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Liu X, Kang Y, Cao N, Sun X, Gu Y, Wang X, Wang H. Early identification and conservative treatment of postpartum hemorrhage in the lower uterine segment after vaginal delivery. J Matern Fetal Neonatal Med 2024; 37:2386081. [PMID: 39098849 DOI: 10.1080/14767058.2024.2386081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE This study examined the efficacy of pulling down the cervix and packing it in the vaginal fornix (PC-PVF) on postpartum hemorrhage in the lower uterine segment (PPH-LUS). METHODS All cases of PPH-LUS after vaginal delivery at two tertiary hospitals between January 2019 and December 2022 were retrospectively investigated. Patients treated successfully with conservative measures were divided into routine treatment only (40 patients), routine treatment + early PC-PVF (33 patients), and routine treatment + late PC-PVF (51 patients) groups. Routine treatment consisted of uterine massage, uterotonics, and tranexamic acid administration. The therapeutic effect was evaluated by comparing the volume and rate of bleeding within 24 h after delivery. RESULTS A total of 124 patients were treated conservatively, except for three patients who underwent laparotomy for hemostasis after PC-PVF failed for incomplete rupture of the lower uterine segment. The efficacy of treatment was 44% (40/91) for routine treatment only and 100% when combined with PC-PVF for PPH-LUS. There was no significant difference in maternal age, gestational week, neonatal weight, and Apgar score. But the total blood loss in the conventional treatment + early PC-PVF group (657.27 ml ± 131.61 ml) was significantly lower than that in the other two groups, which was 847.13 ml ± 250.37 ml(p < .01) and 1040.78 ml ± 242.70 ml (p < .01), respectively. The bleeding rate in the routine treatment + early PC-PVF group decreased significantly after tamponade. CONCLUSIONS PC-PVF is a safe and effective treatment for PPH-LUS. Early identification of PPH-LUS and prompt application of PC-PVF can effectively reduce blood loss after vaginal delivery.
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Affiliation(s)
- Xiao Liu
- Department of obstetrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yan Kang
- Department of obstetrics, Shandong Province Maternal and Child Health Care Hospital, Jinan, China
| | - Nannan Cao
- Department of obstetrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaomei Sun
- Department of obstetrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yongzhong Gu
- Department of obstetrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xietong Wang
- Department of obstetrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hongmei Wang
- Department of obstetrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Hu S, Guo W, Chen S, Wu Z, Zhuang W, Yang J. Factors associated with dysmenorrhoea and menorrhagia improvement in patients with adenomyosis after uterine artery embolisation. J OBSTET GYNAECOL 2024; 44:2372645. [PMID: 38943550 DOI: 10.1080/01443615.2024.2372645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND This study examined the improvement of dysmenorrhoea and menorrhagia after uterine artery embolisation (UAE) in women with symptomatic adenomyosis and identified factors that could predict the improvement of dysmenorrhoea and menorrhagia. METHODS This retrospective study included women with adenomyosis who underwent bilateral UAE between December 2014 and December 2016. The percentage of the volume of the absence of contrast enhancement on T1-weighted images was evaluated 5-7 days after UAE. A receiver operating characteristic (ROC) analysis was used to determine a cut-off point and predict the improvement of dysmenorrhoea and menorrhagia. RESULTS Forty-eight patients were included. At 24 and 36 months after UAE, the improvement rates for dysmenorrhoea and menorrhagia were 60.4% (29/48) and 85.7% (30/35), and the recurrence rates were 19.4% (7/36) and 9.1% (3/33), respectively. Only the percentage of the volume of the absence of contrast enhancement on T1-weighted images was associated with the improvement of dysmenorrhoea (p = 0.001, OR = 1.051; 95% CI: 1.02-1.08) and menorrhagia (p = 0.006, OR = 1.077; 95% CI: 1.021-1.136). When the cut-off value of the ROC analysis was 73.1%, sensitivity, specificity, positive predictive value, and negative predictive value for the improvement of dysmenorrhoea were 58.6%, 94.7%, 94.4%, and 60%, while they were 58.9%, 80%, 100%, 100%, and 45.5% for the improvement of dysmenorrhoea. CONCLUSION Bilateral UAE for symptomatic adenomyosis led to good improvement of dysmenorrhoea and menorrhagia. The percentage of the volume of the absence of contrast enhancement on T1-weighted images of the uterus in postoperative magnetic resonance imaging might be associated with the improvement of dysmenorrhoea and menorrhagia.
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Affiliation(s)
- Siqi Hu
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wenbo Guo
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Song Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhiqiang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wenquan Zhuang
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianyong Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Chatani S, Inoue A, Lee T, Uemura R, Imai Y, Takaki K, Tomozawa Y, Murakami Y, Sonoda A, Tsuji S, Watanabe Y. Clinical outcomes and future fertility after uterine artery embolization for postpartum and post-abortion hemorrhage. Acta Radiol 2024; 65:670-677. [PMID: 38584381 DOI: 10.1177/02841851241244489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) and post-abortion hemorrhage (PAH) are life-threatening conditions. PURPOSE To evaluate the efficacy and safety of uterine arterial embolization (UAE) for PPH and PAH and to investigate future fertility after UAE. MATERIAL AND METHODS This study included 57 consecutive patients (mean age = 34 years) who underwent UAE for PPH (n = 46) and PAH (n = 11) at our institution between January 2011 and December 2022. Technical success, non-visualization of the peripheral portion of bilateral uterine arteries on angiography, and clinical success, complete hemostasis after UAE, were assessed. UAE-associated complications and factors related to clinical success were analyzed. Pregnancy outcomes after UAE and complications during subsequent pregnancy were investigated in 16 patients who desired fertility and were followed up for >1 year. RESULTS The technical and clinical success rates were 100% and 84.2%, respectively. Sepsis (n = 1) and uterine empyema (n = 1) were observed as severe complications. Placental disorder, bleeding within 24 h after delivery or abortion, ≥1.5 shock index, ≥6 units of transfusion erythrocytes, and ≥8 obstetrical disseminated intravascular coagulation score were significantly associated with unfavorable clinical outcomes. In total, 16 pregnancies were observed in 12 patients after UAE, three of which were miscarriages and 13 were successful live births. During pregnancy, uterine rupture (n = 1) and accreta (n = 1) were observed. CONCLUSION UAE is an effective treatment for PPH and PAH. Although UAE could preserve future fertility, careful attention should be paid to perinatal management for unusual complications.
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Affiliation(s)
- Shohei Chatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tokuko Lee
- Department of Radiology, Koseikai Takeda Hospital, Kyoto, Japan
| | - Ryo Uemura
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kai Takaki
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yuki Tomozawa
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoko Murakami
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Yin H, Liu H, Hu R. Uterine necrosis following uterine artery embolization as treatment for postpartum hemorrhage: A case report and literature review. Int J Gynaecol Obstet 2024. [PMID: 38800885 DOI: 10.1002/ijgo.15710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
Uterine necrosis is a rare complication of uterine artery embolization for postpartum hemorrhage and most patients end up having a hysterectomy. Here we report a case in which the patient experienced a recurrent fever 28 days after uterine artery embolization as treatment for postpartum hemorrhage and had no response to antibiotics. Magnetic resonance imaging of the pelvis revealed a mass which was approximately 12-cm in size with air bubbles in the uterus, suggesting necrosis with infection. Transvaginal clamping of the uterine mass was performed and necrotic tissue removed under laparoscopic monitoring, which successfully spared the necessity for a hysterectomy. The patient's subsequent progress was favorable. In the present study we review the high-risk factors of uterine necrosis following uterine artery embolization and summarize the key points of early diagnosis. In addition, we propose a strategy to successfully spare the necessity for a hysterectomy without the spread of infection or uterine perforation.
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Affiliation(s)
- Huifen Yin
- Obstetrics Department, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Haiyan Liu
- Obstetrics Department, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Rong Hu
- Obstetrics Department, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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5
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Lee KE, Lee SU, Kang J, Lim HW, Park IY, Kim MJ. Prognosis of subsequent pregnancy in uterine necrosis after uterine artery embolization. Obstet Gynecol Sci 2024; 67:335-338. [PMID: 38563044 PMCID: PMC11099095 DOI: 10.5468/ogs.23287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/24/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024] Open
Abstract
In an 8-year period at two medical center, 138 patients underwent uterine artery embolization, and 11 of them were diagnosed with uterine necrosis. Among them, three were successfully conceived. However, one of them developed an arteriovenous malformation after an artificial abortion, and another experienced complications, including placenta previa and placenta accreta spectrum, which resulted in early preterm delivery and recurrent postpartum hemorrhage, necessitating subtotal hysterectomy. Therefore, it is crucial to prepare for potential adverse pregnancy outcomes in subsequent pregnancies for patients with a history of uterine necrosis.
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Affiliation(s)
- Kyung Eun Lee
- Department of Obstetrics and Gynecology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
| | - Seon Ui Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jun Kang
- Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyun Wook Lim
- Department of Radiology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Min Jeong Kim
- Department of Obstetrics and Gynecology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
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Chlela M, Dawkins J, Lewis G. Hysterectomy Sparing Management of Uterine Necrosis following Uterine Artery Embolization for Postpartum Hemorrhage. Case Rep Obstet Gynecol 2023; 2023:8276110. [PMID: 37519951 PMCID: PMC10372334 DOI: 10.1155/2023/8276110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/20/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality. Uterine artery embolization (UAE) is an effective procedural intervention for controlling PPH. Uterine necrosis (UN) is a rare complication of UAE and its management usually results in hysterectomy. We highlight a case of UAE complicated by UN managed conservatively without hysterectomy. Case This is the case of a 30-year-old patient who had a cesarean section delivery and subsequently developed PPH due to uterine atony. The estimated blood loss (EBL) was 2500 ml; despite the use of uterotonic medications and trial of intrauterine balloon tamponade. She successfully underwent a UAE with no immediate complications. The remainder of her postnatal course was uncomplicated, and she was discharged on postoperative day 4. On postoperative day 28, the patient presented with fever, vaginal discharge, and abdominal pain. An abdomino-pelvic computed tomography scan revealed areas of necrosis within the uterus secondary to recent UAE. After minimal clinical improvement, the patient underwent a dilation and curettage with ultrasound guidance. The patient improved clinically and was discharged home to complete a 14-day course of antibiotics. Conclusion UAE is an important minimally invasive approach to the management of PPH. UN following UAE can present a clinical challenge to physicians, with the underlying pathophysiology being use of small embolizing particles during UAE and lack of arterial collaterals to embolized areas. A total of 19 cases of UN post-UAE have been described of which most of these cases were managed with a hysterectomy. In this case, an alternative treatment plan was successfully implemented via dilation and curettage under ultrasound guidance for removal of organized necrotic tissue. This was sufficient to improve the patient's symptoms and clinical outcome and saved the patient from the morbidity and mortality risks associated with a hysterectomy.
