Application of 3-d angiography in the management of placenta percreta treated with repeat uterine artery embolization.

BACKGROUND: Rising Caesarean section rates have increased rates of abnormally invasive placentation. In the management of such invasive placentation, hysterectomy may result in greater morbidity than more conservative measures. Non-surgical interventions such as uterine artery embolization (UAE) attempt to decrease placental perfusion and augment placental resorption. Repeat UAE may decrease the risk of unpredictable hemorrhage requiring emergency intervention. Three-dimensional angiography is a novel technology for assessing volume with objective measures of internal flow. CASE: We report a case of placenta previa percreta that was treated conservatively by repeat UAE for persistent densely perfused placenta. Three-dimensional angiography was used to objectively assess placental characterization and vascularization. CONCLUSION: Repeat UAE may be beneficial in reducing the risk of delayed hemorrhage in women with placenta previa accreta or percreta managed conservatively. Objective assessment of placental volume and vascularity by 3-D angiography can provide data on patients at risk and allow case selection for repeat UAE.