conclusion: UAE is a safe and effective method to control intractable PPH for patients with or without PAS.

Keywords: Uterine artery embolization; outcomes analysis; placenta accreta; placenta increta; placenta percreta; postpartum hemorrhage.

MeSH terms

  • Adult
  • Female
  • Humans
  • Middle Aged
  • Placenta Accreta* / diagnostic imaging
  • Placenta Accreta* / therapy
  • Postpartum Hemorrhage* / diagnostic imaging
  • Postpartum Hemorrhage* / therapy
  • Pregnancy
  • Retrospective Studies
  • Uterine Artery Embolization* / methods
  • Young Adult