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. 2025 Jun 13.
doi: 10.1007/s00330-025-11744-5. Online ahead of print.

The efficacy of uterine artery embolization for postpartum hemorrhage with placenta accreta spectrum disorder: clinical outcomes in a cohord of 112 pregnant women

Byung Soo Im  1 , Ji Hoon Shin  2 , Ji Hoon Kim  1 , Gun Ha Kim  1 , Hee Ho Chu  1 , Heung Kyu Ko  1 , Mi Young Lee  3 , Jin Hoon Chung  3 , Hye Sung Won  3
Affiliations

The efficacy of uterine artery embolization for postpartum hemorrhage with placenta accreta spectrum disorder: clinical outcomes in a cohord of 112 pregnant women

Byung Soo Im et al. Eur Radiol. .

Abstract

Objectives: To investigate the outcomes of uterine artery embolization (UAE) for postpartum hemorrhage in pregnant women with placenta accreta spectrum disorder (PASD) and to assess the risk factors for rebleeding.

Materials and methods: This retrospective study evaluated 112 patients with PASD (62 accreta, 40 increta, 10 percreta) who underwent UAE for postpartum hemorrhage between January 2002 and February 2024. The clinical outcomes and rebleeding risk factors were analyzed.

Results: A total of 90 patients (80.4%) were successfully embolized without major complications. Rebleeding occurred in the remaining 22 patients after initial embolization, requiring surgery (n = 11) or repeated embolization (n = 11). The mean time interval between initial UAE and rebleeding was 52.1 h (range, 1-648 h; interquartile range (IQR), 4.0-11.25 h). There were no maternal deaths. Multivariate Cox regression analysis showed that overt disseminated intravascular coagulation (p < 0.001), remnant placenta (p < 0.001), extravasation of contrast media on angiogram (p = 0.005), and the transfused packed red blood cell (p = 0.005) were significant independent factors associated with clinical failure of the embolization.

Conclusion: UAE represents an effective initial treatment option with a high success rate for postpartum hemorrhage in patients with PASD, especially for those aiming to preserve fertility. However, the possibility of rebleeding should be considered in high-risk patients, and achieving complete hemostasis using permanent embolic agents can be beneficial in such cases.

Key points: Question Does uterine artery embolization effectively manage postpartum hemorrhage in patients with placenta accreta spectrum disorder (PASD), minimizing rebleeding and associated complications? Findings Uterine artery embolization effectively controlled postpartum hemorrhage in PASD. Rebleeding was associated with disseminated intravascular coagulation, remnant placenta, transfused red blood cells, and contrast extravasation. Clinical relevance Uterine artery embolization is a reliable and minimally invasive method for managing postpartum hemorrhage in PASD, with a low complication rate and the potential to preserve fertility. Identifying risk factors can enhance patient outcomes and personalized treatment strategies.

Keywords: Placenta accreta; Postpartum hemorrhage; Recurrent bleeding; Uterine artery embolization.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Ji Hoon Shin, M.D., PhD. (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center). Conflict of interest: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: One of the authors has significant statistical expertise. Informed consent: Written informed consent was waived by the Institutional Review Board. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: There are no overlapping study subjects or cohorts that have been previously reported. Methodology: Retrospective observational Performed at one institution

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