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Affiliation(s)
- Myriam Chlela
- Department of Obstetrics and Gynecology, United Health Services Perinatal Center, 33-57 Harrison Street, Johnson City, NY 13790, USA
| | - Josette Dawkins
- Department of Obstetrics and Gynecology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Gregory Lewis
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, 653-1 W. 8th Street, Jacksonville, FL 32209, USA
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Zouaghi C, Chaouch MA, Sanchez S, Zouaghi S. Hysteroscopy after conservative surgical treatment of severe postpartum hemorrhage due to uterine atony: A systematic literature review. Int J Gynaecol Obstet 2023. [PMID: 36710527 DOI: 10.1002/ijgo.14704] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the prevalence of intrauterine anomalies, primarily intrauterine adhesions (IUAd), after conservative surgical treatment of severe postpartum hemorrhage with uterine atony (SPPH-UA) and determine patient eligibility for hysteroscopy. METHODS PubMed and the Cochrane Library were searched by combining keywords "postpartum hemorrhage", "uterine atony", and "hysteroscopy" to perform a literature review. Articles in French and English with more than five cases of hysteroscopy following SPPH-UA were selected. All cases that had hysteroscopy after conservative surgical treatment of SPPH-UA were collected. A blinded statistical analysis revealed IUAd risk factors. RESULTS In all, 83% of patients agreed to hysteroscopy and 38% of 71 cases had an IUAd. Age was not a risk factor (P = 0.950). Other factors included multiparity (odds ratio [OR] 1.93, P = 0.039), cesarean delivery (OR 3.58, P = 0.584) and postpartum infection (OR 3.33, P = 0.04). Risk was at 57% after uterine padding with multiple transfixing square stitches (Cho-technique) (P = 0.001), 6% after non-transfixing uterine folding brace suture (B-Lynch technique) when used alone, 29% after uterine artery embolization and after internal iliac artery ligation (OR 0.98, P = 0.645); uterine vascular ligation (OR 0.69, P = 0.253) and more than two procedures (OR 0.69, P = 2.53). Disparity between authors was observed (P = 0.015) and concerned only the surgical techniques used. CONCLUSION A classification is proposed for deciding post-SPPH hysteroscopy. Further studies are required to determine appropriateness.
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Affiliation(s)
- Chiheb Zouaghi
- Department of Gynecology and Obstetrics, Nevers Agglomeration Hospital, Nevers, France
| | - Mohamed Ali Chaouch
- Department of Visceral Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Stephane Sanchez
- Public Health and Performance Department, Champagne Sud Hospital, Troyes, France
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Takizawa A, Matsushima T, Harigane E, Suzuki S, Kawamata H. Hysteroscopic resection of retained products of conception combined with uterine artery balloon occlusion: A novel case report. J Obstet Gynaecol Res 2023; 49:1295-1299. [PMID: 36650752 DOI: 10.1111/jog.15561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/07/2023] [Indexed: 01/19/2023]
Abstract
Retained products of conception can cause massive bleeding that can be prevented by uterine artery embolization before resection; however, uterine artery balloon occlusion is less invasive. While scattered reports of its use for postpartum hemorrhage exist, no indications have been described. We report a case of hysteroscopic resection of retained products of conception using uterine artery balloon occlusion instead of uterine artery embolization. A 29-year-old woman, gravida 2 para 0, noted an intrauterine mass after an abortion at 7 weeks' gestation. Follow-up visits showed insufficient lowering of human chorionic gonadotropin levels, necessitating surgical treatment. Considering the patient's desire to conceive, we performed uterine artery balloon occlusion to reduce the risk of perinatal complications associated with uterine artery embolization. The operation was completed without complications. The patient conceived spontaneously and had a live baby 7 months after surgery, thus proving the benefits of uterine artery balloon occlusion before hysteroscopic resection.
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Affiliation(s)
- Ayako Takizawa
- Department of Obstetrics and Gynecology, University of Nippon Medical School, Kawasaki, Kanagawa, Japan
| | - Takashi Matsushima
- Department of Obstetrics and Gynecology, University of Nippon Medical School, Kawasaki, Kanagawa, Japan
| | - Eika Harigane
- Department of Obstetrics and Gynecology, University of Nippon Medical School, Kawasaki, Kanagawa, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, University of Nippon Medical School, Kawasaki, Kanagawa, Japan
| | - Hiroshi Kawamata
- Department of Interventional Radiology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
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Dominoni M, Gardella B, Spinillo A. Uterine necrosis in obstetrics after emergency surgical procedure: the dark side of hypogastric artery ligation. Am J Obstet Gynecol 2023; 228:116. [PMID: 35988757 DOI: 10.1016/j.ajog.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy; Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy; Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy.
| | - Arsenio Spinillo
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy; Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
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10
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Hirsch A, Newman R, Naqvi M. Uterine necrosis during pregnancy following exploratory laparotomy. BMJ Case Rep 2022; 15:e252273. [PMID: 36319041 PMCID: PMC9628654 DOI: 10.1136/bcr-2022-252273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Uterine necrosis is an infrequent event and is most commonly reported as a complication of interventions for postpartum haemorrhage management. Cases of uterine necrosis in pregnancy are rare. The mainstay of treatment for uterine necrosis is hysterectomy, and the data regarding conservative management are limited. A gravida 3, para 2 presented at 33 weeks gestation with ovarian torsion and underwent an exploratory laparotomy with ovarian cystectomy. The surgery was complicated by excess bleeding, which was controlled with the placement of sutures along the uterine body. She had multiple subsequent presentations for severe abdominal pain without clear aetiology. Four weeks after the initial surgery, she underwent caesarean delivery, at which time uterine necrosis was diagnosed. Her uterus was preserved. She received postoperative intravenous antibiotics and was closely observed. She continued to do well 10 months postpartum. In patients with uterine necrosis during pregnancy who are haemodynamically stable, conservative management may be an option.
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Affiliation(s)
- Anna Hirsch
- Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rachel Newman
- Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mariam Naqvi
- Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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A Case of Preeclampsia with Uterine Necrosis after Uterine Artery Embolization for Postpartum Hemorrhage. Case Rep Obstet Gynecol 2022; 2022:2859766. [PMID: 35619878 PMCID: PMC9130014 DOI: 10.1155/2022/2859766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/13/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Uterine necrosis is a rare complication in uterine artery embolization (UAE) for postpartum hemorrhage (PPH). Preeclampsia (PE) is a condition characterized with systemic endothelial damage and intravascular volume depletion. Whether a patient with PE is at high risk for uterine necrosis after UAE for PPH has been unknown. A 30-year-old primipara woman was diagnosed with PE based on hypertension and proteinuria during delivery. UAE was performed for PPH after forceps delivery. After UAE, the patient presented with pleural effusion and massive ascites as well as persistent fever unresponsive to antibiotics. Ultrasonography and contrast-enhanced magnetic resonance imaging (MRI) led to the diagnosis of uterine necrosis, for which we performed total laparoscopic hysterectomy. It should be kept in mind that patients with PE associated with massive ascites may be at high risk for uterine necrosis after UAE due to decreased uterine perfusion. Therefore, it is important to pay attention to persistent symptoms such as fever and abdominal pain after UAE to diagnose uterine necrosis.
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12
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Uterine necrosis simulating a textiloma: A case report. Int J Surg Case Rep 2022; 91:106754. [PMID: 35051885 PMCID: PMC8777381 DOI: 10.1016/j.ijscr.2021.106754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/16/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022] Open
Abstract
Uterine necrosis is a rare condition, it is considered a life-threatening complication. A few cases of uterine necrosis are reported in the literature most of them complicating embolizations, occurring after postpartum hemorrhages or severe endometritis. We describe a case of uterine necrosis occurring after a caesarean section, the results of the CT scan simulated a textiloma.
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13
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A systematic review and meta-analysis of obstetric and maternal outcomes after prior uterine artery embolization. Sci Rep 2021; 11:16914. [PMID: 34413380 PMCID: PMC8377070 DOI: 10.1038/s41598-021-96273-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/09/2021] [Indexed: 12/29/2022] Open
Abstract
This study aimed to review the obstetric complications during subsequent pregnancies after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) by exploring the relationship between prior UAE and obstetric complications through a meta-analysis. We conducted a systematic literature review through March 31, 2021, using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials in compliance with the PRISMA guidelines and determined the effect of prior UAE for PPH on the rate of placenta accreta spectrum (PAS), PPH, placenta previa, hysterectomy, fetal growth restriction (FGR), and preterm birth (PTB). Twenty-three retrospective studies (2003–2021) met the inclusion criteria. They included 483 pregnancies with prior UAE and 320,703 pregnancies without prior UAE. The cumulative results of all women with prior UAE indicated that the rates of obstetric complications PAS, hysterectomy, and PPH were 16.3% (34/208), 6.5% (28/432), and 24.0% (115/480), respectively. According to the patient background-matched analysis based on the presence of prior PPH, women with prior UAE were associated with higher rates of PAS (odds ratio [OR] 20.82; 95% confidence interval [CI] 3.27–132.41) and PPH (OR 5.32, 95% CI 1.40–20.16) but not with higher rates of hysterectomy (OR 8.93, 95% CI 0.43–187.06), placenta previa (OR 2.31, 95% CI 0.35–15.22), FGR (OR 7.22, 95% CI 0.28–188.69), or PTB (OR 3.00, 95% CI 0.74–12.14), compared with those who did not undergo prior UAE. Prior UAE for PPH may be a significant risk factor for PAS and PPH during subsequent pregnancies. Therefore, at the time of delivery, clinicians should be more attentive to PAS and PPH when women have undergone prior UAE. Since the number of women included in the patient background-matched study was limited, further investigations are warranted to confirm the results of this study.
