Objectives <p>To investigate the outcomes of uterine artery embolization (UAE) for postpartum hemorrhage in pregnant women with placenta accreta spectrum disorder (PASD) and to assess the risk factors for rebleeding.</p> Materials and methods <p>This retrospective study evaluated 112 patients with PASD (62 accreta, 40 increta, 10 percreta) who underwent UAE for postpartum hemorrhage between January 2002 and February 2024. The clinical outcomes and rebleeding risk factors were analyzed.</p> Results <p>A total of 90 patients (80.4%) were successfully embolized without major complications. Rebleeding occurred in the remaining 22 patients after initial embolization, requiring surgery (<i>n</i> = 11) or repeated embolization (<i>n</i> = 11). The mean time interval between initial UAE and rebleeding was 52.1 h (range, 1–648 h; interquartile range (IQR), 4.0–11.25 h). There were no maternal deaths. Multivariate Cox regression analysis showed that overt disseminated intravascular coagulation (<i>p</i> &lt; 0.001), remnant placenta (<i>p</i> &lt; 0.001), extravasation of contrast media on angiogram (<i>p</i> = 0.005), and the transfused packed red blood cell (<i>p</i> = 0.005) were significant independent factors associated with clinical failure of the embolization.</p> Conclusion <p>UAE represents an effective initial treatment option with a high success rate for postpartum hemorrhage in patients with PASD, especially for those aiming to preserve fertility. However, the possibility of rebleeding should be considered in high-risk patients, and achieving complete hemostasis using permanent embolic agents can be beneficial in such cases.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Does uterine artery embolization effectively manage postpartum hemorrhage in patients with placenta accreta spectrum disorder (PASD), minimizing rebleeding and associated complications?</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Uterine artery embolization effectively controlled postpartum hemorrhage in PASD. Rebleeding was associated with disseminated intravascular coagulation, remnant placenta, transfused red blood cells, and contrast extravasation.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>Uterine artery embolization is a reliable and minimally invasive method for managing postpartum hemorrhage in PASD, with a low complication rate and the potential to preserve fertility. Identifying risk factors can enhance patient outcomes and personalized treatment strategies.</i></p> Graphical Abstract <p></p>