Current Obstetrics and Gynecology Reports

, Volume 8, Issue 4, pp 139–144 | Cite as

The Role of Interventional Radiology in the Management of Placenta Accreta Spectrum Disorders

  • Daniele Di Mascio
  • Pierluigi Benedetti Panici
  • Luigi Nappi
  • Francesco D’AntonioEmail author
Aberrant Placentation: Contemporary Management of Placenta Accreta (E Jauniaux, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Aberrant Placentation: Contemporary Management of Placenta Accreta


Purpose of Review

Placenta accreta spectrum disorders encompass a heterogeneous group of conditions classified according to the degree of invasion of the trophoblastic tissue trough the myometrium and uterine serosa with a detrimental effect on maternal outcomes, including life-threatening hemorrhage, need for blood transfusion, damage to adjacent organs, and eventually death, and this highlights the need of additional procedures to improve surgery. The present review aims to provide an up to date on the role of interventional radiology procedures in affecting the outcome of women undergoing surgery for PAS disorders.

Recent Findings

Endovascular interventional radiology, including balloon catheterization and arterial embolization of pelvic vessels or abdominal aorta, has been proposed as an effective method for the prevention and control of postpartum hemorrhage caused by different obstetrical conditions, but there is no robust evidence on its role in optimizing perioperative outcomes of women affected by PAS.


The current evidence from the available literature shows that abdominal aorta and internal iliac arteries balloon occlusion are both effective methods to reduce maternal morbidity in case of PAS, with a low incidence of procedure-related complications. Further large RCT adequately powered for the most severe surgical adverse outcomes are needed in order to estimate the effect of IR procedures in improving the outcome of women undergoing surgery for PAS disorders.


Placenta accreta spectrum disorders PAS PAS management Interventional radiology Endovascular radiology 


