Prophylactic Pelvic Artery Catheterization and Embolization in Women with Placenta Accreta: Can It Prevent Cesarean Hysterectomy?

ABSTRACT

We present the outcome of a relatively large cohort of women with suspected placenta accreta who underwent prophylactic pelvic artery catheterization prior to cesarean section. All pregnant women with suspected placenta accreta who delivered in one tertiary center were included in this retrospective study. All patients underwent an elective cesarean section with prophylactic pelvic artery catheterization of internal iliac arteries through femoral or brachial approach. Thirty women underwent prophylactic catheterization; placenta accreta was clinically confirmed in 25 (83.3%) cases. Embolization was performed in 23 cases (76.6%) and hysterectomy in 2 (8%). Median estimated amount of blood loss was 2000 mL (500 to 9000 mL). There were no major catheterization-related complications. Three women had a subsequent pregnancy and uncomplicated delivery by cesarean section. Prophylactic pelvic artery catheterization and embolization in women with placenta accreta is safe and effective in prevention of hysterectomy and should be considered in woman wishing to preserve fertility.

KEYWORDS

Balloon occlusion - catheterization - embolization - hysterectomy - placenta accreta

REFERENCES

• 1 Committee on Obstetric Practice . ACOG committee opinion. Placenta accreta. Number 266, January 2002.  Int J Gynaecol Obstet. 2002;  77 77-78
• 2 Oyelese Y, Smulian J C. Placenta previa, placenta accreta, and vasa previa.  Obstet Gynecol. 2006;  107 927-941
• 3 Wu S, Kocherginsky M, Hibbard J U. Abnormal placentation: twenty-year analysis.  Am J Obstet Gynecol. 2005;  192 1458-1461
• 4 Gielchinsky Y, Rojansky N, Fasouliotis S J, Ezra Y. Placenta accreta—summary of 10 years: a survey of 310 cases.  Placenta. 2002;  23 210-214
• 5 Zaideh S M, Abu-Heija A T, El-Jallad M F. Placenta praevia and accreta: analysis of a two-year experience.  Gynecol Obstet Invest. 1998;  46 96-98
• 6 Miller D A, Chollet J A, Goodwin T M. Clinical risk factors for placenta previa-placenta accreta.  Am J Obstet Gynecol. 1997;  177 210-214
• 7 Bretelle F, Courbière B, Mazouni C et al.. Management of placenta accreta: morbidity and outcome.  Eur J Obstet Gynecol Reprod Biol. 2007;  133 34-39
• 8 Usta I M, Hobeika E M, Musa A A, Gabriel G E, Nassar A H. Placenta previa-accreta: risk factors and complications.  Am J Obstet Gynecol. 2005;  193(3 Pt 2) 1045-1049
• 9 Nisenblat V, Barak S, Griness O B, Degani S, Ohel G, Gonen R. Maternal complications associated with multiple cesarean deliveries.  Obstet Gynecol. 2006;  108 21-26
• 10 Clark S L, Koonings P P, Phelan J P. Placenta previa/accreta and prior cesarean section.  Obstet Gynecol. 1985;  66 89-92
• 11 Practice Bulletin ACOG . ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage.  Obstet Gynecol. 2006;  108 1039-1047
• 12 O'Brien J M, Barton J R, Donaldson E S, Donaldson E S. The management of placenta percreta: conservative and operative strategies.  Am J Obstet Gynecol. 1996;  175 1632-1638
• 13 Habek D, Becareviç R. Emergency peripartum hysterectomy in a tertiary obstetric center: 8-year evaluation.  Fetal Diagn Ther. 2007;  22 139-142
• 14 Kacmar J, Bhimani L, Boyd M, Shah-Hosseini R, Peipert J. Route of delivery as a risk factor for emergent peripartum hysterectomy: a case-control study.  Obstet Gynecol. 2003;  102 141-145
• 15 Glaze S, Ekwalanga P, Roberts G et al.. Peripartum hysterectomy: 1999 to 2006.  Obstet Gynecol. 2008;  111 732-738
• 16 Knight M. UKOSS . Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage.  BJOG. 2007;  114 1380-1387
• 17 Kayem G, Davy C, Goffinet F, Thomas C, Clément D, Cabrol D. Conservative versus extirpative management in cases of placenta accreta.  Obstet Gynecol. 2004;  104 531-536
• 18 Timmermans S, van Hof A C, Duvekot J J. Conservative management of abnormally invasive placentation.  Obstet Gynecol Surv. 2007;  62 529-539
