Cesarean delivery with and without uterine artery embolization for the management of placenta accreta spectrum disorder—A comparative study

Abstract

Introduction The aim of this study is to compare immediate and long term obstetrical outcomes of patients who underwent cesarean delivery with and without uterine artery embolization (UAE) for the management of placenta accreta spectrum disorder. Material and methods A retrospective case control study including all pregnant women admitted to a single tertiary medical center, between December 2001 to May 2018 with a diagnosis of placenta accreta spectrum disorder that underwent cesarean delivery with and without UAE. Groups were compared for maternal characteristics, operative management, post‐operative complications rate and long term outcomes. Follow up on future obstetrical outcomes was conducted via telephone questionnaire. Non‐ parametric statistic was used. Results During the study period 272 women met inclusion criteria, of them 64 (23.53%) and 208 (76.47%) underwent preservative cesarean section with and without UAE, respectively. UAE procedure was associated with longer operative time [82.5 (68‐110) vs.50.5(39‐77) min; p=0.001], and higher blood loss [2000 (1500‐3000) vs 1000 (600‐2000) ml; p=0.001]. Hysterectomy rate was comparable between the groups [9 (14%) vs. 35 (16.82%); p=0.88], however, multivariate logistic regression analysis, found UAE to be an independent factor associated with lower hysterectomy rate (p=0.02). Post‐operative complications were more frequent in the UAE group. Follow up was achieved in 29 (59.18%) and 72 (51.79%) of the women with and without UAE, respectively (p=0.36). No differences were found in rate of abortions, pregnancy and deliveries between the groups. Conclusions Cesarean delivery using UAE in placenta accreta spectrum disorder is associated with a higher rate of operative and post‐operative complications. Nevertheless, in severe adherence of the placenta, embolization reduces the need for hysterectomy enabling future fertility.