PROPHYLACTIC UTERINE ARTERY EMBOLIZATION VERSUS CESAREAN SECTION ALONE FOR PLACENTA ACCRETA SPECTRUM: A SYSTEMATIC REVIEW AND META-ANALYSIS
Date
2026-05-12
Authors
Omran MHD Marwan Shrebaty
Leen Alhamd
Moaz Safwan
Mariam Safwan Bourgeh
Batoul Aibour
Mohammad Fateh Martin
Mohammad Samir Mohammad Badr
Mohamed Tharwat Ghazala
Journal Title
Journal ISSN
Volume Title
Publisher
Deanship of Scientific Research - Al-Quds University
Abstract
Background: Placenta accreta spectrum (PAS) is a severe obstetric disorder characterized by abnormal placental invasion into the myometrium, frequently leading to massive hemorrhage, maternal morbidity, and the need for cesarean hysterectomy with consequent loss of fertility. Prophylactic uterine artery embolization (UAE) has been proposed as a uterine-sparing adjunct during cesarean delivery; however, its clinical effectiveness and safety remain uncertain. Aim: This study aimed to evaluate whether prophylactic UAE performed during cesarean delivery improves maternal outcomes in patients with PAS compared with cesarean delivery alone.
Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251266306). Electronic databases were searched through December 2025 for comparative studies assessing prophylactic UAE performed intraoperatively or immediately post-cesarean delivery versus cesarean delivery alone in patients with PAS. Primary outcomes included the rate of hysterectomy, intraoperative blood loss, and blood transfusion requirements. Secondary outcomes were length of hospital stay and intensive care unit (ICU) stay. Pooled risk ratios (RR) and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated. Certainty of evidence was assessed using the GRADE framework.