Uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta

Abstract

Aim: To evaluate the efficacy and safety of uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta.

Materials and methods: Between January 2005 and August 2011, 45 women with placenta accreta, which was discovered during delivery, were managed conservatively in Peking Union Medical College Hospital. They did not experience severe bleeding during delivery. Ten patients (mean age 31 ± 6.4 years) developed secondary postpartum haemorrhage and underwent uterine artery embolization. The complications, control of haemorrhage, and outcome of the placenta left inside the uterus were retrospectively reviewed.

Results: All patients underwent transcatheter embolization of bilateral uterine arteries. The median time between delivery and uterine artery embolization was 11 days (range 3-76 days). The technical success rate of embolization was 100%. Bleeding was controlled in all patients during follow-up (11 ± 6.9 months; range 3-24 months), and no further bleeding occurred. One patient developed lower-extremity deep venous thrombosis after uterine artery embolization, and no other major complications occurred. The placentae that were left inside the uteri gradually decreased in size during follow-up, except in one case. Nine patients resumed normal menstruation. One patient subsequently became pregnant and had an uneventful intrauterine pregnancy carried to term.

Conclusion: Uterine artery embolization is safe and effective for the management of secondary postpartum haemorrhage associated with placenta accreta.