TY - JOUR
T1 - Cesarean delivery with and without uterine artery embolization for the management of placenta accreta spectrum disorder—A comparative study
AU - Mohr-Sasson, Aya
AU - Hochman, Roni
AU - Anteby, Matan
AU - Spira, Maya
AU - Castel, Elias
AU - Hendler, Israel
AU - Mazaki-Tovi, Shali
AU - Sivan, Eyal
N1 - Publisher Copyright:
© 2020 Nordic Federation of Societies of Obstetrics and Gynecology
PY - 2020/10/1
Y1 - 2020/10/1
N2 - 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 and May 2018 with a diagnosis of placenta accreta spectrum disorder, who underwent cesarean delivery with and without UAE. Groups were compared for maternal characteristics, operative management, postoperative complication rate and long-term outcomes. Follow up on future obstetrical outcomes was conducted via telephone questionnaire. Non-parametric statistics were used. Results: During the study period, 272 women met the inclusion criteria: 64 (23.53%) and 208 (76.47%) underwent preservative cesarean section with and without UAE, respectively. UAE procedure was associated with a longer operative time (82.5 [68-110] vs 50.5 [39-77] minutes; P =.001), and higher blood loss (2000 (1500-3000) vs 1000 (600-2000) mL; P =.001). Hysterectomy rate was comparable between the groups (9 [14%] vs 35 [16.82%]; P =.88); however, multivariate logistic regression analysis found UAE to be an independent factor associated with lower hysterectomy rate (P =.02). Postoperative 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 =.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 postoperative complications. Nevertheless, in cases of severe adherence of the placenta, embolization reduces the need for hysterectomy, allowing future fertility.
AB - 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 and May 2018 with a diagnosis of placenta accreta spectrum disorder, who underwent cesarean delivery with and without UAE. Groups were compared for maternal characteristics, operative management, postoperative complication rate and long-term outcomes. Follow up on future obstetrical outcomes was conducted via telephone questionnaire. Non-parametric statistics were used. Results: During the study period, 272 women met the inclusion criteria: 64 (23.53%) and 208 (76.47%) underwent preservative cesarean section with and without UAE, respectively. UAE procedure was associated with a longer operative time (82.5 [68-110] vs 50.5 [39-77] minutes; P =.001), and higher blood loss (2000 (1500-3000) vs 1000 (600-2000) mL; P =.001). Hysterectomy rate was comparable between the groups (9 [14%] vs 35 [16.82%]; P =.88); however, multivariate logistic regression analysis found UAE to be an independent factor associated with lower hysterectomy rate (P =.02). Postoperative 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 =.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 postoperative complications. Nevertheless, in cases of severe adherence of the placenta, embolization reduces the need for hysterectomy, allowing future fertility.
KW - long-term outcome
KW - placenta accreta spectrum disorder
KW - uterine artery embolization
UR - http://www.scopus.com/inward/record.url?scp=85085015764&partnerID=8YFLogxK
U2 - 10.1111/aogs.13868
DO - 10.1111/aogs.13868
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 32282925
AN - SCOPUS:85085015764
VL - 99
SP - 1374
EP - 1380
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
SN - 0001-6349
IS - 10
ER -