Abnormal placentation and selective embolization of the uterine arteries

Objective: Abnormal placentationaccounts for more than 50% of uterine artery embolizationfailure. The authors report their experience in this situation. Study design: Seven women presented with abnormal placentation. Uterine artery embolizationwas carried out in emergency or prophylactic control of postpartum bleeding. Results: In five patients, control of postpartum hemorrhage was obtained without hysterectomy. In two cases with no placentalremoval and prophylactic procedures, hysterectomyand blood transfusionwere not necessary. The manual removal of the placentawas achieved secondarily, respectively on the 25th and the 12th day. Conclusions: The success rate of uterine artery embolizationfor postpartum bleedingappears to be lower with abnormal placentation. In none of the cases with the placentapresent was it possible to leave the residual placentain place. However, embolizationmay permit a safe waiting period and spontaneous migration of the placenta. When the diagnosis is made before delivery, prophylactic uterine artery embolizationwithout placentalremoval should be considered to reduce blood transfusionand preserve fertility.