Endovascular Interventions for the Morbidly Adherent Placenta

Area of Science:

• Maternal-Fetal Medicine
• Interventional Radiology
• Gynecologic Surgery

Background:

• Morbidly adherent placentas (MAP) represent a spectrum of placental invasion, increasing with cesarean delivery rates.
• Historically managed with cesarean hysterectomy due to high morbidity and mortality risks.
• Uterine preservation techniques are emerging for fertility-sparing management.

Purpose of the Study:

• To review the spectrum of morbidly adherent placentas.
• To discuss diagnostic imaging modalities for MAP.
• To outline surgical and endovascular interventions for managing MAP.

Main Methods:

• Review of current literature on morbidly adherent placentas.
• Discussion of imaging findings (ultrasound, MRI).
• Description of surgical approaches and interventional radiology techniques (e.g., embolization).

Main Results:

• Early identification and multidisciplinary team management at tertiary centers improve outcomes.
• Endovascular techniques can reduce morbidity in both hysterectomy and uterine preservation settings.
• Surgical and interventional strategies are tailored to the extent of placental invasion.

Conclusions:

• Morbidly adherent placentas necessitate specialized, multidisciplinary care.
• Interventional radiology plays a key role in managing MAP through endovascular techniques.
• Optimized management strategies balance oncologic safety with fertility preservation.