Conservative management of invasive placental adhesion by prophylactic uterine artery embolization before cesarean section: report of 2 cases

Abnormal placental adhesion refers to abnormal placental implantation in which the anchoring placental villi attach to myometrium and even uterine serosa which may invade the bladder and bowels. One of the most important complications of these abnormalities is severe hemorrhage during placental removing which may even necessitate cesarean hysterectomy. Since uterine conservation is an important issue especially in young women at reproductive age, conservative management has a cardinal role to reduce bleeding during surgery. Uterine artery embolization as the first line conservative approach is reserved for women that fertility preservation is very important or whom the risk of severe bleeding during cesarean section is very high due to abnormal placental adhesion. Use of embolization in unstable patients is limited because it usually cannot be performed as rapidly as other measures. The aim of this study was to report two cases of uterine artery embolization before cesarean section in pregnant women with abnormal placental adhesions.
Two 35 and 37-year-old pregnant women at gestational age of 34 weeks diagnosed as placenta previa and abnormal placental adhesion (placenta percreta) who intended to preserve their fertility underwent bilateral uterine artery embolization before cesarean section in Ghaem hospital, Mashhad University of Medical Sciences, Iran at September 2016. Bleeding during surgery was significantly decreased and uterine preservation was successfully preformed without any serious complications during and after the surgery. In the next follow-ups, they had normal menstruation about two months after the cesarean section.
In placental adhesive disorders, uterine artery embolization at the time of cesarean section could significantly decrease bleeding during surgery, so uterine and fertility preservation could be performed in this situation.