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Abstract 133: Multivessel pelvic embolization during cesarean hysterectomy for placenta accreta spectrum: A single-center experience and comparison to internal iliac artery balloon occlusion
Presentation: Monday, June 13, 3 p.m.
Placenta accreta spectrum (PAS) is a potentially life-threatening condition, in which placental trophoblastic tissue invades into the myometrium. In the most severe cases, placenta percreta, the placenta may even invade other structures. Profuse postpartum hemorrhage is a significant contributor to the high risk for maternal mortality and morbidity associated with PAS. Intra-operative pelvic embolization may be more effective than internal iliac artery balloon occlusion (IIABO) at reducing blood loss for patients undergoing cesarean hysterectomy for PAS, according to researchers.
Presenters of “Multivessel pelvic embolization during cesarean hysterectomy for placenta accreta spectrum: A single-center experience and comparison to internal iliac artery balloon occlusion” analyzed records of patients with PAS at a single institution between 2010–2021 to compare results between IIABO and multivessel embolization.
“In this study, we aimed to compare two different approaches to pelvic devascularization prior to cesarean hysterectomy in treating patients with PAS—intra-operative multivessel pelvic embolization and IIABO,” says Christine Boone, MD. “We found a significant decrease in estimated blood loss with pelvic embolization, a median estimated blood loss of 675 mL compared to that of 2,000 mL in patients who underwent IIABO. Most patients who underwent pelvic embolization did not require blood transfusion, whereas patients who underwent IIABO required a median of 2.5 units of transfused blood products. We also evaluated which vessels required embolization.”
According to Dr. Boone, the data showed that almost half of placental collaterals arose from branches of the external iliac artery. “These placental feeders would not be devascularized by IIABO alone. Our findings suggest that multivessel pelvic embolization prior to caesarean hysterectomy is associated with decreased blood loss compared to IIABO prior to caesarean hysterectomy.” Dr. Boone says a key difference between the techniques is the ability to devascularize the placental collaterals that may arise.
Mitigating the risk of life-threatening hemorrhage is important, Dr. Boone says, because it may help improve the overall survival rate for patients with PAS—which is a significant contributor to the increasing maternal mortality rate. According to Dr. Boone, the incidence of PAS has been steadily increasing, as evidence by a 2016 study that placed the rate at 1 in 272 mothers, compared to 40 or 50 years ago where the estimated prevalence ranged from 1 in 2,510 to 1 in 4,017.
“We hope that these findings will contribute evidence to support further prospective and larger-scale investigation of adjunct devascularization methods, particularly multivessel pelvic embolization, in patients who are expected to undergo cesarean hysterectomy for the management of PAS,” says Dr. Boone. “We also hope these findings may help elucidate potential causes of devascularization failure that may contribute to increased blood loss, such as placental collaterals from branches of the external iliac arteries. Understanding potential pitfalls and obstacles to the success of our procedures will be critical in the further development and improvement of them.”