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Inampudi V, Nimmalapudi S. Efficacy of Embolization in Acquired Uterine Vascular Malformations: An Experience in Tertiary Care Centre in India. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:325-332. [PMID: 37494575 PMCID: PMC10371068 DOI: 10.1055/s-0043-1770092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE To determine the efficacy of Uterine Artery Embolization in patients with bleeding acquired uterine arteriovenous malformations (AVMs). METHODS A prospective review of all patients who underwent Uterine Artery Embolization at our institution between July 2015 and April 2022 was performed. 225 patients were diagnosed with a uterine vascular malformation on doppler and corresponding MRI imaging. All patients underwent transcatheter embolization of the uterine arteries. Embolic agents in the 375 procedures included Histoacryl glue only (n = 326), polyvinyl alcohol (PVA) particles and Histoacryl glue (n = 29), PVA particles (n = 5), Gelfoam (n = 5), coils (n = 4), PVA particles and coils (n = 3), Histoacryl glue and Gelfoam (n = 2), and Histoacryl glue and coils (n = 1). RESULTS A total of 375 embolization procedures were performed in 225 patients. 90 patients required repeat embolization for recurrence of bleeding. The technical success rate of embolization was 100%. The clinical success rate was 92%: bleeding was controlled in 222 of 225 patients and three patients underwent a hysterectomy. 60 of the 225 patients had uneventful intrauterine pregnancies carried to term. The 210 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up of 53 months (range, 5-122 months) after treatment. 15 patients were eventually lost to follow-up. One minor complication (0.4%) of non-flow-limiting dissection of the internal iliac artery occurred. CONCLUSION Uterine Artery Embolization is a safe, effective, minimally invasive method to treat uterine AVMs with long-term efficacy, which can provide the preservation of fertility.
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Affiliation(s)
- Vineel Inampudi
- Department of Radiodiagnosis, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh, India
| | - Sunanda Nimmalapudi
- Department of Radiodiagnosis, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh, India
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Fatima K, Zubairi MB, Azeemuddin M, Sayani R. Acquired Uterine Vascular Anomaly: Experience from a tertiary care centre in Pakistan. Sultan Qaboos Univ Med J 2023; 23:48-54. [PMID: 36865433 PMCID: PMC9974042 DOI: 10.18295/squmj.1.2022.006] [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: 06/16/2021] [Revised: 10/10/2021] [Accepted: 11/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to retrospectively review imaging findings and the outcomes of uterine artery embolisation (UAE) in symptomatic uterine vascular anomalies (UVA). Methods This study included a total of 15 patients with acquired UVA admitted to the Aga Khan University Hospital in Karachi, Pakistan, from 2010 to 2020. These patients were evaluated using ultrasound, computed tomography and magnetic resonance imaging, either alone or in combination. All patients had a history of dilatation and curettage or uterine instrumentation and underwent angiography and embolisation of the uterine arteries. The primary outcome post embolisation was assessed clinically and/or in combination with ultrasound. Post-procedure pregnancies were also recorded. Results Non-invasive imaging was abnormal in all patients; however, this pre-intervention imaging was unable to accurately classify the type of vascular anomaly, except in the case of a pseudoaneurysm. Conventional angiography showed uterine artery hyperaemia in six patients, arteriovenous malformation in seven patients and pseudoaneurysm in two patients. The technical success rate was 100% and no repeat embolisation was needed. The follow-up ultrasound in 12 patients revealed a resolution of the abnormal findings, while the remaining three were found to be normal on clinical follow-up. Seven patients (46.7%) had a normal pregnancy 15.7 months after the procedure (range: 4-28 months). Conclusions UAE is a safe and effective management option for intractable severe bleeding in patients with UVA post instrumentation and it was found that the procedure does not impair future pregnancy.
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Affiliation(s)
- Kulsoom Fatima
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Muhammad Azeemuddin
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan,Corresponding Author’s e-mail:
| | - Raza Sayani
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
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Liang D, Zhao H, Liu D, Lin Y. Internal iliac artery balloon occlusion in the management of placenta accreta: A systematic review and meta-analysis. Eur J Radiol 2021; 139:109711. [PMID: 33910145 DOI: 10.1016/j.ejrad.2021.109711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To examine the effectiveness and safety of prophylactic internal iliac artery balloon occlusion for hemorrhage control in placenta accreta. METHOD EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials data-bases were searched through November 2020. Clinical trials comparing the management of placenta accreta with and without internal iliac artery balloon occlusion were included. The meta-analysis results were expressed as the risk ratio (RR) or mean difference, with 95 % CIs. RESULTS Fifteen studies including 1098 women were eligible. No statistically significant difference was found between the internal arterial balloon occlusion group and the control group with respect to estimated blood loss volume (-0.525 mL, [95 % CI, -1.112 to -0.061], p = 0.079.), red blood cells (RBCs) transfused in observational studies (-0.682 mL, [95 % CI, -1.540 to 0.176], p = 0.119.) and in randomized controlled trials (0.134 mL, [95 % CI, -0.214 to 0.482], p = 0.451.), intensive care unit admission (p = 0.197), hysterectomy in observational studies (p = 0.969) and in randomized controlled trials (p = 0.323), urinary system injury in observational studies (p = 0.182) and in randomized controlled trials (p = 0.956), Apgar score at 5 min (p = 0.641), and neonatal intensive care unit admission (p = 0.973). CONCLUSIONS The currently available data demonstrate no significant differences between the internal iliac artery balloon occlusion group and the control group in blood loss and packed RBCs transfused for women with placenta accreta. Further large randomized controlled studies are needed to confirm our findings.