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Imafuku H, Tanimura K, Shi Y, Uchida A, Deguchi M, Terai Y. Clinical factors associated with a placenta accreta spectrum. Placenta 2021; 112:180-184. [PMID: 34375912 DOI: 10.1016/j.placenta.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Placenta accreta spectrum (PAS) is a life-threating obstetric complication, and prenatal prediction of PAS can decrease maternal morbidity and mortality. The aim of this prospective cohort study was to determine the clinical factors associated with PAS. METHODS Pregnant women who delivered at a university hospital were enrolled. Clinical data were collected from medical records, and logistic regression analyses were performed to determine which clinical factors were associated with PAS. RESULTS Eighty-seven (2.1%) of the 4146 pregnant women experienced PAS. Multivariable analyses revealed that a prior history of cesarean section (CS) (OR 3.3; 95% CI 1.9-5.7; p < 0.01), dilation and curettage (D&C) (OR 2.8; 95% CI 1.7-4.6; p < 0.01), hysteroscopic surgery (OR 5.7; 95% CI 2.3-14.4; p < 0.01), uterine artery embolization (UAE) (OR 44.1; 95% CI 13.8-141.0; p < 0.01), current pregnancy via assisted reproductive technology (ART) (OR 4.1; 95% CI 2.4-7.1; p < 0.01), and the presence of placenta previa in the current pregnancy (OR 13.1; 95% CI 7.9-21.8; p < 0.01) were independently associated with the occurrence of PAS. CONCLUSION Pregnant women who have a prior history of CS, D&C, hysteroscopic surgery, UAE, current pregnancy via ART, and the presence of placenta previa in the current pregnancy are high risk for PAS.
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Affiliation(s)
- Hitomi Imafuku
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Tanimura
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yutoku Shi
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akiko Uchida
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masashi Deguchi
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
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15
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Cezar C, Torres de la Roche LA, Hennefründ J, Verhoeven HC, Devassy R, De Wilde RL. Can uterine artery embolization be an alternative to plastic and reconstructive uterus operation by minimally invasive surgery? GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2021; 10:Doc07. [PMID: 34194918 PMCID: PMC8204672 DOI: 10.3205/iprs000157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Plastic and reconstructive minimally invasive surgery has been established as gold standard in myomectomy. Therapy failure eventually leads to future surgical interventions or hysterectomy: surgeons and patients should be aware of the risks and benefits. We conducted a systematic review to analyse the evidence on the therapeutic indications and adverse events associated with uterine artery embolization and thereby evaluating if this method could be a valid alternative therapy. Methods: In concordance with PRISMA guidelines, literature research was made in PubMed, Cochrane Library, UpToDate, Amboss and Medline databases. Clinical trials, reviews and case reports published in English between January 2010 and June 2020 were included. Results: 44 articles were included out of 838 papers identified at initial search. Regarding uterine fibroids, three original papers and one Cochrane review reported the benefits of the procedure as an alternative to surgery, even in large and giant fibroids. Furthermore, several studies discussed the use of embolization for postpartum haemorrhage to decrease rates of hysterectomy after other haemostatic methods were exhausted, because of the potential risk of abnormal placentation in a future pregnancy. The procedure can also be successfully used as prophylactic method in different obstetrical procedures. Conclusions: The use of embolization in different uterine pathologies is a minimally invasive procedure as an alternative to surgery, especially in women who desire to preserve their uterus. Its related complications are described and can be avoided by a stringent indication of the procedure. More evidence regarding fertility after UAE, use of the procedure prophylactically in obstetrical haemorrhage or in adenomyosis is needed.
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Affiliation(s)
- Cristina Cezar
- University Hospital for Gynecology, Pius Hospital, Carl von Ossietzky University Oldenburg, Germany
| | | | | | - Hugo Christian Verhoeven
- Private Center for Endocrinology, Preventive Medicine, Reproductive Medicine and Gynecology, Dusseldorf, Germany
| | - Rajesh Devassy
- University Hospital for Gynecology, Pius Hospital, Carl von Ossietzky University Oldenburg, Germany
| | - Rudy Leon De Wilde
- University Hospital for Gynecology, Pius Hospital, Carl von Ossietzky University Oldenburg, Germany
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16
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Luo L, Wan J, Chen X, Zhang H, Zhang M, Chen Q. Uterine necrosis, infection, and subinvolution: complications observed after combined application of modified B-Lynch suture and vascular ligation. J Int Med Res 2021; 49:3000605211010730. [PMID: 33947256 PMCID: PMC8113939 DOI: 10.1177/03000605211010730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Compression sutures are primarily used to treat atonic postpartum hemorrhage. We
herein describe three cases of selective arterial ligation combined with B-Lynch
or modified B-Lynch suture for the treatment of intractable postpartum
hemorrhage unresponsive to available conservative interventions. Three pregnant
women underwent a cesarean section for a macrosomic fetus, fetal distress, and
oligohydramnios, respectively. All three women developed intractable postpartum
hemorrhage due to uterine atony with no chance of embolization therapy. B-Lynch
or modified B-Lynch suture and additional selective arterial ligation were
performed using braided absorbable suture. The first woman developed
postoperative hematometra and infection without response to drainage and
antibiotic therapy. Although laparoscopic exploration was performed to loosen
the suture line and drain the hematometra and pyometra, the necrosis and
infection could not be controlled. Subtotal hysterectomy was therefore
conducted, and the necrotic uterine adnexa was removed. The other two women
developed subinvolution of the uterus resulting in prolonged menstruation and
amenorrhea, although the uterus was preserved and the bleeding was controlled.
Modified B-Lynch suture combined with vascular ligation is an invaluable
technique for women with severe intractable postpartum hemorrhage. However, it
can lead to serious complications such as uterine necrosis, infection, and
subinvolution.
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Affiliation(s)
- Linfeng Luo
- The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China
| | - Junhui Wan
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xinping Chen
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Huan Zhang
- Department of Gynaecology and Obstetrics, Jinxian County People's Hospital, Nanchang, Jiangxi, China
| | - Minjie Zhang
- Queen Mary College of Nanchang University, Nanchang, Jiangxi, China
| | - Qi Chen
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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17
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The Emergent Pelvic Artery Embolization in the Management of Postpartum Hemorrhage: A Systematic Review and Meta-analysis. Obstet Gynecol Surv 2021; 76:234-244. [PMID: 33908615 PMCID: PMC8081441 DOI: 10.1097/ogx.0000000000000887] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Postpartum hemorrhage (PPH) is an emergent obstetric complication and the leading cause of maternal mortality. Pelvic arterial embolization (PAE) is an effective treatment for intractable PPH. However, a unique protocol has not been accepted in obstetrical practice. Objective To evaluate its efficiency, safety, complications, and outcomes, we conducted a systematic review and meta-analysis of PAE for PPH in the literature. Evidence Acquisition The Medline, the database of abstract of reviews, the index to allied health literature, and the Chinese database Sino-Med were searched on March 31, 2020, for studies on PAE for PPH. The data for PAE indication, agents, arteries, success rate, complications, and outcomes were extracted and syncretized for meta-analysis. Results From 1075 identified articles, 113 abstracts or full articles were retrieved and 43 studies were finally identified as meeting the including criteria. The results demonstrated that the indications for PAE were as follows: uterine atony, placental abnormality, delivery tract injury, disseminated intravascular coagulation, arteriovenous malformation, and vaginal hematoma. The embolization agents mostly in order were gelatin sponge particles, polyvinyl alcohol particles, Gelfoam, N-butyl cyanoacrylate, microcoil, and glue; for arteries, they were mostly uterine artery and internal iliac artery. The clinical success rate was 90.5%, whereas the technical success rate was 99.3%. The most common complications of PAE were postembolization syndrome and menstrual abnormality. Conclusions and Relevance The emergent PAE is a safe and effective method with high success rate in life-threatening PPH management. Gelatin sponge granules measuring 500 to 1000 μm in diameter have safe results. Pelvic arterial embolization may affect the recovery of menses and increase PPH in the subsequent pregnancy, but there was no noted correlation with fetal growth restriction.
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18
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Wada Y, Takahashi H, Suzuki H, Ohashi M, Ogoyama M, Nagayama S, Baba Y, Usui R, Suzuki T, Ohkuchi A, Fujiwara H. Expectant management of retained products of conception following abortion: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2021; 260:1-5. [PMID: 33689917 DOI: 10.1016/j.ejogrb.2021.02.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To clarify the natural history of retained products of conception (RPOC) following abortion at less than 22 weeks of gestation, and those who show major bleeding during course observation. STUDY DESIGN We retrospectively reviewed 640 patients who had spontaneous or artificial abortion at less than 22 weeks of gestation between January 2011 and August 2019 in our institute. Of those, patients with RPOC were included. The maternal background, RPOC characteristics, and subsequent complications including additional interventions were reviewed. RESULTS Fifty-four patients with RPOC were included. The incidence of RPOC was 6.7 %. The median (interquartile range: IQR) RPOC length was 29 (20-38) mm. RPOC hypervascularity was observed in 26 (48 %) patients. The median (IQR) periods of RPOC flow disappearance and RPOC disappearance on ultrasound from abortive treatment were 50 (28-76) and 84 (50-111) days, respectively. Of the 54, 44 patients were selected for expectant management. Of the 44, 34 (77 %) patients were observed without intervention (recovery group); the other 10 (23 %) patients required additional interventions associated with subsequent bleeding (intervention group). Compared with the recovery group, heavy bleeding (> 500 mL) at abortion (6/10: 60 %) and RPOC hypervascularity (8/10: 80 %) were more frequently observed in the intervention group. CONCLUSION Expectant management was successful in almost 80 % of patients with RPOC following abortion. The additional interventions were required in patients with heavy bleeding at abortion and RPOC hypervascularity.
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Affiliation(s)
- Yoshimitsu Wada
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan.
