title: Retrospective cohort study of prophylactic intraoperative uterine artery embolization for abnormally invasive placenta.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of prophylactic intraoperative uterine artery embolization (UAE) during cesarean delivery as conservative treatment for patients with abnormally invasive placenta.
  
  
  METHODS
  A retrospective cohort study enrolled patients surgically diagnosed with abnormally invasive placenta who underwent cesarean delivery at the First Affiliated Hospital of Nanjing Medical University, Nanjing, China, between February 1, 2012, and February 28, 2015. Postpartum estimated blood loss, blood transfusions, hysterectomy, and adverse events were compared between patients who underwent cesarean delivery only (control group) and those who underwent concurrent prophylactic intraoperative UAE (UAE group).
  
  
  RESULTS
  There were 45 patients included in the study; 26 and 19 in the UAE and control groups, respectively. Among patients who did not undergo hysterectomy owing to placenta accreta, the mean estimated blood loss was lower among patients in the UAE group (P=0.005); however, among patients who did undergo hysterectomy for placenta increta or percreta, no difference in mean estimated blood loss was observed (P=0.973). There were no differences in the hysterectomy rate (P=0.639) or incidence of requiring massive blood transfusion (P=0.050) between the groups. Only one patient in the UAE group experienced uterine necrosis.
  
  
  CONCLUSIONS
  Prophylactic intraoperative UAE was relatively safe and effective for reducing postpartum hemorrhage among patients with placenta accreta. The potential benefits could be lower among patients with placenta increta or percreta.
authors.affiliation: Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Zhengqiang
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Neonatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Shudong
authors.initials: S
authors.lastname: Cui
authors.affiliation: Department of Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Wei
authors.initials: W
authors.lastname: De
authors.affiliation: Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Lizhou
authors.initials: L
authors.lastname: Sun
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000379:methods*; D002681:China; D000072700:Conservative Treatment / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D010921:Placenta Accreta / Q000601:surgery*; D010923:Placenta Previa / Q000601:surgery*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055357:Uterine Artery Embolization / Q000379:methods*
keywords: Abnormally invasive placenta; Hysterectomy; Placenta previa; Postpartum hemorrhage; Prophylactic intraoperative uterine artery embolization