Prophylactic uterine artery embolization in second-trimester pregnancy termination with placenta previa and accreta spectrum after prior cesarean delivery: a retrospective cohort study

This study evaluated the efficacy of prophylactic uterine artery embolization (PUAE) during surgical termination of second-trimester pregnancies complicated by placenta previa and placenta accreta spectrum (previa PAS) following prior cesarean delivery (CD). A retrospective cohort study was conducted at a tertiary referral center in China between December 2016 and December 2022. A total of 92 patients were included, with 31 undergoing PUAE (study group) and 61 not (control group). Prophylactic uterine artery embolization did not significantly reduce intraoperative blood loss (p = 0.234) or the rate of peripartum hysterectomy (p = 0.331), but was associated with increased surgical duration, prolonged postoperative hospitalization, and a higher incidence of postoperative fever (p < 0.0001, p = 0.0004, and p = 0.002, respectively). No significant differences were observed between the two groups regarding the number of packed red blood cells or fresh frozen plasma transfused, cryoprecipitate use, urinary system injury, intensive care unit admissions, or postoperative complications (including intrauterine hematocele, intrauterine infection, surgical site infection, and deep tissue infection). In this retrospective analysis, PUAE was associated with increased febrile morbidity and prolonged recovery, without a significant reduction in blood loss or hysterectomy rates in second-trimester pregnancy terminations with previa PAS and prior CD.