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan
| | - Mai Ohashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan
| | - Manabu Ogoyama
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan
| | - Shiho Nagayama
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan
| | - Yosuke Baba
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan
| | - Tatsuya Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, 329-0498, Japan
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19
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Hirashima H, Kaminaga K, Koyashiki Y, Tabata K, Usui R, Ohkuchi A. Uterine necrosis following uterine artery embolism due to postpartum hemorrhage: A case report and review. HYPERTENSION RESEARCH IN PREGNANCY 2021. [DOI: 10.14390/jsshp.hrp2020-002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hiroto Hirashima
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
| | - Kyoko Kaminaga
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
| | - Yohei Koyashiki
- Department of Radiology, Jichi Medical University School of Medicine
| | - Kenichi Tabata
- Department of Diagnostic Pathology, Jichi Medical University Hospital
| | - Rie Usui
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
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20
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Hawthorn BR, Ratnam LA. Role of interventional radiology in placenta accreta spectrum (PAS) disorders. Best Pract Res Clin Obstet Gynaecol 2021; 72:25-37. [PMID: 33640296 DOI: 10.1016/j.bpobgyn.2021.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
Placenta accreta spectrum (PAS) disorders are rare but potentially life-threatening obstetric conditions, which can result in severe post-partum haemorrhage (PPH). Traditional management necessitates peripartum hysterectomy, but this carries high rates of morbidity and mortality. More recently, interventional radiology techniques have been developed in order to reduce morbidity and preserve fertility. This article summarises and compares the various reported interventional radiology techniques. Arterial embolisation performed to treat PPH is the therapeutic option which is supported by the highest degree of evidence. The role of preventative procedures, such as temporary balloon occlusion of the internal iliac arteries or distal aorta, continues to be debated due to conflicting outcome data and concerns regarding associated morbidity. The choice of which, if any, interventional radiological technique is utilised is determined by local expertise, available resources and the planned obstetric approach. The most complex patients are likely to benefit from multidisciplinary management in high-volume centres.
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Affiliation(s)
- Benjamin R Hawthorn
- St George's Hospital University Hospitals NHS Foundation Trust, London, SW17 0QT, United Kingdom.
| | - Lakshmi A Ratnam
- St George's Hospital University Hospitals NHS Foundation Trust, London, SW17 0QT, United Kingdom.
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21
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Eggel B, Bernasconi M, Quibel T, Horsch A, Vial Y, Denys A, Baud D. Gynecological, reproductive and sexual outcomes after uterine artery embolization for post-partum haemorrage. Sci Rep 2021; 11:833. [PMID: 33436979 PMCID: PMC7804269 DOI: 10.1038/s41598-020-80821-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/23/2020] [Indexed: 01/27/2023] Open
Abstract
In this case control study, long-term gynecological, reproductive and sexual outcomes after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) were evaluated. The study was performed in a single referral hospital for PPH in Lausanne from 2003 to 2013. Each woman whose delivery was complicated by PPH and treated by UAE was included, and compared to a control group of women whose delivery was uncomplicated. Cases were matched by maternal age, parity, ethnicity, year and mode of delivery, birth weight and gestational age in a 1–3 ratio. A total of 77 patients treated by UAE for PPH were identified in our obstetrical database. Among them, 63 were included and compared to 189 matched patients (no PPH). The mean interval time between UAE and this study was 8.1 years. Time to menstrual cycle recovery after delivery (3.9 vs 5.6 months, p = 0.66), spotting (7.9% vs 7.2%, p = 0.49), dysmenorrhea (25.4% vs 22.2%, p = 0.60) and amenorrhea (14.3% vs 12.2%, p = 0.66) were similar between the two groups. There was no difference in the FSFI score between the groups (23.2 ± 0.6 vs 23.8 ± 0.4; p = 0.41). However, the interval time to subsequent pregnancy was longer for patients after UAE than the control group (35 vs 18 months, p = 0.002). In case of pregnancy desire, the success rate was lower after UAE compared to controls (55% vs 93.5%, p < 0.001). The rate of PPH was higher in those with previous PPH (6.6% vs 36.4%, p = 0.010). Patients treated by UAE for PPH did not report higher rates of gynecological symptoms or sexual dysfunction compared to patients with uneventful deliveries. The inter-pregnancy interval was increased and the success rate was reduced. In subsequent pregnancies, a higher rate of PPH was observed in those that underwent UAE.
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Affiliation(s)
- Béatrice Eggel
- Materno-Fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant"-"Woman-Mother-Child", University of Lausanne and Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Maude Bernasconi
- Materno-Fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant"-"Woman-Mother-Child", University of Lausanne and Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Thibaud Quibel
- Materno-Fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant"-"Woman-Mother-Child", University of Lausanne and Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education in Healthcare Research, University of Lausanne and Lausanne University Hospital, 1011 Lausanne, Switzerland.,Neonatology Service, Department Woman-Mother-Child, University of Lausanne and Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Yvan Vial
- Materno-Fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant"-"Woman-Mother-Child", University of Lausanne and Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology, University of Lausanne and Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant"-"Woman-Mother-Child", University of Lausanne and Lausanne University Hospital, 1011, Lausanne, Switzerland. .,Obstetric Service, Department "Femme-Mère-Enfant"-"Woman-Mother-Child", Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne and Lausanne University Hospital, 1011, Lausanne, Switzerland.
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22
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Rand T, Patel R, Magerle W, Uberoi R. CIRSE standards of practice on gynaecological and obstetric haemorrhage. CVIR Endovasc 2020; 3:85. [PMID: 33245432 PMCID: PMC7695782 DOI: 10.1186/s42155-020-00174-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
This CIRSE Standards of Practice document provides best practices for obstetric haemorrhage embolisation (OHE) in the management of postpartum haemorrhage (PPH). The document is aimed at interventional radiologists involved in treating postpartum haemorrhage, and has been developed by a writing group established by the CIRSE Standards of Practice Committee. CIRSE Standards of Practice documents are not clinical practice guidelines and do not intend to impose a standard of care, rather provide reasonable approaches to and best practices for specific interventional radiology treatments and techniques.
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Affiliation(s)
- Thomas Rand
- Institute for Interventional and Diagnostic Radiology, Klinik Floridsdorf, Brünnerstr.68, 1210, Vienna, Austria. .,Scientific research in diagnostics and interventional radiology, Karl Landsteiner Society, St. Pölten, Austria.
| | - Rafiuddin Patel
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Raman Uberoi
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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23
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Jung YM, Kim HJ, Choi WS, Park JY, Seong NJ, Oh KJ, Hong JS, Yoon CJ. CT angiography for the management of postpartum hemorrhage refractory to conservative treatment. J Matern Fetal Neonatal Med 2020; 35:4081-4088. [PMID: 33207995 DOI: 10.1080/14767058.2020.1846708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality. Computerized tomographic (CT) angiography is a useful tool to identify hemorrhage from various conditions. However, the feasibility of CT angiography for the management of PPH has not been well evaluated. OBJECTIVE To evaluate the clinical usefulness of CT angiography in the management of PPH refractory to the conservative treatment. METHODS This retrospective cohort study consisted of 528 consecutive patients who were transferred to our institute after delivery at 28 primary maternity hospitals for the management of PPH between 2009 and 2017. Immediate intervention such as arterial embolization and hysterectomy were performed on 278 patients. Of the remaining 250 patients, CT angiography was performed on 61 patients with hemodynamic stability but with sustained hemorrhage refractory to medical treatment. The diagnostic index was assessed using conventional angiography as the reference standard. The clinical outcome was compared between patients with and without contrast extravasation on CT angiography. RESULTS (1) The prevalence of contrast extravasation was found in 61% of patients (37/61); (2) conventional angiography and arterial embolization were performed in 78% of patients (29/37) with contrast extravasation on CT angiography. Contrast extravasation was confirmed in 83% of patients (24/29) by conventional angiography; (3) among the 24 patients without contrast extravasation on CT angiography, 96% (23/24) were managed conservatively; (4) the patients with contrast extravasation on CT angiography received more packed red blood cell (PRBC) transfusion than those without that condition (7.3 ± 5.2 units vs. 3.8 ± 2.9 units, p = .009). Massive transfusion (defined as transfusion of 10 or more units of PRBC) was more common in patients with contrast extravasation than in those without (27% [10/37] vs. 0% [0/24], p = .004). CONCLUSIONS Conservative treatment succeeded in 96% of patients without contrast extravasation on CT angiography. CT angiography is useful to identify patients requiring intervention in the management of hemorrhage refractory to medical treatment.
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Affiliation(s)
- Young Mi Jung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won Seok Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nak Jong Seong
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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24
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Mironov NR, Kram JJF, Heslin K, Michelson ELD. Retrospective review of cesarean hysterectomy outcomes utilizing uterine intravascular interventions in a large, community-based healthcare setting. Eur J Obstet Gynecol Reprod Biol 2020; 255:237-241. [PMID: 33160153 DOI: 10.1016/j.ejogrb.2020.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore outcomes of women with planned cesarean hysterectomies, with or without use of internal iliac intravascular occlusive balloon catheter or uterine artery embolization (UAE). STUDY DESIGN We retrospectively reviewed adult women who underwent a planned cesarean hysterectomy, 2004-2019. All planned cases were included, regardless of indication. Planned surgeries were divided into three groups: balloon placement, UAE, or no intervention. Patients with balloon placement were further subdivided into: balloons placed but not deployed or balloons placed and deployed intraoperatively. Hemorrhage was defined as estimated blood loss (EBL) ≥1,500 mL. An adverse outcome was defined as one or more of the following: intensive care unit admission, thromboembolism, ureteral stent placement, amputation, or reoperation. Basic descriptive and inferential statistics were used to explore differences among groups and adverse outcomes. RESULTS A total of 34 patients underwent planned cesarean hysterectomy. Ten patients (29.4%) had balloons placed, nine (26.5%) had UAE, and 15 (44.1%) had no intervention. Risk of hemorrhage was clinically higher among those with balloon placement (80% vs. 33% UAE vs. 60% no intervention; P = 0.14), with mean EBL (3,605.0 mL vs. 1,488.9 mL vs. 2,289.3 mL; P = 0.05) and mean transfusion requirements (9.3 units vs. 2.8 vs. 4.4; P = 0.01) being significantly higher. Adverse outcomes were also significantly higher among those with balloon placement (80.0% vs. 66.7% UAE vs. 20.0% no intervention; P ≤ 0.01). Of the ten patients with balloons placed, four were deployed. Among those with balloons placed and deployed, mean EBL (5,250.0 mL vs. 2,508.3 mL balloons placed but not deployed vs. 2,289.3 mL no intervention; P=0.04) and mean transfusion requirements (11 units vs. 7.5 units balloons placed but not deployed vs. 4.4 units no intervention; P = 0.05) were significantly higher. Adverse outcomes were also significantly higher among those who had balloons placed and deployed (100.0% vs. 66.7% balloons placed but not deployed vs. 20.0% no intervention; P ≤ 0.01). CONCLUSIONS Balloon placement, regardless of deployment, may not be beneficial to women undergoing a planned cesarean hysterectomy. Although UAE was also associated with adverse outcomes, it may be a better option for reducing intraoperative blood loss among patients with a planned cesarean hysterectomy.