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Affiliation(s)
- Deku Liang
- Department of Obstetrics and Gynecology, Chengdu Women and Children's Central Hospital Affiliated to University of Electronic Science and Technology of China, Chengdu, 1617 Riyue Avenue, Qingyang District, Sichuan Province, China
| | - Hu Zhao
- Department of Obstetrics and Gynecology, Chengdu Women and Children's Central Hospital Affiliated to University of Electronic Science and Technology of China, Chengdu, 1617 Riyue Avenue, Qingyang District, Sichuan Province, China
| | - Dandan Liu
- Department of Obstetrics and Gynecology, Chengdu Women and Children's Central Hospital Affiliated to University of Electronic Science and Technology of China, Chengdu, 1617 Riyue Avenue, Qingyang District, Sichuan Province, China
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu Women and Children's Central Hospital Affiliated to University of Electronic Science and Technology of China, Chengdu, 1617 Riyue Avenue, Qingyang District, Sichuan Province, China.
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Abstract
Since the introduction of uterine artery embolization as a treatment option for symptomatic leiomyomas, there has been a growing interest in expanding the role of interventional radiology (IR) in the evaluation and treatment of obstetrics and gynecology (OBGYN) patients. This review provides an overview of opportunities for collaboration between IR and OBGYN. This can include medically and/or surgically complex patients, efforts to reduce quantitative blood loss, obstetrical emergencies, and consideration of fertility or uterine preservation. Increased collaborative efforts between IR and OBGYN would allow for patients to be fully informed regarding the complete spectrum of surgical and nonsurgical treatment options available to them. The purpose of this review is to foster opportunities to improve outcomes and respect patient values.
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Zwimpfer TA, Monod C, Redling K, Willi H, Takes M, Fellmann-Fischer B, Manegold-Brauer G, Hösli I. Uterine pseudoaneurysm on the basis of deep infiltrating endometriosis during pregnancy-a case report. BMC Pregnancy Childbirth 2021; 21:282. [PMID: 33836672 PMCID: PMC8034083 DOI: 10.1186/s12884-021-03753-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Pseudoaneurysm of the uterine artery (UPA) is a rare cause of potentially life-threatening hemorrhage during pregnancy and puerperium. It is an uncommon condition that mainly occurs after traumatic injury to a vessel following pelvic surgical intervention, but also has been reported based on underlying endometriosis. There is an increased risk of developing UPA during pregnancy. Diagnosis includes clinical symptoms, with severe abdominal pain and is confirmed by sonographic or magnetic resonance imaging (MRI). Due to its potential risk of rupture, with a subsequent hypovolemic maternal shock and high fetal mortality, an interdisciplinary treatment should be considered expeditiously. Case presentation We present the case of a 34-year old pregnant symptomatic patient, where a large UPA was detected at 26 weeks, based on deep infiltrating endometriosis (DIE). The UPA was successfully treated by selective arterial embolization. After embolization, the pain decreased but the woman still required intravenous analgesics during follow-up. At 37 weeks she developed a sepsis from the intravenous catheter which led to a cesarean section and delivery of a healthy boy. She was discharged 10 days postpartum. Conclusions UPA should be considered in pregnant women with severe abdominal and pelvic pain, once other obstetrical factors have been excluded. DIE might be the underlying diagnosis. It is a rare but potentially life-threatening condition for mother and fetus.
