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

2020 ◽  
Vol 99 (10) ◽  
pp. 1374-1380 ◽  
Author(s):  
Aya Mohr‐Sasson ◽  
Roni Hochman ◽  
Matan Anteby ◽  
Maya Spira ◽  
Elias Castel ◽  
...  
2020 ◽  
Author(s):  
Duzhou Zheng ◽  
Huawei Shen ◽  
Mingxing Liu ◽  
Shikuan Huang ◽  
Weifeng Liu ◽  
...  

Abstract Objective: To estimate the related factors of hysterectomy in patients with Placenta accreta spectrum (PAS) after uterine artery embolization (UAE), and try to evaluate the effectiveness and safety of UAE in patients with PAS.Methods: From January 2012 to July 2020, a retrospective analysis was performed in 85 patients undergoing TAE for PAS. Information regarding clinical data, angiography as well as embolization details, and clinical outcomes was obtained. Univariate and multivariate analyses were performed to determine the factors related to hysterectomy.Results: Bleeding greater than or equal to 500ml during the delivery(p = 0.037), the placenta type by MR or US(placenta increta vs placenta percreta, P = 0.01) and the type of ovarian artery(No vs Bilateral, P = 0.005; Unilateral vs Bilateral, P = 0.01) were independent risk factors of hysterectomy in PAS patients treated with UAE. The area under the curve (AUC) of the predictive model that incorporated the independent risk factors was 0.844. Abnormal collateral vessels communicating with uterine artery were observed on angiography in 24 patients (28.2%) with 31 abnormal collateral vessels. The major abnormal collateral vessel was the abnormal branches of the internal iliac artery(n = 13), followed by the inferior vesical artery (n = 11), internal pudendal artery(n = 3), obturator artery (n = 2), vaginal artery(n = 1) and the abnormal branches of the external iliac artery(n = 1).Conclusions: TAE is safe and effective for patients with PAS. Bleeding greater than or equal to 500ml during the delivery, the placenta type by MR or US and the type of ovarian artery were related to the hysterectomy. For patients with hypertrophic ovarian-uterine artery anastomosis and no fertility requirements, Ovarian artery embolization(OAE) could be a feasible choice.


2016 ◽  
Vol 31 (4) ◽  
pp. 228-232 ◽  
Author(s):  
Zhi-wei Wang ◽  
Xiao-guang Li ◽  
Jie Pan ◽  
Xiao-bo Zhang ◽  
Hai-feng Shi ◽  
...  

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Helena Isabel Lopes ◽  
Maria Isabel Sá ◽  
Rosa Maria Rodrigues

Background. Several pregnancies have been reported after embolization of uterine artery. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids but its safety in women desiring future childbearing is not well established.Case Report. We present a 40-year-old woman with leiomyomata who became pregnant after previously undergone uterine artery embolization for three times. The placenta was previa and the fetus was in transverse position. She had a cesarean delivery of an appropriately grown fetus at 37 weeks, which was followed by uterine atony requiring hysterectomy.Conclusion. Although pregnancy-related outcomes remain understudied, the available reports evidence that pregnancies after uterine artery embolization may be at significantly increased risk for postpartum hemorrhage, cesarean delivery, abnormal placentation, and malpresentation. In patients who are undergoing this type of treatment and contemplating pregnancy, the possibility of adverse complications should be taken in consideration and women should be appropriately advised.


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