Placenta accreta: management with uterine artery embolization in 17 cases.

摘要

PURPOSE: To report on the management of placenta accreta with uterine artery embolization (UAE) and to analyze the outcomes. MATERIALS AND METHODS: A retrospective study was performed over a 128-month period of all women with placenta accreta who underwent UAE in a single center. Seventeen patients were included, and they were further divided into two groups: a preventive group (diagnosis was made in the prenatal period, n = 6) and a curative group (diagnosis was made during delivery, n = 11). The mean patient age was 34.6 years +/- 5.5 in the preventive group and 31.4 years +/- 4.3 in the curative group. The mean term of pregnancy was 35 weeks +/- 2 of amenorrhea in the preventive group and 38 weeks +/- 2 in the curative group. RESULTS: The primary success of embolization was 100% in both groups. In the preventive group, massive bleeding occurred in a patient 2 days after unsuccessful manual placenta delivery resulted in an hysterectomy; in a second case, delayed bleeding (2 months after the procedure) was controlled with a second embolization. There were no episodes of repeat bleeding in the curative group. In the preventive group, two patients presented with uterine scarring, with synechiae in one and endometrial atrophy in the other. In the curative group, one patient presented with secondary amenorrhea. The delay before embolization was significantly different in the two groups (23.3 minutes +/- 5.1 in the preventive group vs 73 minutes +/- 44.7 in the curative group, P < .01), and total blood loss was 0.7 L +/- 0.8 in the preventive group and 2.6 L +/- 1.2 in the curative group (P < .01). CONCLUSIONS: Prenatal diagnosis of placenta accreta permits its preventive management, which reduces time to embolization and blood loss.