Nonremoval of an abnormally invasive placenta at cesarean section with postoperative uterine artery embolization

Acta Obstet Gynecol Scand. 2013 Nov;92(11):1250-5. doi: 10.1111/aogs.12230. Epub 2013 Sep 7.


Objective: To evaluate the outcome of three different modes of management of abnormally invasive placenta over a 6-year period.

Design: Retrospective cohort study.

Setting: Tertiary hospital in Hong Kong.

Population: In 39 757 deliveries, 25 cases of abnormally invasive placenta were identified at cesarean section.

Methods: Identification of cases by hospital database and review of medical records.

Main outcome measures: Blood loss, blood transfusion requirement, operative time, duration of hospital stay, secondary postpartum hemorrhage and endometritis.

Results: Six women were managed by leaving the placenta in situ and by postoperative uterine artery embolization. Ten women were managed by an extirpative approach and nine women with direct cesarean hysterectomy. The success rate of nonremoval of the placenta with uterine artery embolization was 4/6 (67%). The intraoperative blood loss, blood transfusion requirements and operation times were lowest in the group with nonremoval of the placenta, although a higher secondary complication rate and a longer hospital stay followed.

Conclusion: Nonremoval of an abnormally invasive placenta at cesarean section and prophylactic postoperative uterine artery embolization are an alternative to elective cesarean hysterectomy.

Keywords: Abnormally invasive placenta; hysterectomy; placenta accreta; placenta increta; placenta percreta; retained placenta; uterine artery embolization.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cesarean Section / methods*
  • Female
  • Humans
  • Hysterectomy / methods*
  • Placenta Accreta / diagnosis
  • Placenta Accreta / therapy*
  • Postoperative Period
  • Postpartum Hemorrhage / prevention & control*
  • Postpartum Hemorrhage / therapy
  • Pregnancy
  • Retrospective Studies
  • Treatment Outcome
  • Uterine Artery Embolization / methods*