Cesarean delivery with and without uterine artery embolization for the management of placenta accreta spectrum disorder—A comparative study. (20th May 2020)

• Record Type: Journal Article
• Authors: Mohr‐Sasson, Aya; Hochman, Roni; Anteby, Matan; Spira, Maya; Castel, Elias; Hendler, Israel; Mazaki‐Tovi, Shali; Sivan, Eyal
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 99:Number 10(2020)
• Page Start: 1374
• Page End: 1380
• Publication Date: 2020-05-20
• Subjects: long‐term outcome -- placenta accreta spectrum disorder -- uterine artery embolization; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.13868
• Languages: English
• ISSNs: 0001-6349

Abstract

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.