Case Report: This report presents two cases of vaginally delivered pregnancies complicated by placenta increta, both treated with uterine artery embolization (UAE) followed by placental extraction at different time intervals. In both cases, UAE proved highly effective in controlling acute and severe vaginal bleeding. In case 1, immediate placental extraction was attempted after UAE; however, uncontrolled vaginal bleeding recurred, necessitating a laparotomy for further placental extraction. This was followed by ligation of the bilateral uterine arteries and application of uterine body compression sutures. In case 2, manual placental extraction was performed 48 hours after UAE, when ultrasound Doppler indicated adequate uterine contraction and minimal placental blood flow. The placenta was successfully extracted intact with minimal bleeding.

Conclusions: Delayed placental extraction following UAE may reduce the risk of recurrent massive vaginal bleeding in vaginal deliveries complicated by placenta accreta spectrum (PAS).