Abnormal placentation and selective embolization of the uterine arteries

Objective: Abnormal placentation accounts for more than 50% of uterine arte ry embolization failure. The authors report their experience in this situat ion. Study design: Seven women presented with abnormal placentation. Uterin e artery embolization was carried out in emergency or prophylactic control of postpartum bleeding. Results: In five patients, control of postpartum he morrhage was obtained without hysterectomy. In two cases with no placental removal and prophylactic procedures, hysterectomy and blood transfusion wer e not necessary. The manual removal of the placenta was achieved secondaril y, respectively on the 25th and the 12th day. Conclusions: The success rate of uterine artery embolization for postpartum bleeding appears to be lower with abnormal placentation, In none of the cases with the placenta present was it possible to leave the residual placenta in place. However, emboliza tion may permit a safe waiting period and spontaneous migration of the plac enta. When the diagnosis is made before delivery, prophylactic uterine arte ry embolization without placental removal should be considered to reduce bl ood transfusion and preserve fertility. (C) 2001 Elsevier Science Ireland L td. All rights reserved.