title: Uterine Artery Embolization before Delivery to Prevent Postpartum Hemorrhage.
abstract: OBJECTIVE
  To assess the safety and outcomes of uterine artery embolization (UAE) performed before delivery in patients with placental implant anomalies at high risk for peripartum or postpartum hemorrhage.
  
  
  METHODS
  From January 2013 to January 2015, 50 consecutive patients with placental implant anomalies at 35-36 weeks of pregnancy were recruited. UAE was performed superselectively by injecting reabsorbable pledgets. We applied 5 dosimeters to patients' backs to measure the uterine radiation dose, considered to be the same radiation dose that the fetus received. Newborns were assessed immediately after birth and at 6-month follow-up.
  
  
  RESULTS
  All procedures were technically successful. Of patients, 64% did not require transfusions. Mean blood units transfused was 0.7 U (range, 0-4 U). No patient was transferred to the intensive care unit. Hysterectomy was performed in 13 patients (26%). Mean fluoroscopy operative time was 3 minutes 42 seconds (range, 1 min 21 s-6 min 58 s), and mean uterine radiation dose was 15.61 mGy (range, 8.15-38.18 mGy). Mean time between embolization and delivery was 6 minutes 4 seconds (range, 4 min 18 s-8 min 12 s). The 1-minute and 5-minute Apgar scores were 8-9 in all newborns; 8 newborns were lost to follow-up at 6 months. A normal cognitive outcome was evident in all 42 children studied.
  
  
  CONCLUSIONS
  UAE before delivery appeared to reduce bleeding during cesarean sections in this consecutive series of patients with placental implant anomalies. In the hands of experienced staff, radiation dose to the fetus was minimal.
authors.affiliation: Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Niola
authors.affiliation: Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy; Radiology Department, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo 200, Rome 00198, Italy. Electronic address: francescogiurazza@hotmail.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giurazza
authors.affiliation: Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nazzaro
authors.affiliation: Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy; Radiology Department, Università degli Studi di Napoli Federico II, Naples, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Silvestre
authors.affiliation: Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nasti
authors.affiliation: Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy.
authors.forename: Maria Antonella
authors.initials: MA
authors.lastname: Di Pasquale
authors.affiliation: Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Albano
authors.affiliation: Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Valentino
authors.affiliation: Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Sirimarco
authors.affiliation: Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Maglione
mesh_terms: D000328:Adult; D001034:Apgar Score; D001803:Blood Transfusion; D002585:Cesarean Section / Q000009:adverse effects; D002657:Child Development; D005260:Female; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy; D007223:Infant; D007231:Infant, Newborn; D010922:Placenta Diseases / Q000175:diagnosis; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D011829:Radiation Dosage; D000069079:Radiation Exposure; D015641:Radiography, Interventional; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000009:adverse effects; D055815:Young Adult