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

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.