Persistent secondary postpartum hemorrhage after uterine artery embolization

Placenta Increta Presenting as Retained Placenta: A Report of 3 Cases

OBJECTIVES

Morbid adherence is a risk factor for retained placenta (RP). We encountered three cases of placenta increta presenting clinically as delayed postpartum hemorrhage.

METHODS

This was a retrospective study of three cases of placenta increta presenting as RP.

RESULTS

One "routine" term placenta had heavy bleeding 2 weeks later; one missed abortion at 16 weeks with fetal and placental tissue submitted, had heavy bleeding 6 weeks later; and one elective abortion (no tissue submitted), had delayed postpartum bleeding leading to a curettage with blood only, then 6 weeks later a hysterectomy for menorrhagia. All 3 pathology specimens showed necrotic villi. However, all three also showed myometrium with keratin-positive interstitial trophoblasts in a zone of damaged myometrium, consistent with increta. All three cases had basal plate myofibers (BPMF) in the placenta, with BPMF recurrence in the two cases with another pregnancy.

CONCLUSION

RP may be a presenting clinical manifestation of placenta increta.

Anesthetic management of cesarean section in cases of placenta accreta, with versus without abdominal aortic balloon occlusion: study protocol for a randomized controlled trial

BACKGROUND

Placenta accreta (PA), a severe complication during delivery, is closely linked with massive hemorrhage which could endanger the lives of both mother and baby. Moreover, the incidence of PA has increased dramatically with the increasing rate of cesarean deliveries in the past few decades. Therefore, studies evaluating the effects of different perioperative managements based on different modalities in the treatment of PA are necessary. Among the numerous treatment measures, prophylactic abdominal aortic balloon occlusion (AABO) in combination with cesarean section for PA seems to be more advantageous than others. However, up to now, all studies on AABO were almost retrospective. Current evidence is insufficient to recommend for or against routinely using the AABO technology for control intraoperative hemorrhage in patients with PA. Thus, we hope to carry out a prospective, randomized controlled trial (RCT) study to confirm the effectiveness of the AABO technology in patients with PA.

METHODS/DESIGN

This trial is an investigator-initiated, prospective RCT that will test the superiority of AABO in combination with cesarean section compared to the traditional hysterectomy following cesarean section for parturients with PA. A total of 170 parturients with PA undergoing cesarean section will be randomized to receive either AABO in combination with cesarean section or the traditional hysterectomy following cesarean section. The primary outcome is estimated blood loss. The most important secondary outcome is the occurrence of cesarean hysterectomy during delivery; others include blood transfusion volume, operating time, neonate's Apgar scores (collected at 1, 5 and 10 min), length of stay in intensive care unit, total hospital stay, and balloon occlusion-relative data.

DISCUSSION

This prospective trial will test the superiority of AABO in combination with cesarean section compared to the traditional hysterectomy following cesarean section for parturients with PA. It may provide strong evidence about the benefits and risks of AABO in combination with cesarean section for parturients with PA.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-INR-16008842 . Registered on 14 July 2016.

Role of ovarian artery-to-uterine artery anastomoses in uterine artery embolization: initial anatomic and radiologic studies

PURPOSE

To explore the anatomic features of normal human ovarian artery-to-uterine artery anastomoses and their impact on uterine artery embolization (UAE).

METHODS

Using slice computed tomography (CT) scanning and vascular casting; models of the uterine arterial vascular network were constructed using five sets of uterus, bilateral adnexa and vagina from normal adult females. The anatomy and characteristics of these models were then studied.

RESULTS

Both the casting specimen and the CT-reconstructed model showed the ovarian artery-to-uterine artery anastomoses clearly. Each was composed of the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery. All 10 ovarian artery-to-uterine artery anastomoses were formed by direct connection between the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery.

CONCLUSIONS

Thin slice CT scanning combined with vascular casting is a useful method to study the small arterial network. The anastomoses between the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery were formed mainly by direct connection. The implications of the ovarian artery-to-uterine artery anastomoses on UAE are unclear; further function assessments are needed.