Abnormal placentation and selective embolization of the uterine arteries.
OBJECTIVE
Abnormal placentation accounts for more than 50% of uterine artery embolization failure. The authors report their experience in this situation.


METHODS
Seven women presented with abnormal placentation. Uterine artery embolization was carried out in emergency or prophylactic control of postpartum bleeding.


RESULTS
In five patients, control of postpartum hemorrhage was obtained without hysterectomy. In two cases with no placental removal and prophylactic procedures, hysterectomy and blood transfusion were not necessary. The manual removal of the placenta was achieved secondarily, respectively on the 25th and the 12th day.


CONCLUSIONS
The success rate of uterine artery embolization for postpartum bleeding appears to be lower with abnormal placentation. In none of the cases with the placenta present was it possible to leave the residual placenta in place. However, embolization may permit a safe waiting period and spontaneous migration of the placenta. When the diagnosis is made before delivery, prophylactic uterine artery embolization without placental removal should be considered to reduce blood transfusion and preserve fertility.
Descargues
G
G
Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France. gerome.descargues@chu-rouen.fr
Douvrin
F
F
Degré
S
S
Lemoine
J P
JP
Marpeau
L
L
Clavier
E
E
D000328:Adult; D001158:Arteries / Q000601:surgery; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D010922:Placenta Diseases / Q000601:surgery / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D014592:Uterine Hemorrhage / Q000517:prevention & control; D014599:Uterus / Q000601:surgery