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For All PAS Cases (Elective and Emergent)
(IR-specific steps are indicated in red)
For All PAS Cases (Elective and Emergent)
(IR-specific steps are indicated in red)
1. Anesthesia and Patient Preparation
Administer anesthesia per standard protocol.
Position the patient in lithotomy, prepping from mid-thighs to xiphoid.
2. Femoral Arterial Access (IR)
Obtain unilateral or bilateral femoral arterial access at the discretion of the interventional radiologist.
Secure arterial sheaths.
3. Delivery (OB)
Perform delivery of the infant.
Assess placenta and uterus.
If proceeding with hysterectomy, uterine closure may be performed as appropriate.
4. Internal Iliac Artery Embolization (IR)
Embolize the internal iliac arteries using Gelfoam.
Target the anterior division if feasible.
Do not delay embolization in attempts to be overly selective.
Goal: Reduce pelvic blood flow to minimize hemorrhage while avoiding significant ischemic complications (e.g., buttock claudication).
5. Completion Angiography (IR)
Evaluate bilateral common iliac arteries for parasitized vessels or additional embolization targets.
Embolize any identified vessels if appropriate and safe.
6. Sheath Management (IR)
Remove arterial sheaths and perform closure.
Leave sheaths in place only if requested by OB for high-risk cases where REBOA may be needed.
7. Surgical Completion (OB and Surgical Teams)
Complete hysterectomy and any additional procedures as indicated.
8. Postprocedural Care (IR)
Evaluate groin access site on Postoperative Day 1 (POD#1).
Priya Mody, MD
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