Obstetrical hemorrhage remains a leading cause of maternal morbidity and mortality in the United States, affecting up to 18% of deliveries. It is commonly defined as blood loss exceeding 500 mL (1). The most common etiology of primary hemorrhage (defined as hemorrhage within 24 hours of delivery) is uterine atony, whereas secondary hemorrhage is usually attributable to retained products or, less commonly, arterial pseudoaneurysm. Interventional radiologists (IRs) developed uterine artery embolization (UAE) to control deep pelvic bleeding and have used embolization to effectively control postpartum hemorrhage (PPH) since it was first described in 1979(1).

Placental abnormalities may be increasing given the increase in advanced reproductive technologies, twin births, and cesarean sections (2). Placental abnormalities are divided by the depth of invasion into the uterine wall, with an accreta, the least invasive, and percreta, the most invasive. The prevalence of placental abnormalities is estimated at 1 per 500 pregnancies (2). The risks of abnormal placentation are life-threatening and include hemorrhage, infection, hysterectomy, and death. The IR is increasingly asked to help mitigate these risks with the placement of bilateral internal iliac artery (IIA) occlusion balloon catheters in an effort to reduce blood loss (3). Although the efficacy of this procedure is controversial, it may allow uterine conservation in women in whom the diagnosis of accreta is equivocal or to reduce intraoperative blood loss during cesarean hysterectomy. Cesarean hysterectomy is the traditional treatment for placental implantation anomalies.