The following is a summary of “Implementation and outcomes of a uterine artery embolization and tranexamic acid protocol for placenta accreta spectrum,” published in the JULY 2023 issue of Obstetrics and Gynecology by Munoz, et al.

Placenta accreta spectrum disorders encompass a range of placental pathologies that can lead to significant maternal morbidity and mortality. The severity of morbidity was linked to the degree of placental adherence, making patients with placenta increta or percreta particularly high-risk. Hemorrhage and the need for blood product transfusions are major contributors to the morbidity associated with placenta accreta spectrum. For a study, researchers sought to establish a evidence-based intraoperative protocol for managing cases of placenta accreta spectrum.

The study conducted a retrospective analysis of patients with antenatally suspected placenta increta and percreta over a 5-year period (2018–2022), comparing outcomes before and after implementing a protocol involving both uterine artery embolization and tranexamic acid. Patient data, including demographics and relevant outcomes, were collected from electronic medical records.

A total of 126 cases of placenta accreta spectrum were managed during the study period, of which 66 were suspected cases of placenta increta/percreta. After implementing the uterine artery embolization and tranexamic acid protocol, 30 of the cases (47%) were treated using this approach. The remaining 34 cases (53%) did not receive uterine artery embolization or tranexamic acid infusion and served as the pre-implementation comparison group. The protocol led to longer operative times (416 vs. 187 minutes; P<.01) and a higher likelihood of receiving general anesthesia (80% vs. 47%; P<.01). However, it also resulted in a significant reduction in blood loss (33% 2000 vs 3000 cc decrease; P=.03), a 51% decrease in overall blood transfusion rates (odds ratio, 0.05 [95% CI, 0.001–0.20]; P<.01), and a five-fold reduction in massive blood transfusions (>10 units) (odds ratio, 0.17 [95% CI, 0.02–0.17]; P=.02). Postoperative complication rates remained similar between the two groups (4 vs. 10 events; P=.14), and neonatal outcomes were comparable.

The uterine artery embolization and tranexamic acid protocol for placenta accreta spectrum management was an effective approach that standardized the treatment of complex cases, resulting in favorable perioperative outcomes and reduced maternal morbidity.

Source: ajog.org/article/S0002-9378(23)00174-6/fulltext