• 19 Hudon L, Belfort M A, Broome D R. Diagnosis and management of placenta percreta: a review.  Obstet Gynecol Surv. 1998;  53 509-517
• 20 Sumigama S, Itakura A, Ota T et al.. Placenta previa increta/percreta in Japan: a retrospective study of ultrasound findings, management and clinical course.  J Obstet Gynaecol Res. 2007;  33 606-611
• 21 Badawy S Z, Etman A, Singh M, Murphy K, Mayelli T, Philadelphia M. Uterine artery embolization: the role in obstetrics and gynecology.  Clin Imaging. 2001;  25 288-295
• 22 Hansch E, Chitkara U, McAlpine J, El-Sayed Y, Dake M D, Razavi M K. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience.  Am J Obstet Gynecol. 1999;  180(6 Pt 1) 1454-1460
• 23 Chauleur C, Fanget C, Tourne G, Levy R, Larchez C, Seffert P. Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases.  Hum Reprod. 2008;  23 1553-1559
• 24 Ornan D, White R, Pollak J, Tal M. Pelvic embolization for intractable postpartum hemorrhage: long-term follow-up and implications for fertility.  Obstet Gynecol. 2003;  102(5 Pt 1) 904-910
• 25 Salomon L J, deTayrac R, Castaigne-Meary V et al.. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study.  Hum Reprod. 2003;  18 849-852
• 26 Alanis M, Hurst B S, Marshburn P B, Matthews M L. Conservative management of placenta increta with selective arterial embolization preserves future fertility and results in favorable outcome in subsequent pregnancies.  Fertil Steril. 2008;  86 1514.e3–7
• 27 Warshak C R, Eskander R, Hull A D et al.. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta.  Obstet Gynecol. 2006;  108(3 Pt 1) 573-581
• 28 Mazouni C, Gorincour G, Juhan V, Bretelle F. Placenta accreta: a review of current advances in prenatal diagnosis.  Placenta. 2007;  28 599-603
• 29 Comstock C H, Love Jr J J, Bronsteen R A et al.. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy.  Am J Obstet Gynecol. 2004;  190 1135-1140
• 30 Ojala K, Perälä J, Kariniemi J, Ranta P, Raudaskoski T, Tekay A. Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage*.  Acta Obstet Gynecol Scand. 2005;  84 1075-1080
• 31 Tan C H, Tay K H, Sheah K et al.. Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta.  AJR Am J Roentgenol. 2007;  189 1158-1163
• 32 Bodner L J, Nosher J L, Gribbin C, Siegel R L, Beale S, Scorza W. Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta.  Cardiovasc Intervent Radiol. 2006;  29 354-361
• 33 Shrivastava V, Nageotte M, Major C, Haydon M, Wing D. Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta.  Am J Obstet Gynecol. 2007;  197 402, e1–e5
• 34 Shih J C, Liu K L, Shyu M K. Temporary balloon occlusion of the common iliac artery: new approach to bleeding control during cesarean hysterectomy for placenta percreta.  Am J Obstet Gynecol. 2005;  193 1756-1758
• 35 Sewell M F, Rosenblum D, Ehrenberg H. Arterial embolus during common iliac balloon catheterization at cesarean hysterectomy.  Obstet Gynecol. 2006;  108(3 Pt 2) 746-748
• 36 Kidney D D, Nguyen A M, Ahdoot D, Bickmore D, Deutsch L S, Majors C. Prophylactic perioperative hypogastric artery balloon occlusion in abnormal placentation.  AJR Am J Roentgenol. 2001;  176 1521-1524
• 37 Levine A B, Kuhlman K, Bonn J. Placenta accreta: comparison of cases managed with and without pelvic artery balloon catheters.  J Matern Fetal Med. 1999;  8 173-176
• 38 Weeks S M, Stroud T H, Sandhu J, Mauro M A, Jaques P F. Temporary balloon occlusion of the internal iliac arteries for control of hemorrhage during cesarean hysterectomy in a patient with placenta previa and placenta increta.  J Vasc Interv Radiol. 2000;  11 622-624
• 39 Dubois J, Garel L, Grignon A, Lemay M, Leduc L. Placenta percreta: balloon occlusion and embolization of the internal iliac arteries to reduce intraoperative blood losses.  Am J Obstet Gynecol. 1997;  176 723-726
• 40 Kuczkowski K M. Anesthesia for the repeat cesarean section in the parturient with abnormal placentation: what does an obstetrician need to know?.  Arch Gynecol Obstet. 2006;  273 319-321