Endovascular interventional modalities for haemorrhage control
in abnormal placental implantation deliveries: a systematic review
Chun Lap Pang
Received: 28 August 2017 / Revised: 20 November 2017 /Accepted: 28 November 2017 /Published online: 5 February 2018
European Society of Radiology 2018
Objectives To examine the evidence regarding the effectiveness and safety of endovascular interventional modalities for haem-
orrhage control in abnormal placentation deliveries.
Methods MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from
inception to July 2017. Blood loss volume was regarded as the primary endpoint. Other important results are described.
Random and fixed effects models were used for the meta-analysis.
Results Of 385 studies identified, 69 (1,811 patients, mean age 32.9 years, range 23–39 years) were included. Mean
gestational age at delivery was 35.1 weeks (range 27–38 weeks). Of 1,395 patients who underwent endovascular
intervention, 587 (42%) had placenta accreta, 254 (18%) placenta increta and 313 (22%) placenta percreta.
Prophylactic balloon occlusion of the internal iliac arteries (PBOIIA) was performed in 470 patients (33.6%), of the
abdominal aorta (PBOAA) in 460 patients (33%), of the uterine artery (PBOUA) in 181 patients (13%), and of the
common iliac arteries (PBOCIA) in 21 patients (1.5%). Primary embolization of the UA was performed in 246 patients
(18%), of the pelvic collateral arteries in 12 patients (0.9%), and of the anterior division of the IIA in 5 patients (0.3%).
Follow-up ranged from 0.5 to 42 months. Endovascular intervention was associated with less blood loss than no
endovascular intervention (p < 0.001) with the lowest blood loss volume in patients who underwent PBOAA (p <
0.001). PBOAA was associated with a lower rate of hysterectomy (p = 0.030). Endovascular intervention did not result
in increases in operative time or hospital stay.
Conclusions Endovascular intervention is effective in controlling haemorrhage in abnormal placentation deliveries. PBOAA was
associated with a lower rate of hysterectomy and less blood loss than other modalities.
• Endovascular intervention in abnormal placentation deliveries is effective in reducing blood loss.
• Endovascular intervention did not result in longer operative time or hospital stay.
• Prophylactic balloon occlusion of the abdominal aorta is superior to other modalities.
Keywords Endovascular procedures
Uterine artery embolization
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00330-017-5222-0) contains supplementary
material, which is available to authorized users.
* Yo us ef Shahin
Academic Unit of Radiology, University of Sheffield, Glossop Road,
Sheffield S10 2JF, UK
Department of Clinical Radiology, Sheffield Teaching Hospitals,
Plymouth University Peninsula Schools of Medicine and Dentistry,
Department of Radiology, Derriford Hospital, Plymouth, UK
European Radiology (2018) 28:2713–2726