Prophylactic uterine artery embolization during cesarean delivery for management of hemorrhage in complete placenta previa: An observational study

Abstract

Complete placenta previa is a major cause of morbidity and mortality in pregnant women and fetuses. This study aimed to evaluate whether prophylactic uterine artery embolization (PUAE) could reduce bleeding in patients with complete placenta previa. We retrospectively analyzed patients with complete placenta previa admitted to Taixing People's Hospital for elective cesarean delivery between January 2019 and December 2020. The women were treated with PUAE (PUAE group, n = 20) or without (control group, control, n = 20). Risk factors for bleeding (age, gestational age, pregnancy times, delivery times, cesarean delivery times), intraoperative blood loss, hemoglobin difference before and after surgery, transfusions volume, hysterectomy cases, major maternal complication cases, neonatal birth weight, neonatal Apgar score in 1 minute, postoperative hospitalization time were compared between 2 groups. There were no significant differences on risk factors for bleeding, neonatal birth weight, neonatal Apgar score in 1 minute, postoperative hospitalization time between 2 groups. However, the intraoperative blood loss, hemoglobin before and after operation, transfusion volume in the PUAE group was significantly lower than the control. There was no case of hysterectomy or major maternal complications in both groups. PUAE during cesarean may be an effective and safe strategy to reduce intraoperative blood loss and transfusion volume for patients with complete placenta previa.

Figure 1.

Placenta previa diagnosed by ultrasonography and effects of uterine artery embolization on the circulation of uterine arteries. (A) showed placenta completely covering cervical OS. (B) left (left uterine artery), (C) left (right uterine artery) showed the bilateral uterine arteries blood flow before uterine artery embolization. (B) right (left uterine artery), (D) right (right uterine artery) presented the bilateral uterine arteries blood flow after uterine artery embolization.

Figure 2.

Data collected for study. A total of 40 people were included in this study after screening, exclusion and loss of follow-up. There were 20 participants in the PUAE group and 20 participants in the CON group. CON = control. PUAE = prophylactic uterine artery embolization.

Figure 3.

The effects of PUAE on hemorrhage volume, hemoglobin changes, transfusion volume, and post operateive hospitalization time. Figure 2A–D showed intraoperative blood loss, hemoglobin difference before and after operation, transfusion volume, and postoperative hospitalization time in both PUAE group and CON group. CON: treated without PUAE, PUAE: treated with PUAE. *, P < .05. **, P < .01. CON = control, PUAE = prophylactic uterine artery embolization.