Placenta accreta: management with uterine artery embolization in 17 cases.
OBJECTIVE
To report on the management of placenta accreta with uterine artery embolization (UAE) and to analyze the outcomes.


METHODS
A retrospective study was performed over a 128-month period of all women with placenta accreta who underwent UAE in a single center. Seventeen patients were included, and they were further divided into two groups: a preventive group (diagnosis was made in the prenatal period, n = 6) and a curative group (diagnosis was made during delivery, n = 11). The mean patient age was 34.6 years +/- 5.5 in the preventive group and 31.4 years +/- 4.3 in the curative group. The mean term of pregnancy was 35 weeks +/- 2 of amenorrhea in the preventive group and 38 weeks +/- 2 in the curative group.


RESULTS
The primary success of embolization was 100% in both groups. In the preventive group, massive bleeding occurred in a patient 2 days after unsuccessful manual placenta delivery resulted in an hysterectomy; in a second case, delayed bleeding (2 months after the procedure) was controlled with a second embolization. There were no episodes of repeat bleeding in the curative group. In the preventive group, two patients presented with uterine scarring, with synechiae in one and endometrial atrophy in the other. In the curative group, one patient presented with secondary amenorrhea. The delay before embolization was significantly different in the two groups (23.3 minutes +/- 5.1 in the preventive group vs 73 minutes +/- 44.7 in the curative group, P < .01), and total blood loss was 0.7 L +/- 0.8 in the preventive group and 2.6 L +/- 1.2 in the curative group (P < .01).


CONCLUSIONS
Prenatal diagnosis of placenta accreta permits its preventive management, which reduces time to embolization and blood loss.
Department of Visceral and Vascular Radiology, Centre Hopistalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand cedex 1, Clermont-Ferrand, France. ndoyediop@yahoo.com
Abdoulaye N
AN
Diop
Pascal
P
Chabrot
Armelle
A
Bertrand
Jean M
JM
Constantin
Lucie
L
Cassagnes
Brigitte
B
Storme
Denis
D
Gallot
Louis
L
Boyer
D000328:Adult; D005260:Female; D006801:Humans; D010921:Placenta Accreta / Q000628:therapy*; D011247:Pregnancy; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*