Placental uterine artery embolization followed by delayed hysterectomy for placenta percreta: A case series

• Published in: Gynecologic oncology reports 2021-08, Vol.37, p.100833, Article 100833
• Main Authors: Gatta, Luke A., Lee, Paula S., Gilner, Jennifer B., Weber, Jeremy M., Adkins, LaMani, Salinaro, Julia R., Habib, Ashraf S., Pabon-Ramos, Waleska, Strickland, Kyle C., Ronald, James, Erkanli, Alaattin, Mehdiratta, Jennifer E., Grotegut, Chad A., Secord, Angeles Alvarez
• Format: Article
• Language: English
• Subjects: Case Reports and Case Series; Massive transfusion protocol; Morbidly adherent placenta; Multidisciplinary team; Placenta accreta spectrum; Postpartum hemorrhage; Uterine artery embolization
• ISSN: 2352-5789; 2352-5789
• DOI: 10.1016/j.gore.2021.100833

•Approximately 23% of women intending delayed hysterectomy for placenta accreta spectrum will have an unscheduled surgery.•Targeted embolization for placenta accreta spectrum appears to be a safe and feasible adjunct to surgical management.•Placental regression may contribute to discrepancy between intraoperative and pathology diagnoses in delayed hysterectomy.•A multidisciplinary approach to placenta accreta spectrum is associated with a lower blood loss. We describe outcomes of patients with suspected placenta percreta treated with placental uterine artery embolization (P-UAE) followed by delayed hysterectomy. This is a prospective case series of subjects from 2005 to 2018 with suspected placenta percreta who underwent P-UAE at the time of cesarean delivery followed by delayed hysterectomy. Both scheduled and unscheduled surgical cases were included. Maternal characteristics, surgical approaches, intra- and postoperative outcomes were abstracted from medical records. In total, twenty-two subjects were included. Median (interquartile range, IQR) delivery gestational age was 34.6 (31.9, 35.7) weeks, occurring as scheduled in 17 (77.3%) subjects and unscheduled in 5 (22.7%). Delayed hysterectomy was performed as scheduled in 17 (77.3%) subjects at a median (IQR) 40.5 (38.0, 44.0) days after delivery, and 5 (22.7%) subjects had a hysterectomy prior to scheduled date, median (IQR) 27.0 (17.0, 35.0) days after delivery. Indications for the 5 unscheduled hysterectomies included bleeding (n = 3) and suspected endometritis (n = 2). Three subjects (13.6%) received a blood transfusion (1, 3, 3 units) during delivery, and 7 (31.8%) were transfused during delayed hysterectomy (median [IQR] 2 [1,3] units). Three (13.6%) subjects had bladder resection at the time of hysterectomy; 1 (4.5%) had an unintentional cystotomy and 1 (4.5%) had a ureteral injury. P-UAE followed by delayed hysterectomy appears to be a safe and feasible, although appropriate patient selection and close surveillance are imperative, as 22.7% of patients underwent unscheduled hysterectomy.