Prophylactic Uterine Artery Embolization during Cesarean Delivery for Advanced Placenta Accreta Spectrum Disorders

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 747–758

DOI: 10.4688 कार्र2026/IJOG/000543

Original Research Article

Title: Prophylactic Uterine Artery Embolization during Cesarean Delivery for Advanced Placenta Accreta Spectrum Disorders

Names of Authors: Fatima B. Aliyu¹, Tunde M. Bakare¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria

Abstract:
Placenta Accreta Spectrum (PAS) disorders carry extreme risks of catastrophic intrapartum hemorrhage, frequently requiring emergency peripartum hysterectomies. This prospective cohort study evaluated the efficacy and safety of a hybrid surgical protocol combining prophylactic intraoperative Uterine Artery Embolization (UAE) immediately following fetal delivery during planned cesarean section for PAS. Sixty pregnant women diagnosed with high-grade PAS (increta or percreta) via magnetic resonance imaging were divided into two arms: the hybrid UAE group (prophylactic internal iliac artery balloon occlusion followed by gelatin sponge embolization; n = 30) and the standard surgical hemostasis control group (standard vascular ligation and resection; n = 30). The hybrid intervention significantly lowered the mean calculated intraoperative blood loss compared to standard surgery (1142.5 ± 250.4 mL vs. 2840.6 ± 680.2 mL, p < 0.001). The requirement for blood transfusions was reduced by 60.0% in the UAE cohort (p < 0.001). Crucially, the rate of successful uterine preservation (avoidance of peripartum hysterectomy) was significantly higher in the hybrid intervention arm (86.7% vs. 43.3%, p = 0.001). No severe ischemic complications or infectious secondary endometritis were noted up to 12 weeks postpartum. Prophylactic intraoperative uterine artery embolization during planned cesarean section represents a highly effective hemostatic technique that minimizes surgical blood loss and optimizes uterine preservation metrics in patients with advanced placenta accreta spectrum.

Keywords: Placenta Accreta Spectrum; Uterine Artery Embolization; Postpartum Hemorrhage; Hybrid Surgery; Peripartum Hysterectomy; Blood Transfusion.

Manuscript Timeline: Received: August 04, 2026; Revised: August 30, 2026; Accepted: September 10, 2026; Published: September 18, 2026.

Citation: Aliyu FB, Bakare TM. Prophylactic Uterine Artery Embolization during Cesarean Delivery for Advanced Placenta Accreta Spectrum Disorders. International Journal of Obstetrics and Gynecology. 2026; 14(9): 747–758.

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