Emergency uterine artery embolization for life-threatening hemorrhage in placenta previa with placenta percreta: A...

Postpartum hemorrhage (PPH) remains a major contributor to maternal morbidity and mortality worldwide, in the presence of placenta previa and placenta accreta spectrum (PAS) disorders. Placenta percreta represents the most severe form and is frequently associated with massive, life-threatening bleeding. Uterine artery embolization (UAE) has emerged as a valuable uterus-sparing intervention when conventional measures fail to achieve hemostasis. We present the case of a 36-year-old multiparous woman (G4P4) with 3 prior cesarean deliveries who was diagnosed with complete placenta previa and antenatal suspicion of placenta percreta. She developed spontaneous labor with acute vaginal bleeding and hemodynamic instability, requiring emergency cesarean delivery. Because of firm placental adherence and high hemorrhagic risk, the placenta was intentionally left in situ. Ultrasound confirmed placenta previa, while MRI demonstrated grade IV placenta percreta with full-thickness myometrial invasion, serosal disruption, and anterior abdominal wall extension with bladder involvement. Angiography revealed markedly hypertrophied uterine arteries supplying an extensive placental vascular network. Immediately after cesarean delivery, urgent bilateral UAE was performed using 800-1200 μm PVA particles followed by absorbable gelatin sponge to reinforce proximal embolization. Final angiography confirmed complete devascularization with preservation of vesical and vaginal branches. Postoperative evolution was favorable, with no recurrent bleeding. Follow-up MRI at 3 weeks showed complete devascularization, and the patient remained asymptomatic with normal menstrual cycles at 5 months. This case highlights the effectiveness of emergency UAE as a life-saving and uteruspreserving option for severe PPH due to placenta percreta, even in hemodynamically unstable patients.