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Affiliation(s)
- Natalie R Mironov
- Des Moines University College of Osteopathic Medicine, United States, Des Moines, IA, United States; Aurora UW Medical Group, Center for Urban Population Health, Advocate Aurora Health, Aurora Sinai Medical Center, United States, Milwaukee, WI, United States
| | - Jessica J F Kram
- Aurora UW Medical Group, Center for Urban Population Health, Advocate Aurora Health, Aurora Sinai Medical Center, United States, Milwaukee, WI, United States
| | - Kayla Heslin
- Aurora UW Medical Group, Center for Urban Population Health, Advocate Aurora Health, Aurora Sinai Medical Center, United States, Milwaukee, WI, United States; Advocate Aurora Research Institute, Advocate Aurora Health, United States, Milwaukee, WI, United States
| | - Elizabeth L Dickson Michelson
- Department of Oncology, Advocate Aurora Health, Aurora West Allis Medical Center, United States, West Allis, WI, United States.
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Sonographic findings after induced medical abortion at 12–21 weeks of gestation: Retrospective cohort study. Contraception 2020; 102:87-90. [DOI: 10.1016/j.contraception.2020.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022]
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The Role of Interventional Radiology for the Treatment of Hepatic Metastases from Neuroendocrine Tumor: An Updated Review. J Clin Med 2020; 9:jcm9072302. [PMID: 32698459 PMCID: PMC7408651 DOI: 10.3390/jcm9072302] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023] Open
Abstract
Interventional radiology plays an important role in the management of patients with neuroendocrine tumor liver metastasis (NELM). Transarterial embolization (TAE), transarterial chemoembolization (TACE), and selective internal radiation therapy (SIRT) are intra-arterial therapies available for these patients in order to improve symptoms and overall survival. These treatment options are proposed in patients with NELM not responding to systemic therapies and without extrahepatic progression. Currently, available data suggest that TAE should be preferred to TACE in patients with NELM from extrapancreatic origin because of similar efficacy and better patient tolerance. TACE is more effective in patients with pancreatic NELM and SIRT has shown promising results along with good tolerance. However, large randomized controlled trials are still lacking in this setting. Available literature mainly consists in small sample size and retrospective studies with important technical heterogeneity. The purpose of this review is to provide an updated overview of the currently reported endovascular interventional radiology procedures that are used for the treatment of NELM.
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Kim MJ, Kim IJ, Kim S, Park IY. Postpartum hemorrhage with uterine artery embolization: the risk of complications of uterine artery embolization. MINIM INVASIV THER 2020; 31:276-283. [PMID: 32662700 DOI: 10.1080/13645706.2020.1789662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the efficacy and adverse effects of uterine artery embolization (UAE) to treat postpartum hemorrhage (PPH) and determine the factors associated with clinical outcomes. MATERIAL AND METHODS This study included 117 patients who underwent UAE for PPH between January 2010 and November 2018. Their medical records were retrospectively reviewed to assess the mode of delivery, causes of bleeding, detailed laboratory results, clinical outcomes, time from delivery to UAE, and embolizing material used. RESULTS The clinical UAE success rate was 99.1%. Late complications were found in 11 patients. Two total hysterectomies were performed. Most PPH cases treated with UAE had early-onset PPH caused by uterine atony. Late-onset PPH was caused by placenta-related problems (remnant placenta, placenta accreta). Body mass index, cesarean section, the use of mixed embolizing materials, placenta abruption as the cause of PPH, and transferred patients were associated with uterine necrosis. Age, re-embolization, and the use of mixed embolizing materials were associated with adverse complications. CONCLUSIONS Although UAE is a safe and effective way to manage PPH, a long-term follow-up is needed to determine the complications of UAE. When uterine necrosis is suspected, prompt and adequate treatment should be performed due to the effects of necrosis on menstrual cycles, fertility, and subsequent pregnancies.
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Affiliation(s)
- Min Jung Kim
- Department of Obstetrics and Gynecology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Il Jung Kim
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shinyoung Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Huang KL, Leung-Chit Tsang L, Cheng YF, Huang FJ, Fu HC, Kung FT, Tsai CC, Cheng HH, Lai YJ, Ou CY, Chen WT, Tong YS, Chen YC, Huang YJ, Hsu TY. Planned conservative management of placenta increta and percreta with prophylactic transcatheter arterial embolization and leaving placenta in situ for women who desire fertility preservation. Placenta 2020; 97:51-57. [PMID: 32792063 DOI: 10.1016/j.placenta.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/15/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The objective of our study was to demonstrate planned conservative management of placenta increta and percreta in a single tertiary center. METHODS From April 2005 to July 2019, patients with placenta increta and percreta were managed conservatively at the Kaohsiung Chang Gung Memorial Hospital in Taiwan. The severity of placenta invasion was diagnosed by magnetic resonance imaging (MRI). After delivery of the neonate, prophylactic transcatheter arterial embolization (TAE) was performed immediately. The placenta was left in situ and prophylactic antibiotics were administered during hospitalization. The patient profiles, outcomes, and complications were retrospectively reviewed. RESULTS Based on the MRI findings, twenty-one patients with placenta increta or percreta were included. With prophylactic TAE, the mean surgical blood loss was 854.7 ± 478.2 mL. The mean natural resorption time of residual placenta was 4.69 ± 1.65 months. Regarding maternal complications, 4 patients (19%) had delayed postpartum hemorrhage (PPH), 12 patients (57.1%) developed postpartum infections, 3 patients (14.3%) progressed to sepsis, 4 patients (19%) underwent surgical evacuation, and 4 patients (19%) underwent hysterectomy. No maternal mortality was reported. Main neonatal complications were prematurity and respiratory distress. Regarding fertility, 16 (76.1%) patients had return of menstruation, and one (4.7%) had a subsequent pregnancy resulting in a live birth. DISCUSSION Planned conservative management with prophylactic TAE and leaving placenta in situ is feasible and safe for women with placenta increta or percreta who desire fertility preservation. Delayed PPH and postpartum infection are common complications after conservative treatment.
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Affiliation(s)
- Kun-Long Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Leo Leung-Chit Tsang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Jen Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chun Fu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Ching-Chang Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Hsin Cheng
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yun-Ju Lai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Yu Ou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Ting Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Shun Tong
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chen Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jen Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Te-Yao Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Fukuoka Y, Katou H, Shibata T, Tokuda H, Iizuka N, Nakago S. Treatment strategy for failed repair of uterine rupture: Cleansing an abscess via the cervical Canal. J Obstet Gynaecol Res 2020; 46:1207-1210. [PMID: 32410216 DOI: 10.1111/jog.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/19/2020] [Accepted: 04/09/2020] [Indexed: 11/29/2022]
Abstract
We present a new, conservative treatment strategy for the cases in which an initial repair surgery of uterine rupture failed. In a case presented here, the patient underwent a repair surgery for the uterine rupture that became apparent 4 days after the cesarean delivery, but a part of the wound did not heal and an abscess formed in the surrounding area. The patient had purulent discharge from vagina, which led us to try to insert a Nelaton tube from vagina via cervical canal and to cleanse the abscess cavity. This procedure was successful and the abscess disappeared 38 days later, allowing the healing of the ruptured wound. The patient could deliver a baby 2 years later. Even if the initial repair treatment fails, a possibility of preserving the uterus should be considered for next pregnancy. One of the concrete treatment strategies for this purpose was presented.
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Affiliation(s)
- Yasunori Fukuoka
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
| | - Hiroki Katou
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
| | - Takashi Shibata
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
| | - Hisato Tokuda
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
| | - Noriaki Iizuka
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
| | - Satoshi Nakago
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Osaka, Japan
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Ruiz Sánchez E, Peinado Rodenas J, Gil Martínez-Acacio L, Arones Collantes M, Villar García M, García de la Torre JP, Amezcua Recover AN. Uterine necrosis. A rare complication of embolisation due to post-partum haemorrhage. J Gynecol Obstet Hum Reprod 2020; 50:101773. [PMID: 32325270 DOI: 10.1016/j.jogoh.2020.101773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/20/2022]
Abstract
Post-partum haemorrhage (PPH) is a major cause of maternal mortality, according to the WHO. Early PPH occurs in 5% to 15% of births. In 80% of cases, uterine atonia is the cause. We describe a case of uterine necrosis following uterine artery embolization (UAE). due to PPH. The patient was a 37-year-old woman who had a normal delivery after her second pregnancy, but experienced haemorrhage due to uterine atonia that failed to respond to drugs. She underwent UAE with Spongostan® with no complications. The peri-partum period was normal. At 16 days, she consulted due to recurrence of fever. Magnetic resonance imaging confirm the diagnosis of uterine necrosis. Abdominal hysterectomy was performed.
