Intraoperative uterine artery embolization in two patients with placenta previa accreta: Comparison of two approaches to control bleeding

Placenta previa accreta, the combination of placenta previa and placenta acrreta, can cause life-threatening massive post-partum hemorrhage (PPH) and may require emergent hysterectomy. Intraoperative transcatheter arterial embolization (TAE) performed after fetal delivery and before placenta expulsion can significantly reduce blood loss and preserve the uterus. However, TAE may fail under the status of hemorrhagic shock, vasospasm of the uterine arteries, and disseminated intravascular coagulopathy (DIC) due to immediate blood loss after placental delivery. We describe two cases of pregnancy complicated by placenta previa accreta and embolization was performed via different approaches to control bleeding. Emergent TAE failed in the first patient due to impending shock, vasospasm of the uterine artery and DIC. Eventually, an emergent hysterectomy was performed in this patient. Preoperative insertion of a 5 French right femoral arterial angiosheath was done in the second patient. It was easier to perform intraoperative TAE and the blood loss was much less. In our case, insertion of a right femoral arterial sheath before cesarean section with subsequent UAE after fetal delivery is an effective method to control the post-partum hemorrhage due to placenta previa accreta. It may reduce blood loss, preserve ovary function and the patient's uterus for further fertility.