title: Feasibility and safety of prophylactic uterine artery catheterization and embolization in the management of placenta accreta.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of prophylactic uterine artery catheterization and embolization in the management of placenta accreta (PA).
  
  
  METHODS
  Retrospective chart review was performed of 95 consecutive patients with prenatal suspicion of PA managed in a 10-year period with a strategy that included prophylactic bilateral uterine artery catheterization, delivery of the baby, uterine artery embolization if indicated, and subsequent surgery. Feasibility was defined as catheterization being possible to perform, technical success as embolization being possible when indicated and complete stasis of the vessels achieved, and clinical success as no maternal death or major blood loss. Median gestational age at delivery was 36 weeks (interquartile range, 24-39 wk).
  
  
  RESULTS
  PA was confirmed in 79 patients (83%). Feasibility was 97% (92 of 95); in three cases (3%), acute early massive hemorrhage forced emergency delivery without catheterization. Embolization was performed in 83 of 92 patients (87%) to the extent of complete stasis; in the remaining nine, it was unnecessary because spontaneous placental detachment was visualized after fetal delivery (technical success rate, 100%). There were several complications, including bleeding requiring blood transfusion (49%) and bladder surgery (37%), but there were no major complications attributable to the endovascular procedures. There was one minor complication presumably related to embolization (transient paresthesia and decreased temperature of lower limb), with uneventful follow-up. Clinical success rate was 86%, with no maternal deaths, but 14% of patients received large-volume blood transfusion.
  
  
  CONCLUSIONS
  Prophylactic uterine artery catheterization and embolization in the management of PA appeared to be feasible and safe in this consecutive series of patients.
authors.affiliation: Obstetrics Service, Hospital Italiano de Buenos Aires, JD Peron 4190 (C1199ACI), Buenos Aires, Argentina.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Izbizky
authors.affiliation: Obstetrics Service, Hospital Italiano de Buenos Aires, JD Peron 4190 (C1199ACI), Buenos Aires, Argentina.
authors.forename: César
authors.initials: C
authors.lastname: Meller
authors.affiliation: Obstetrics Service, Hospital Italiano de Buenos Aires, JD Peron 4190 (C1199ACI), Buenos Aires, Argentina.
authors.forename: Mario
authors.initials: M
authors.lastname: Grasso
authors.affiliation: Gynecology Service, Hospital Italiano de Buenos Aires, JD Peron 4190 (C1199ACI), Buenos Aires, Argentina.
authors.forename: Andrea
authors.initials: A
authors.lastname: Velazco
authors.affiliation: Radiology Service, Hospital Italiano de Buenos Aires, JD Peron 4190 (C1199ACI), Buenos Aires, Argentina.
authors.forename: Oscar
authors.initials: O
authors.lastname: Peralta
authors.affiliation: Obstetrics Service, Hospital Italiano de Buenos Aires, JD Peron 4190 (C1199ACI), Buenos Aires, Argentina.
authors.forename: Lucas
authors.initials: L
authors.lastname: Otaño
authors.affiliation: Radiology Service, Hospital Italiano de Buenos Aires, JD Peron 4190 (C1199ACI), Buenos Aires, Argentina.. Electronic address: ricardo.garciamonaco@hospitalitaliano.org.ar.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Garcia-Monaco
mesh_terms: D000328:Adult; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010921:Placenta Accreta / Q000000981:diagnostic imaging / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D015641:Radiography, Interventional / Q000379:methods; D012307:Risk Factors; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000009:adverse effects / Q000379:methods*