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Affiliation(s)
- Esther Ruiz Sánchez
- Department of Obstetrics and Gynaecology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain.
| | - Javier Peinado Rodenas
- Department of Radiology, Hospital of Alcázar de San Juan (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Leyre Gil Martínez-Acacio
- Department of Obstetrics and Gynaecology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Marco Arones Collantes
- Department of Obstetrics and Gynaecology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Miguel Villar García
- Department of Radiology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Juan Pablo García de la Torre
- Department of Anatomical Pathology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Antonio N Amezcua Recover
- Department of Obstetrics and Gynaecology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
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Jitsumori M, Matsuzaki S, Endo M, Hara T, Tomimatsu T, Matsuzaki S, Miyake T, Takiuchi T, Kakigano A, Mimura K, Kobayashi E, Ueda Y, Kimura T. Obstetric Outcomes of Pregnancy After Uterine Artery Embolization. Int J Womens Health 2020; 12:151-158. [PMID: 32184677 PMCID: PMC7064279 DOI: 10.2147/ijwh.s236443] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/20/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Uterine artery embolization (UAE) is used to treat severe postpartum hemorrhage (PPH). According to a few studies, UAE for PPH was associated with preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) in subsequent pregnancies. These previous studies, however, lacked controls, and to the best of our knowledge, no systematic literature reviews have been conducted thus far. We report the results of our retrospective case-control study of pregnancies after UAE at a single center and include a literature review to evaluate the risk of PAS in pregnancies after UAE. METHODS We retrospectively reviewed data from deliveries at our hospital between January 2012 and October 2017. We divided the delivery data into cases with previous UAEs performed for PPH (the post-UAE group) and those without UAEs (the non-UAE group, which included women without previous PPH). We defined PAS as cases in which hysterectomy was performed and pathological examination confirmed the diagnosis. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS We used data from 3155 patients in this study, of whom 16 patients had undergone UAE (post-UAE group) and 3139 had not (non-UAE group). We found no differences between the groups in terms of frequency of preterm births (12.5% versus 14.2%, respectively; OR, 0.863; 95% CI, 0.218 to 3.414; P = 0.84) or FGR (6.2% versus 10.0%, respectively; OR, 0.602; 95% CI, 0.104 to 3.584; P = 0.61). However, cases of PAS were significantly more common in the post-UAE group (37.5%) than in the non-UAE group (1.2%; OR, 50.303; 95% CI, 17.38 to 145.592; P < 0.01). CONCLUSION Our results suggest that previous UAE is a significant risk factor for PAS.
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Affiliation(s)
- Mariko Jitsumori
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeya Hara
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoko Matsuzaki
- Department of Obstetrics and Gynecology, Otemae Hospital, Osaka, Japan
| | - Tatsuya Miyake
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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Weston M, Soyer P, Barral M, Dohan A, Pierre S, Rabei R, Garcia-Reyes K, Kohi MP. Role of Interventional Procedures in Obstetrics and Gynecology. Radiol Clin North Am 2020; 58:445-462. [PMID: 32044017 DOI: 10.1016/j.rcl.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Radiological guided intervention techniques are discussed in obstetric and gynecologic patients. Fallopian tube recanalization, postpartum hemorrhage control, techniques of treating uterine leiomyomas, pelvic congestion treatment, and the use of percutaneous and transvaginal ultrasonography-guided aspirations and biopsy are covered. These techniques use basic radiological interventional skills and show how they are adapted for use in the female pelvis.
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Affiliation(s)
- Michael Weston
- Department of Radiology, St James's University Hospital, Leeds LS9 7TF, UK.
| | - Philippe Soyer
- Department of Radiology, Service de Radiologie A, Hopital Cochin, APHP & Université de Paris-Descartes Paris 5, 27 rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Matthias Barral
- Department of Radiology, Service de Radiologie A, Hopital Cochin, APHP & Université de Paris-Descartes Paris 5, 27 rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Anthony Dohan
- Department of Radiology, Service de Radiologie A, Hopital Cochin, APHP & Université de Paris-Descartes Paris 5, 27 rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Sacha Pierre
- Department of Radiology, St James's University Hospital, Leeds LS9 7TF, UK
| | - Rana Rabei
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-361, San Francisco, CA 94143, USA
| | - Kirema Garcia-Reyes
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-361, San Francisco, CA 94143, USA
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-361, San Francisco, CA 94143, USA
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Palacios-Jaraquemada JM. Conservative vs. Radical Management of Placenta Accreta Spectrum (PAS). CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020. [DOI: 10.1007/s13669-019-00274-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yuan Q, Jin Y, Chen L, Ling L, Bai XM. Prophylactic uterine artery embolization during cesarean delivery for placenta previa complicated by placenta accreta. Int J Gynaecol Obstet 2019; 149:43-47. [PMID: 31778209 DOI: 10.1002/ijgo.13072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/02/2019] [Accepted: 11/26/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of prophylactic uterine artery embolization (UAE) during cesarean delivery for women with placenta previa complicated by placenta accreta. METHODS A retrospective analysis of women with placenta previa admitted to The Second Affiliated Hospital of Soochow University, Suzhou, China, for elective cesarean between February 2003 and July 2016. Postpartum estimated blood loss, blood transfusion, hysterectomy, disseminated intravascular coagulation (DIC) incidence, intensive care unit (ICU) duration, and postoperative stay were compared between control women who underwent cesarean delivery only and women who underwent prophylactic intraoperative UAE during cesarean. RESULTS There were 28 and 26 women in the UAE and control group, respectively. There were no differences in hysterectomy incidence (P=0.291), or duration of ICU stay (P=0.085), or postoperative hospitalization (P=0.668) between the groups; however, the incidence of DIC was lower in the UAE group (P=0.035). Mean estimated blood loss (P=0.018) and blood transfusion (P=0.011) were also lower in the UAE group. No serious complications were associated with the endovascular procedures. CONCLUSION Prophylactic intraoperative UAE seemed to effectively reduce blood loss, need for blood transfusion, and incidence of DIC among women with placenta previa complicated by placenta accreta.
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Affiliation(s)
- Qiang Yuan
- Department of Interventional Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yong Jin
- Department of Interventional Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Ling
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xu-Ming Bai
- Department of Interventional Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Imafuku H, Yamada H, Morizane M, Tanimura K. Recurrence of post-partum hemorrhage in women with a history of uterine artery embolization. J Obstet Gynaecol Res 2019; 46:119-123. [PMID: 31608524 DOI: 10.1111/jog.14129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/06/2019] [Indexed: 11/29/2022]
Abstract
AIM To evaluate pregnancy outcome and complications in subsequent pregnancies after severe post-partum hemorrhage (PPH) between women with and without a history of uterine artery embolization (UAE). METHODS Women who had a history of severe PPH, and delivered newborns at ≥22 gestational weeks in subsequent pregnancies were enrolled. Severe PPH was defined as blood loss volume of more than 2000 mL. RESULTS The blood loss volume (median 1581 mL) in women with UAE (n = 14) was significantly more than that in women without UAE (median 1021 mL, n = 32, P < 0.01), and the recurrence rate of severe PPH in women with UAE (n = 5, 35.7%) was significantly higher than that in women without UAE (n = 3, 9.4%, P < 0.05). There were no significant differences in frequencies of premature delivery, hypertensive disorders of pregnancy, fetal growth restriction, or placenta previa/low lying placenta. Of 14 women with UAE, 7 (50.0%) had abnormally invasive placenta, whereas of 32 women without UAE, none had abnormally invasive placenta. CONCLUSION Subsequent pregnancies after UAE for severe PPH had high risks for recurrence of severe PPH.
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Affiliation(s)
- Hitomi Imafuku
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideto Yamada
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mayumi Morizane
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Tanimura
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
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Habib N, Luton D, Centini G, Renuit I, Birbarah C, Ceccaldi PF. Advanced Interventional Procedures after Intrauterine Tamponade Balloon Insertion in a Tertiary Care Center. J INVEST SURG 2019; 34:373-379. [PMID: 31322016 DOI: 10.1080/08941939.2019.1637976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the rate of success and practicability of the intrauterine tamponade balloon (ITB) for managing PPH as a fertility-sparing tool. Methods: a five-year retrospective monocentric study in a tertiary care center including patients transferred for severe PPH. Results: In 231 patients, the success rate of ITB (n = 57), embolization (n = 58), and medical management (n = 114) was 84.21%, 74.13%, and 76.32%, respectively. Cesarean section during labor did not influence the risk of advanced interventional procedures (AIPs) for patients with ITB (odds ratio [OR] = 1.08) but did so in patients who were under expectant management in the intensive care (OR = 5.29). In the AIP subgroup of the ITB group, hemostasis was significantly deteriorated. Prothrombin time <50% (OR = 11.5), fibrinogen <2 g/L (OR = 6.88), and >4 red blood cells units (RBCs) transfused (OR = 17.2) were associated with a significantly higher risk of failure. Blood loss in the AIP patients in the embolization group was significantly higher. Patients requiring >4 units of RBCs were 22.9 times more likely to have an AIP (p = .0001). Conclusion: Compared with uterine embolization and medical management, ITB use in a tertiary care center was associated with lower risk of undergoing AIP, but further prospective study is required to confirm this.
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Affiliation(s)
- Nassir Habib
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France
| | - Dominique Luton
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France.,Obstetrics and Gynecology Service, Bichat Teaching Hospital, Paris and Paris Diderot University, Paris, France
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Isabelle Renuit
- Anesthesiology and Reanimation Department, Beaujon Teaching Hospital and Paris Diderot University, Clichy, France
| | - Christian Birbarah
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France
| | - Pierre-François Ceccaldi
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France
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Fu CJ, Irama W, Wong YC, Tseng HJ, Wang LJ, Yeow KM, Wu CH. Transarterial embolization for postpartum hemorrhage: lessons learned. Acta Radiol 2018; 59:1451-1457. [PMID: 29667848 DOI: 10.1177/0284185118769691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although transarterial embolization (TAE) can powerfully control postpartum hemorrhage (PPH), clinical failure of TAE is not uncommon. PURPOSE To discover whether any parameters could predict timely clinical failure of TAE, then whether a supplementary intervention could be promptly initiated. MATERIAL AND METHODS We retrospectively analyzed 118 TAE procedures in 113 patients with PPH performed at our institution between January 2012 and May 2015. The patients were divided into the following groups: clinically successful TAE and failed TAE. Successful TAE was defined as obviation of supplementary embolization or surgical intervention for hemostasis. Gestational conditions, angiographic factors, maternal vital signs, and laboratory data were compared between the two groups. RESULTS In total, 100 (84.8%) TAEs were clinically successful. Multivariate logistic regression analyses revealed independent risk factors of TAE clinical failure, including the requirement for augmented embolic agents, placental retention, and international normalized ratio > 1.3 ( P = 0.009, 0.001, and 0.005, respectively). The post-TAE shock index was significantly associated with TAE failure, using a cut-off value of 0.8. CONCLUSION The discovered independent risk factors of TAE clinical failure existed before or during the TAE procedure and could not reflect the post-TAE conditions. Although the post-TAE shock index was not an independent factor, it reflected the conditions after TAE and could indicate TAE clinical failure timely.
