(152) Prophylactic selective embolization of pelvic arteries for invasive placenta: a prospective cohort study

Objective:
Invasive placenta accreta spectrum (PAS) is associated with high maternal morbidity, particularly from hemorrhage during cesarean hysterectomy. This study aimed to evaluate whether prophylactic selective embolization of pelvic arteries (SEPA) reduces intraoperative blood loss and transfusion requirements in patients with invasive PAS.

Study Design:
We conducted a prospective cohort study of 42 patients with histologically confirmed invasive PAS (grades 2–3) who underwent cesarean hysterectomy at a tertiary referral center from January 2017 to December 2023. Seventeen patients received prophylactic SEPA following cesarean delivery and prior to hysterectomy; 25 did not. Demographic, clinical, and surgical characteristics, as well as maternal and neonatal outcomes, were compared. The primary outcome was intraoperative blood loss. Continuous variables were compared using unpaired t-tests or Mann-Whitney U tests, and categorical variables with chi-square or Fisher’s exact tests. A planned multiple linear regression model adjusted for baseline differences.

Results:
The SEPA and non-SEPA groups were similar in most baseline characteristics, although SEPA recipients had lower parity and more frequent MRI use; neither variable was significantly associated with blood loss in adjusted models. SEPA was associated with a 48% reduction in the risk of blood component replacement (95% CI, 0.26–0.90; p = 0.02), lower median intraoperative blood loss (1,500 mL vs. 2,000 mL; p = 0.02), and fewer transfused packed red blood cell units (0 vs. 2; p = 0.04). Other maternal and neonatal outcomes were similar.

Conclusion:
Prophylactic SEPA significantly reduced intraoperative blood loss and transfusion needs during cesarean hysterectomy for invasive PAS, supporting its use as an adjunct in surgical management at experienced centers.