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19.07.2021 | Scientific Paper (other)

Prophylactic Intraoperative Uterine Artery Embolization During Cesarean Section or Cesarean Hysterectomy in Patients with Abnormal Placentation: A Systematic Review and Meta-Analysis

verfasst von: Cheng-Chun Yang, Yi-Chen Chou, Tian-Ni Kuo, Jyun-Yan Liou, Hua-Ming Cheng, Yu-Ting Kuo

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 4/2022

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Abstract

Purpose

To evaluate the effectiveness and safety of prophylactic intraoperative uterine artery embolization (UAE) performed immediately after fetal delivery during planned cesarean section or cesarean hysterectomy in patients with placenta accreta spectrum disorder or placenta previa.

Methods

A systematic search was conducted on Ovid MEDLINE and Embase, PubMed, Web of Science, and Cochrane databases. Studies were selected using the Population/Intervention/Comparison/Outcomes (PICO) strategy. The intraoperative blood loss and the rate of emergent peripartum hysterectomy (EPH) were the primary outcomes, whereas the length of hospital stay and volume of blood transfused were the secondary outcomes. A random-effects model was employed to pool each effect size. The cumulative values of the primary outcomes were calculated using the generic inverse variance method.

Results

Eleven retrospective cohort studies and five case series were included, recruiting 421 women who underwent prophylactic intraoperative UAE (UAE group) and 374 women who did not (control group). Compared with the control group, the UAE group had significantly reduced intraoperative blood loss (p = 0.020) during cesarean section or cesarean hysterectomy. Furthermore, the EPH rate was also significantly decreased (p = 0.020; cumulative rate: 19.65%), but not the length of hospital stay (p = 0.850) and volume of pRBC transfused (p = 0.140), after cesarean section in the UAE group. The incidence of major complications was low (3.33%), despite two patients with uterine necrosis.

Conclusion

The currently available data provides encouraging evidence that prophylactic intraoperative UAE may contribute to hemorrhage control and fertility preservation in women with abnormal placentation.

Registration

PROSPERO registration code: CRD42021230581. https://​clinicaltrials.​gov/​ct2/​show/​CRD42021230581

Level of Evidence

Level 2a, systematic review of retrospective cohort studies.
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Metadaten
Titel
Prophylactic Intraoperative Uterine Artery Embolization During Cesarean Section or Cesarean Hysterectomy in Patients with Abnormal Placentation: A Systematic Review and Meta-Analysis
verfasst von
Cheng-Chun Yang
Yi-Chen Chou
Tian-Ni Kuo
Jyun-Yan Liou
Hua-Ming Cheng
Yu-Ting Kuo
Publikationsdatum
19.07.2021
Verlag
Springer US
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 4/2022
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-021-02921-2

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