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Affiliation(s)
- Chen-Ju Fu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Wiwan Irama
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Yon-Cheong Wong
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Hsiao-Jung Tseng
- Center for Big Data Analytics and Statistics, Chang Gung Memorial University, Taiwan
| | - Li-Jen Wang
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Kee-Min Yeow
- Department of Medical Imaging and Intervention, Division of Gastrointestinal Radiology, Chang Gung Memorial Hospital, Chang Gung University, Gueishan, Taoyuan, Taiwan
| | - Cheng-Hsien Wu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
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Liu Z, Wang Y, Yan J, Li J, Liu X, Zhang L, Cheng L. Uterine artery embolization versus hysterectomy in the treatment of refractory postpartum hemorrhage: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2018; 33:693-705. [PMID: 30354858 DOI: 10.1080/14767058.2018.1497599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: We carried out a systematic review and meta-analysis to assess the safety and effectiveness of uterine artery embolization (UAE) compared with conventional hysterectomy on refractory postpartum hemorrhage (PPH).Methods: We searched PubMed, Embase, Chinese National Knowledge Infrastructure database (CNKI), Cochrane Library, and Wanfang database through October 2017 for randomized controlled trials (RCTs) and observational studies assessing the safety and effectiveness of UAE compared with hysterectomy on refractory PPH. The main outcome measures included the blood loss, operating time, hemostatic effective rate, and length of stay.Results: Six RCTs and nine observational studies were included in the meta-analysis, which involved 1142 women with refractory PPH. The results demonstrated that UAE was more beneficial on refractory PPH compared with hysterectomy using four scales: blood loss (WMD 893.39 mL; 95% CI: -1205.65, -581.13; p < .001); operating time (WMD -37.19 minutes; 95% CI: -44.42, -29.96; p < .001); length of stay (WMD -5.36 days; 95% CI: -5.76, -4.97; p < .001), hemostatic effective rate (OR 1.58, 95% CI: 0.80, 3.12, p = .184) .Conclusions: In the present meta-analysis, the positive findings suggest UAE has beneficial effects on refractory PPH. UAE significantly reduced blood loss, shortened the operating time, and length of stay compared with hysterectomy. And there is no difference between the UAE group and hysterectomy group in hemostatic effective rate. However, those findings should be treated with caution because of heterogeneity and potential biases.
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Affiliation(s)
- ZhiRong Liu
- Department of General Surgery, Second People's Hospital of Chengdu, Chengdu, China
| | - Yaxuan Wang
- Department of Medical Imaging, Chengdu Medical College, Chengdu, China
| | - Jingxin Yan
- Department of Medical Imaging, Chengdu Medical College, Chengdu, China
| | - Juan Li
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - XinLian Liu
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - LuShun Zhang
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China.,Development and Regeneration Key Laboratory of Sichuan Province, Collaborative Innovation Center of Sichuan for Elderly Care and Health, Chengdu Medical College, Chengdu, China
| | - Li Cheng
- School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China
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Kim JE, So YH, Kim BJ, Kim SM, Choi YH, Sung CK. Postpartum hemorrhage from non-uterine arteries: clinical importance of their detection and the results of selective embolization. Acta Radiol 2018; 59:932-938. [PMID: 29065701 DOI: 10.1177/0284185117738547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Identification of the source of postpartum hemorrhage (PPH) is important for embolization because PPH frequently originates from non-uterine arteries. Purpose To evaluate the clinical importance of identifying the non-uterine arteries causing the PPH and the results of their selective embolization. Material and Methods This retrospective study enrolled 59 patients who underwent embolization for PPH from June 2009 to July 2016. Angiographic findings and medical records were reviewed to determine whether non-uterine arteries contributed to PPH. Arteries showing extravasation or hypertrophy accompanying uterine hypervascular staining were regarded as sources of the PPH. The results of their embolization were analyzed. Results Of 59 patients, 19 (32.2%) underwent embolization of non-uterine arteries. These arteries were ovarian (n = 7), vaginal (n = 5), round ligament (n = 5), inferior epigastric (n = 3), cervical (n = 2), internal pudendal (n = 2), vesical (n = 1), and rectal (n = 1) arteries. The embolic materials used included n-butyl cyanoacrylate (n = 9), gelatin sponge particles (n = 8), gelatin sponge particles with microcoils (n = 1), and polyvinyl alcohol particles (n = 1). In 13 patients, bilateral uterine arterial embolization was performed. Re-embolization was performed in two patients with persistent bleeding. Hemostasis was achieved in 17 (89.5%) patients. Two patients underwent immediate hysterectomy due to persistent bleeding. One patient experienced a major complication due to pelvic organ ischemia. One patient underwent delayed hysterectomy for uterine infarction four months later. Conclusion Non-uterine arteries are major sources of PPH. Detection and selective embolization are important for successful hemostasis.
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Affiliation(s)
- Jeong-Eun Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Seoul, Republic of Korea
| | - Young Ho So
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sun Min Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Ho Choi
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Chang Kyu Sung
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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Wong AJ, Schlumbrecht M, Huang M. Management of placenta percreta in a Jehovah's Witness patient. BMJ Case Rep 2018; 2018:bcr-2018-225260. [PMID: 29895551 DOI: 10.1136/bcr-2018-225260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Placenta percreta is increasing in incidence and is associated with the risk of life-threatening haemorrhage. Patients who do not accept blood products present a unique challenge to obstetrician-gynaecologists. In this case report, we present the case of a 42-year-old pregnant Jehovah's Witness with a complete placenta previa and confirmed percreta at 26 weeks' gestation. Due to her religious beliefs against the use of blood products, she was managed with a stepwise surgical approach which involved caesarean delivery with internal iliac (hypogastric) artery ligation, weekly methotrexate and delayed hysterectomy 6 weeks later. Non-traditional, alternative approaches to the management of abnormal placentation in patients declining blood products warrant exploration.
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Affiliation(s)
- Adriana J Wong
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Matthew Schlumbrecht
- Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marilyn Huang
- Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Uterine Necrosis after Uterine Artery Embolization for Symptomatic Fibroids. Case Rep Obstet Gynecol 2018; 2018:9621741. [PMID: 29998027 PMCID: PMC5994572 DOI: 10.1155/2018/9621741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/21/2018] [Accepted: 04/24/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Uterine artery embolization (UAE) is a minimally invasive intervention that is used in the treatment of fibroids. UAE can lead to complications including postembolization syndrome, postprocedure pain, infection, endometrial atrophy leading to secondary amenorrhea, and uterine necrosis. Uterine necrosis after UAE is very rare and hence poses a clinical dilemma for any clinician in its identification and management. We document a case of uterine necrosis after UAE and conduct a literature review on its causation, clinical features, and management principles. Case A patient presented one month after UAE with abdominal pain and abdominal vaginal discharge. Her work-up revealed features of possible uterine necrosis with sepsis and she was scheduled for a laparotomy and a subtotal hysterectomy was performed. She was subsequently managed with broad spectrum antibiotic and recovered well. Conclusion Uterine necrosis after UAE is a rare occurrence and we hope the documentation of this case will add to the body of knowledge around it. Theories that explain its occurrence include the use of small particles at embolization, the use of Contour-SE a spherical poly-vinyl alcohol, and lack of collateral supply to the uterus. Its symptoms may be nonspecific but unremitting abdominal pain is invariably present. Finally although conservative management may be successful at times, surgical management with hysterectomy will be required in some cases. The prognosis is good after diagnosis and surgical management.
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Kutuk MS, Kilic A, Ak M, Ozgun M. Infectious complications in morbidly adherent placenta treated with leaving placenta in situ: a cohort series and suggested approach . J Matern Fetal Neonatal Med 2018; 32:3520-3525. [PMID: 29671364 DOI: 10.1080/14767058.2018.1465918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: The aim of this study is to assess the clinical and microbiological features of infections in patients with morbidly adherent placenta (MAP) treated by leaving placenta in situ (LPIS). Materials and methods: Retrospective analysis of MAP cases who were treated by LPIS between 2 May 2010 and 15 March 2017. The inclusion criteria were gestational age at or above 24 weeks, prenatal diagnosis, elective operation, and complete data. Results: Nineteen MAP cases were treated by LPIS during the study period. The mean ± SD duration for total placental resorbtion was 145 ± 47 days. Three patients were readmitted to the hospital because of fever (3/19). A total of 65 culture samples were taken from the patients during their follow- up periods. In four cases (4/12) cervical cultures showed positive growth [Escherichia coli (2), Klebsiella pneumoniae (1), mixed culture with Enterococcus spp. and E. coli (1)]. Fifteen (15/26) urine samples were sterile, three were polymicrobial. In eight cases, urine culture revealed E. coli growth (one E. coli and Enterococcus spp.). Three out of 16 (3/16) surgical incision samples revealed growth of E. coli. No bacterial growth was detected in blood cultures. Susceptibility results of Gram-negatives indicate that the resistance rates of beta-lactam antibiotics are high (14/20, 70%). No secondary surgical intervention occurred during the study period due to infection. Conclusions: Majority of postpartum cervical discharge, fever, and increased CRP levels do not represent morbid infections and/or sepsis. With early detection, and implementation of antibiotherapy (combination of an aminoglycoside and clindamycin), they can be easily controlled and secondary surgical interventions can be prevented.
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Affiliation(s)
- Mehmet Serdar Kutuk
- a Faculty of Medicine, Obstetrics and Gynecology , Bezmialem Foundation University , İstanbul , Turkey
| | - Aysegul Kilic
- b Faculty of Medicine, Clinical Microbiology and İnfectious Disease , Erciyes University , Kayseri , Turkey
| | - Mehmet Ak
- c Faculty of Medicine, Obstetrics and Gynecology , Erciyes University , Kayseri , Turkey
| | - Mahmut Ozgun
- c Faculty of Medicine, Obstetrics and Gynecology , Erciyes University , Kayseri , Turkey
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Lindquist JD, Vogelzang RL. Pelvic Artery Embolization for Treatment of Postpartum Hemorrhage. Semin Intervent Radiol 2018; 35:41-47. [PMID: 29628615 PMCID: PMC5886774 DOI: 10.1055/s-0038-1636520] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Postpartum hemorrhage (PPH) is the leading cause of maternal perinatal morbidity and mortality worldwide. Defined as greater than 500 mL blood loss after vaginal delivery, and greater than 1,000 mL blood loss after cesarean delivery, PPH has many causes, including uterine atony, lower genital tract lacerations, coagulopathy, and placental anomalies. Correction of coagulopathy and identification of the cause of bleeding are mainstays of treatment. Medical therapies such as uterotonics, balloon tamponade, pelvic artery embolization, and uterine-sparing surgical options are available. Hysterectomy is performed when conservative therapies fail. Pelvic artery embolization is safe and effective, and is the first-line therapy for medically refractory PPH. A thorough knowledge of pelvic arterial anatomy is critical. Recognition of variant anatomy can prevent therapeutic failure. Pelvic embolization is minimally invasive, has a low complication rate, spares the uterus, and preserves fertility.
