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Article

Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

by
Vanessa Neef
1,*,
Armin N. Flinspach
1,
Katrin Eichler
2,
Tirza R. Woebbecke
1,
Stephanie Noone
1,
Jan A. Kloka
1,
Lukas Jennewein
3,
Frank Louwen
3,
Kai Zacharowski
1 and
Florian J. Raimann
1
1
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
2
Department of Interventional Radiology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
3
Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(4), 1062; https://doi.org/10.3390/jcm13041062
Submission received: 31 December 2023 / Revised: 2 February 2024 / Accepted: 9 February 2024 / Published: 13 February 2024
(This article belongs to the Special Issue Recent Advances in Obstetric Anesthesiology: Part II)
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Abstract

Background: Placenta accreta spectrum (PAS) disorders are a continuum of placental pathologies with increased risk for hemorrhage, blood transfusion and maternal morbidity. Uterine artery embolization (UAE) is a safe approach to the standardization of complex PAS cases. The aim of this study is to analyze anemia and transfusion rate, outcome and anesthesiological management of women who underwent caesarean delivery with subsequent UAE for the management of PAS. Material and Methods: This retrospective observational study included all pregnant women admitted to the University Hospital Frankfurt between January 2012 and September 2023, with a diagnosis of PAS who underwent a two-step surgical approach for delivery and placenta removal. Primary procedure included cesarean delivery with subsequent UAE, secondary procedure included placenta removal after a minim of five weeks via curettage or HE. Maternal characteristics, anesthesiological management, complications, anemia rate, blood loss and administration of blood products were analyzed. Results: In total, 17 women with PAS were included in this study. Of these, 5.9% had placenta increta and 94.1% had placenta percreta. Median blood loss was 300 (200–600) mL during primary procedure and 3600 (450–5500) mL during secondary procedure. In total, 11.8% and 62.5% of women received red blood cell transfusion during the primary and secondary procedures, respectively. After primary procedure, postpartum anemia rate was 76.5%. The HE rate was 64.7%. Regional anesthesia was used in 88.2% during primary procedure. Conclusion: The embolization of the uterine artery for women diagnosed with PAS is safe. Anemia management and the implementation of blood conservation strategies are crucial in women undergoing UAE for the management of PAS.
Keywords: placenta accreta spectrum; postpartum hemorrhage; blood transfusion; pregnancy; uterine artery embolization placenta accreta spectrum; postpartum hemorrhage; blood transfusion; pregnancy; uterine artery embolization

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MDPI and ACS Style

Neef, V.; Flinspach, A.N.; Eichler, K.; Woebbecke, T.R.; Noone, S.; Kloka, J.A.; Jennewein, L.; Louwen, F.; Zacharowski, K.; Raimann, F.J. Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization. J. Clin. Med. 2024, 13, 1062. https://doi.org/10.3390/jcm13041062

AMA Style

Neef V, Flinspach AN, Eichler K, Woebbecke TR, Noone S, Kloka JA, Jennewein L, Louwen F, Zacharowski K, Raimann FJ. Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization. Journal of Clinical Medicine. 2024; 13(4):1062. https://doi.org/10.3390/jcm13041062

Chicago/Turabian Style

Neef, Vanessa, Armin N. Flinspach, Katrin Eichler, Tirza R. Woebbecke, Stephanie Noone, Jan A. Kloka, Lukas Jennewein, Frank Louwen, Kai Zacharowski, and Florian J. Raimann. 2024. "Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization" Journal of Clinical Medicine 13, no. 4: 1062. https://doi.org/10.3390/jcm13041062

APA Style

Neef, V., Flinspach, A. N., Eichler, K., Woebbecke, T. R., Noone, S., Kloka, J. A., Jennewein, L., Louwen, F., Zacharowski, K., & Raimann, F. J. (2024). Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization. Journal of Clinical Medicine, 13(4), 1062. https://doi.org/10.3390/jcm13041062

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