Compliance with Ethical Standards

Conflict of Interest

Daniele Di Mascio, Pierluigi Benedetti Panici, Luigi Nappi, and Francesco D’Antonio declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. Obstetric Care Consensus No. 7: placenta accreta spectrum. Obstet Gynecol. 2018;132:e259–75.CrossRefGoogle Scholar
  2. 2.
    Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol. 2013;208:219 e1–7.CrossRefGoogle Scholar
  3. 3.
    Iacovelli A, Liberati M, Khalil A, Timor-Trisch IE, Leombroni M, Buca D, et al. Risk factors for abnormally invasive placenta: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2018;22:1–11.Google Scholar
  4. 4.
    Timor-Tritsch IE, Monteagudo A, Calì G, Vintzileos A, Viscarello R, Al-Khan A, et al. Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol. 2014;44:346–53.CrossRefGoogle Scholar
  5. 5.
    Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One. 2012;7:e52893.CrossRefGoogle Scholar
  6. 6.
    Esh-Broder E, Ariel I, Abas-Bashir N, Bdolah Y, Celnikier DH. Placenta accreta is associated with IVF pregnancies: a retrospective chart review. BJOG. 2011;118:1084–9.CrossRefGoogle Scholar
  7. 7.
    Jauniaux E, Chantraine F, Silver RM, Langhoff-Roos J, FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: epidemiology. Int J Gynaecol Obstet. 2018;140:265–73.CrossRefGoogle Scholar
  8. 8.
    Upson K, Silver RM, Greene R, Lutomski J, Holt VL. Placenta accreta and maternal morbidity in the Republic of Ireland, 2005-2010. J Matern Fetal Neonatal Med. 2014;27:24–9.CrossRefGoogle Scholar
  9. 9.
    Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstetr Gynecol Clin. 2015;42:381–402.CrossRefGoogle Scholar
  10. 10.
    Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006;107:927–41.CrossRefGoogle Scholar
  11. 11.
    •• Di Mascio D, Calì G, D’Antonio F. Updates on the management of placenta accreta spectrum. Minerva Ginecol. 2019;71:113–20 One of the most recent updates on the overall management of PAS throughout pregnancy.CrossRefGoogle Scholar
  12. 12.
    Silver RM, Fox KA, Barton JR, Abuhamad AZ, Simhan H, Huls CK, et al. Center of excellence for placenta accreta. Am J Obstet Gynecol. 2015;212:561–8.CrossRefGoogle Scholar
  13. 13.
    Salomon LJ, de Tayrac R, Castaigne-Meary V, Audibert F, Musset D, Ciorascu R, et al. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod. 2003;18:849–52.CrossRefGoogle Scholar
  14. 14.
    Kirby JM, Kachura JR, Rajan DK, Sniderman KW, Simons ME, Windrim RC, et al. Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol. 2009;20:1036–45.CrossRefGoogle Scholar
  15. 15.
    •• Shahin Y, Pang CL. Endovascular interventional modalities for haemorrhage control in abnormal placental implantation deliveries: a systematic review and meta-analysis. Eur Radiol. 2018;28:2713–26 A large meta-analysis on the effectiveness of endovascular interventions for hemorrhage control in abnormal placentation, particularly PAS. CrossRefGoogle Scholar
  16. 16.
    Teixidor Vinas M, Belli AM, Arulkumaran S, Chandraharan E. Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure. Ultrasound Obstet Gynecol. 2015;46:350–5.CrossRefGoogle Scholar
  17. 17.
    Royal College of Obstetricians and Gynaecologists. The role of emergency and elective interventional radiology in postpartum hemorrhage. Royal College of Obstetricians and Gynaecologists Good Practice Guideline No. 6, 2017.Google Scholar
  18. 18.
    •• D'Antonio F, Iacovelli A, Liberati M, Leombroni M, Murgano D, Cali G, et al. Role of interventional radiology in pregnancies complicated by placenta accreta spectrum disorders: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019;53:743–51 The most recent and comprehensive systematic review and meta-analysis on the role of IR techniques in women affected by PAS disorders. CrossRefGoogle Scholar
  19. 19.
    Salim R, Chulski A, Romano S, Garmi G, Rudin M, Shalev E. Precesarean prophylactic balloon catheters for suspected placenta accreta: a randomized controlled trial. Obstet Gynecol. 2015;126(05):1022–8.CrossRefGoogle Scholar
  20. 20.
    Marcellin L, Delorme P, Bonnet MP, Grange G, Kayem G, Tsatsaris V, et al. Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta. Am J Obstet Gynecol. 2018;219:193.e1.CrossRefGoogle Scholar
  21. 21.
    Shamshirsaz AA, Fox KA, Salmanian B, Diaz-Arrastia CR, Lee W, Baker BW, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol. 2015;212:218.e1.CrossRefGoogle Scholar
  22. 22.
    Petrov DA, Karlberg B, Singh K, Hartman M, Mittal PK. Perioperative internal iliac artery balloon occlusion, in the setting of placenta accreta and its variants: the role of the interventional radiologist. Curr Probl Diagn Radiol. 2018;47:445–51.CrossRefGoogle Scholar
  23. 23.
    Cali G, Forlani F, Giambanco L, Amico ML, Vallone M, Puccio G, et al. Prophylactic use of intravascular balloon catheters in women with placenta accreta, increta and percreta. Eur J Obstet Gynecol Reprod Biol. 2014;179:36–41.CrossRefGoogle Scholar
  24. 24.
    Shrivastava V, Nageotte M, Major C, Haydon M, Wing D. Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta. Am J Obstet Gynecol. 2007;197:402-e1–5.CrossRefGoogle Scholar
  25. 25.
    Jaraquemada JMP, Mónaco RG, Barbosa NE, Ferle L, Iriarte H, Conesa HA. Lower uterine blood supply: extrauterine anastomotic system and its application in surgical devascularization techniques. Acta Obstet Gynecol Scand. 2007;86:228–34.CrossRefGoogle Scholar
  26. 26.
    Wang YL, Duan XH, Han XW, Wang L, Zhao XL, Chen ZM, et al. Comparison of temporary abdominal aortic occlusion with internal iliac artery occlusion for patients with placenta accreta - a non-randomised prospective study. Vasa. 2017;46:53–7.CrossRefGoogle Scholar
  27. 27.
    Cui SH, Zhi YX, Cheng GM, Zhang K, Zhang L, Shen L. Retrospective analysis of placenta previa with abnormal placentation with and without prophylactic use of abdominal aorta balloon occlusion. Int J Gynecol Obstet. 2017;137:265–70.CrossRefGoogle Scholar
  28. 28.
    Zeng C, Yang M, Ding Y, Yu L, Deng W, Hu Y, et al. Preoperative infrarenal abdominal aorta balloon catheter occlusion combined with Bakri tamponade reduced maternal morbidity of placenta increta/percreta. Medicine (Baltimore). 2017;96:e8114.CrossRefGoogle Scholar
  29. 29.
    Panici PB, Anceschi M, Borgia ML, Bresadola L, Masselli G, Parasassi T, et al. Intraoperative aorta balloon occlusion: fertility preservation in patients with placenta previa accreta/increta. J Matern Fetal Neonatal Med. 2012;25:2512–6.CrossRefGoogle Scholar
  30. 30.
    Pan Y, Zhou X, Yang Z, Cui S, De W, Sun L. Retrospective cohort study of prophylactic intraoperative uterine artery embolization for abnormally invasive placenta. Int J Gynaecol Obstet. 2017;137(1):45–50.CrossRefGoogle Scholar
  31. 31.
    Ballas J, Hull AD, Saenz C, Warshak CR, Roberts AC, Resnik RR, et al. Preoperative intravascular balloon catheters and surgical outcomes in pregnancies complicated by placenta accreta: a management paradox. Am J Obstet Gynecol. 2012;207:216e1–5.CrossRefGoogle Scholar
  32. 32.
    Chou MM, Kung HF, Hwang JI, Chen WC, Tseng JJ. Temporary prophylactic intravascular balloon occlusion of the common iliac arteries before cesarean hysterectomy for controlling operative blood loss in abnormal placentation. Taiwan J Obstet Gynecol. 2015;54:493–8.CrossRefGoogle Scholar
  33. 33.
    Minas V, Gul N, Shaw E, Mwenenchanya S. Prophylactic balloon occlusion of the common iliac arteries for the management of suspected placenta accreta/percreta: conclusions from a short case series. Arch Gynecol Obstet. 2015;291:461–5.CrossRefGoogle Scholar
  34. 34.
    Buca D, Liberati M, Calì G, Forlani F, Caissutti C, Flacco ME, et al. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;52:304–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Daniele Di Mascio
    • 1
  • Pierluigi Benedetti Panici
    • 1
  • Luigi Nappi
    • 2
  • Francesco D’Antonio
    • 2
    Email author
  1. 1.Department of Maternal and Child Health and Urological SciencesSapienza University of RomeRomeItaly
  2. 2.Department of Medical and Surgical Sciences, Institute of Obstetrics and GynecologyUniversity of FoggiaFoggiaItaly

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