Angstmann et al. AJOG January 2010

Objective

The purpose of this study was to describe the use of a staged procedure
that involved femoral artery catheterization, classic cesarean section
delivery, and uterine and placental embolization before hysterectomy
for placenta accreta.

Study Design

We conducted a cohort study of retrospective and prospective data from
cases of histologically identified placenta accreta at a tertiary
teaching hospital with access to interventional radiology.

Results

Twenty-six cases of placenta accreta were identified histologically (7 accretas, 5
incretas, and 14 percretas); 8 cases were successful staged
embolization procedures. These cases had significant reductions in
blood loss (553 vs 4517 mL; P = .0001), need for transfusion (2 vs 16; P = .001), and units of blood transfused (0.5 vs 7.9; P = .0013). The total operation time was no different between the 2
groups, but there was a longer length of anesthesia (2.7 vs 6.6 hours; P = .0001). There were nonsignificant reductions in admission to the intensive care unit and length of hospital stay.

Conclusion

We found that the successful use of a staged embolization hysterectomy
procedure for placenta accreta is associated with decreased maternal
morbidity.