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Affiliation(s)
- Jonathan D. Lindquist
- Division of Interventional Radiology, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Robert L. Vogelzang
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital and McGaw Medical Center, Chicago, Illinois
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Ho CY, Seow KM, Huang LW, Tsai YL. Fertility outcomes following pelvic embolization in women with acquired uterine arteriovenous malformation. Taiwan J Obstet Gynecol 2017; 56:831-835. [DOI: 10.1016/j.tjog.2017.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 10/18/2022] Open
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Sun W, Duan S, Xin G, Xiao J, Hong F, Hong H, Wu Y, Xu Y. Safety and efficacy of preoperative abdominal Aortic balloon occlusion in placenta increta and/or percreta. J Surg Res 2017; 222:75-84. [PMID: 29273378 DOI: 10.1016/j.jss.2017.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/05/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND With the increase of cesarean deliveries globally, the incidence of placenta adhesive disorder has been on the rise greatly which is associated closely with maternal and infant morbidity and mortality. We sought to investigate the safety and efficacy of preoperative transfemoral balloon occlusion of abdominal aorta in cesarean section of women with placenta increta or percreta. METHODS We conducted a retrospective study of 31 patients with placenta increta or percreta diagnosed by ultrasound and/or magnetic resonance imaging. The observation group included 19 patients who received transfemoral abdominal aorta balloon occlusion for preoperative prophylaxis, while the other 12 patients in the control group did not receive any preoperative interventional managements. Clinical outcomes were compared between the two groups. RESULTS Patients in observation group had significantly less estimated blood loss during surgery than those in control group (1.2 L versus 3.15 L, P = 0.006). The average transfusion volume of the observation group was significantly lower than the control group (0.8 L versus 1.95 L, P = 0.017). Seventy-nine percent (15 of 19) patients in the observation group and 50% (6 of 12) in the control group had their uterus successfully retained (P = 0.093). No peripheral tissues including bladder, ureter, and bowel were injured in all patients. Neonatal weight and Apgar scores of 1 min and 5 min had no statistical difference (P = 0.513 and P = 1, respectively) between the two groups. The mean radiation exposure time of fetus in the observation group was 22.68 ± 8.07 s and mean radiation exposure dose was 4.20 ± 1.49 mGy. Both operation time and postoperative hospital stay had no statistical difference between the two groups (2 versus 2.75 h, P = 0.063; 7.0 versus 6.5 d, P = 0.846). No patients had long-term complications after 6-8 wk follow-up. CONCLUSIONS Application of preoperative transfemoral abdominal aorta balloon occlusion during cesarean section is a safe and effective strategy for patients with placenta increta and/or percreta. It could reduce intraoperative blood loss and enhance the possibility of uterus preservation and ensure the safety of life from severe complications.
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Affiliation(s)
- Wenjuan Sun
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Shuhong Duan
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Gang Xin
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Juan Xiao
- Department of Evidence-based medicine, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Fanzhen Hong
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Haijie Hong
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Yuange Wu
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Yongping Xu
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, Shandong, China.
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Aguilar-Crespo A, Morales-Roselló J, Sánchez-Ajenjo C, Valle-Tejero A, García-Marcos R, Perales-Marín A. Postpartum hemorrhage with pelvic arterial embolization, study of 33 cases. J Matern Fetal Neonatal Med 2017; 32:573-578. [PMID: 28965438 DOI: 10.1080/14767058.2017.1387527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe our cases of postpartum hemorrhage (PPH) with pelvic arterial embolization (PAE). MATERIAL AND METHODS All patients with PPH who underwent PAE in our center in the interval 2011-1016 were retrospectively studied, evaluating the technical procedure, clinical results, and subsequent fertility. RESULTS There were 33 cases of PPH with PAE. The majority occurred in primiparous women (N = 22, 66.6%) who delivered vaginally (N = 20, 61%). In addition, most PPH with PAE cases had an early onset (N = 26, 79%) and were caused by uterine atony (N = 14, 42.4%). Success of PAE occurred in 27 (81.8%) cases and a satisfactory clinical follow-up was the rule, with 21 (64%) women recovering their normal menstruation, and six (18.2%) becoming pregnant in the following years. CONCLUSIONS PAE is a safe and efficacious technique with minor complications. Moreover, it allows conservation of the uterus with preservation of fertility.
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Affiliation(s)
- Alejandra Aguilar-Crespo
- a Obstetrics and Gynecology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | - José Morales-Roselló
- a Obstetrics and Gynecology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | - Carlos Sánchez-Ajenjo
- a Obstetrics and Gynecology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | - Ana Valle-Tejero
- a Obstetrics and Gynecology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | - Raúl García-Marcos
- b Vascular and Interventional Radiology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | - Alfredo Perales-Marín
- a Obstetrics and Gynecology Department , Hospital Universitario y Politécnico la Fe , Valencia , Spain
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Soyama H, Miyamoto M, Sasa H, Ishibashi H, Takano M, Furuya K. Pregnancy with asymptomatic uterine complete rupture after uterine artery embolization for postpartum hemorrhage. Taiwan J Obstet Gynecol 2017; 56:538-540. [DOI: 10.1016/j.tjog.2016.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 11/15/2022] Open
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Leleup G, Fohlen A, Dohan A, Bryan-Rest L, Le Pennec V, Limot O, Le Dref O, Soyer P, Pelage JP. Value of Round Ligament Artery Embolization in the Management of Postpartum Hemorrhage. J Vasc Interv Radiol 2017; 28:696-701. [DOI: 10.1016/j.jvir.2017.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/13/2017] [Accepted: 01/26/2017] [Indexed: 10/20/2022] Open
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Mori M, Iwase A, Osuka S, Kondo M, Nakamura T, Nakahara T, Goto M, Kikkawa F. Choosing the optimal therapeutic strategy for placental polyps using power Doppler color scoring: Transarterial embolization followed by hysteroscopic resection or expectant management? Taiwan J Obstet Gynecol 2017; 55:534-8. [PMID: 27590378 DOI: 10.1016/j.tjog.2014.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate a protocol for selection of placental polyp management, including expectant management and hysteroscopic resection with or without transarterial embolization (TAE), using power Doppler color score (PDCS) as the vascularity parameter. MATERIALS AND METHODS This retrospective case-control study included 25 patients who were diagnosed with placental polyps. We evaluated the vascularity of placental polyps with PDCS measured by transvaginal ultrasonography as follows: PDCS 1, no blood flow; PDCS 2, minimal flow; PDCS 3, moderate flow; and PDCS 4, marked blood flow. We then selected expectant management or hysteroscopic resection with or without TAE. RESULTS Three of 17 patients with PDCS 1 or 2 underwent surgical intervention, and expectant management was successful in 14. Seven of eight patients with PDCS 3 or 4 underwent surgical intervention, while expectant management was successful in only one patient. CONCLUSION PDCS is a simple examination for evaluating the vascularity of placental polyps. PDCS might be useful for selecting the optimal treatment for placental polyps, such as expectant management or surgical intervention, according to their vascularity.
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Affiliation(s)
- Masahiko Mori
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mika Kondo
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuo Nakahara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Chen H, Zhou J, Wang H, Tan W, Yao M, Wang X. The Treatment of Cesarean Scar Pregnancy with Uterine Artery Embolization and Curettage as Compared to Transvaginal Hysterotomy. Eur J Obstet Gynecol Reprod Biol 2017; 214:44-49. [PMID: 28472704 DOI: 10.1016/j.ejogrb.2017.04.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the outcome and menstrual status in patients after treatment of cesarean scar pregnancy (CSP) by transvaginal hysterotomy or uterine artery embolization combined with uterine curettage. STUDY DESIGN A retrospective cohort study. An analysis of CSP patients was performed using records from Shanghai First Maternity & Infant Hospital affiliated with Tongji University for the period between July 16, 2014 and January 22, 2016. Twenty-seven patients were treated with transvaginal hysterotomy and in this group, 49 patients received uterine curettage after UAE. The clinical information on these patients and clinical outcomes especially the status of menstruation were reviewed. RESULTS There was only one complication in transvaginal hysterotomy group, while 3 cases of villus residue occurred in UAE group. Nineteen patients (70.4%) in transvaginal hysterotomy group self-assessed their menstrual volumes, which had no remarkable changes; 6 patients (22.2%) felt that their menstrual volumes had decreased. Thirty-five patients in UAE group (71.4%) reported that their menstrual volumes decreased (P<0.05). The range of pictorial blood loss score was 55-82 in transvaginal hysterotomy group and 9-74 in UAE group, and the mean pictorial blood loss score was decreased from 68.4 to 65.8 in transvaginal hysterotomy group (a 3.2±4.4% reduction) and from 66.4 to 38.8 in UAE group (a 41.7±26.4% reduction) (P<0.05). CONCLUSIONS Transvaginal hysterotomy appears to be more advantageous than UAE combined with uterine curettage. The menstrual interval and duration changed significantly in UAE group.
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Affiliation(s)
- Huihui Chen
- Department of Gynecology, Shanghai First Maternity & Infant Hospital affiliated with Tongji University, Shanghai, China
| | - Jieru Zhou
- Department of Gynecology, Shanghai First Maternity & Infant Hospital affiliated with Tongji University, Shanghai, China
| | - Husheng Wang
- Department of Gynecology, Shanghai First Maternity & Infant Hospital affiliated with Tongji University, Shanghai, China
| | - Weilin Tan
- Department of Gynecology, Shanghai First Maternity & Infant Hospital affiliated with Tongji University, Shanghai, China
| | - Min Yao
- Department of Gynecology, Shanghai First Maternity & Infant Hospital affiliated with Tongji University, Shanghai, China
| | - Xipeng Wang
- Department of Gynecology, Shanghai First Maternity & Infant Hospital affiliated with Tongji University, Shanghai, China.
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