Internal iliac artery embolization before hysterectomy for placenta accreta.

Six patients with early sonographic diagnosis of invasive placenta previa increta/percreta before fetal viability were offered hysterectomy to terminate the pregnancy with prophylactic internal iliac artery embolization (IIAE). The mean gestational age at treatment was 19.7 weeks (range, 14-23). Among these six patients undergoing hysterectomy, the mean estimated blood loss was 1,767 mL +/- 1,213 (range, 300-3000), and the mean transfusion requirements were 4.33 U +/- 4.08. With this limited experience, we are encouraged by the apparent reduction in operative blood loss and fewer transfusion requirements after the use of prophylactic IIAE compared with historical controls. These preliminary findings are based on a small number of patients, and therefore further investigation is needed to determine the effectiveness of this procedure.