Vaginal delivery with placenta previa totalis by selective embolization of the placenta: a case report of TOP due to bilateral kidney agenesis

Introduction Being diagnosed with placenta praevia totalis is associated with increased risks of many complications during labour. Bleeding during pregnancy, premature delivery, life-threatening postpartum haemorrhage, delivery by caesarean section and its associated risks, and many more. It is a life-threatening risk for both the baby and the mother.

So far, there have been many attempts to find methods to reduce the risk of bleeding. For example, artery embolization, artery ligation, or trans-catheter ballon occlusion of different uterine artery embolization, trans-catheter arterial ballon occlusion of of the large vessels from the aorta and iliac vessels to the uterine artery. All coming hand in hand with severe risks for both the baby and the mother. Therefore, the search for a better method continued.

Material/Methods In 2023 a team of obstetricians and interventional radiologists brought their knowledge and experience together to combine the clinical outcome in one particular case. A young patient (26 a), presented at 18 weeks of pregnancy with multiple non-viable malformations of the fetus and placenta praevia totalis for termination of pregnancy. In order to spare her a caesarean section parva, the selective emoblisation of the placental vessels with silicone beeds was carried out by interventional radiologists.

Results The birth could then be induced in a normal way and was without complications, increased blood loss or loss of uterine tissue or other complications that often occur with more extensive endovascular interventions.

Discussion So far, this is a single case. In order to test the method sufficiently, a larger number of cases would have to be evaluated.

Publication History

Article published online:
15 November 2023