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Affiliation(s)
- Tibor Andrea Zwimpfer
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland. .,Department of Biomedicine, University Hospital of Basel and University Basel, Basel, Switzerland.
| | - Cécile Monod
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - Katharina Redling
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - Heike Willi
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - Martin Takes
- Department of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
| | | | | | - Irene Hösli
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
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Estimating the radiation dose to the fetus during prophylactic internal iliac occlusion in patients with abnormal placentation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:435-440. [PMID: 33252114 DOI: 10.5507/bp.2020.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/02/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS To evaluate the estimated fetal radiation dose during prophylactic internal iliac arterial occlusion in patients with abnormal placenta and to estimate the risk of radiation induced cancer in child age. METHODS Prophylactic occlusion of the internal iliac arteries during Caesarean section was performed in 42 patients with placenta praevia and/or placenta accreta spectrum. Fogarty embolectomy catheters were used for prophylactic occlusion of the internal iliac arteries. All procedures were performed in the hybrid operating room using Philips Allura Xper FD 20 X-ray system. Low dose X-ray fluoroscopy (7.5 frames per second) was used. The CODE (Conceptus dose estimation) Software was used to estimate the fetal dose and the risk of radiation induced carcinoma. RESULTS Fluoroscopy times required for insertion of Fogarty catheters were 0.5-4.2 min (mean: 1.7 min, median: 1.5 min). The estimated radiation dose to the fetus was 0.26-3.36 mGy (mean: 1.49 mGy, median: 1.25 mGy). The risk of radiation induced cancer in child age was 0.01-0.04% (mean 0.02%, median 0.01%). One patient developed thrombosis of a common femoral artery. CONCLUSION Prophylactic occlusion of the internal iliac arteries is a simple and safe procedure with minimal risk of complications and with a very low estimated radiation dose to the fetus.
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Lee AY, Ballah D, Moreno I, Dong PR, Cochran R, Picel A, Lee EW, Moriarty J, Padgett M, Nelson K, Kohi MP. Outcomes of balloon occlusion in the University of California Morbidly Adherent Placenta Registry. Am J Obstet Gynecol MFM 2019; 2:100065. [PMID: 33345981 DOI: 10.1016/j.ajogmf.2019.100065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/20/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Morbidly adherent placenta, also known as placenta accreta spectrum, is associated with severe maternal morbidity and mortality. Multiple adjunctive procedures have been proposed to improve outcomes, and at many institutions, interventional radiologists will play a role in assisting obstetricians in these cases. OBJECTIVE The objective of the study was to evaluate the outcomes of women with morbidly adherent placenta who underwent cesarean hysterectomy with aortic balloon occlusion or internal iliac artery balloon occlusion catheters, compared with cesarean hysterectomy with surgical ligation of the iliac arteries, or cesarean hysterectomy without adjunctive procedures. STUDY DESIGN A retrospective review of women with morbidly adherent placenta treated with cesarean hysterectomy was performed at 5 institutions from May 2014 to April 2018. The balloon occlusion group had either prophylactic aortic or iliac balloons placed prior to cesarean hysterectomy. Comparison groups included those who underwent internal iliac artery ligation prior to hysterectomy or a control group if they underwent cesarean hysterectomy without adjuvant procedures. Evaluated outcomes include estimated blood loss, transfusion requirements, intensive care unit admission, and adverse event rates. RESULTS There were 171 women with morbidly adherent placenta included in the study. Twenty-eight had balloon placement prior to cesarean hysterectomy, 18 had intraoperative internal iliac artery ligation, and there were 125 control women who underwent cesarean hysterectomy without any adjunctive procedures. Compared with the women who underwent cesarean hysterectomy without adjunctive procedures, women who underwent aortic or iliac artery balloon occlusion prior to hysterectomy had significantly lower estimated blood loss (30.9% decrease, P < .001), transfusion requirements (76.8% decrease, P < .001), intensive care unit admission rates (0% vs 15.2%, P < .001), and intensive care unit stay lengths (0.0 vs 3.1 days, P < .001). Compared with women who underwent surgical ligation of the internal iliac arteries prior to hysterectomy, women who underwent aortic or iliac artery balloon occlusion prior to cesarean hysterectomy had lower estimated blood loss (54.2% decrease, P < .01), transfusion requirements (90.5% decrease, P < .001), operating room times (40.0% decrease, P < .01), intensive care unit admissions rates (0% vs 77.8%, P < .001), intensive care unit stay lengths (0.0 vs 1.4 days, P < .001), and adverse events (3.6% vs 44.4%, P < .01). CONCLUSION Aortic and iliac artery balloon occlusion are associated with lower estimated blood loss, transfusion requirements, intensive care unit admission rates, and adverse event rates compared with women who underwent internal iliac artery ligation prior to cesarean hysterectomy or women who had no adjunctive interventions prior to cesarean hysterectomy for morbidly adherent placenta.
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Affiliation(s)
- Andrew Y Lee
- Department of Radiology, University of California, Davis, Sacramento, CA
| | - Deddeh Ballah
- Department of Radiology, University of California, San Francisco, San Francisco, CA
| | - Ismael Moreno
- Department of Radiology, University of California, Davis, Sacramento, CA
| | - Paul R Dong
- Department of Radiology, University of California, Davis, Sacramento, CA; Department of Radiology, Sutter Medical Group, Northern California, Sacramento, CA
| | - Rory Cochran
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Andrew Picel
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Edward W Lee
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA
| | - John Moriarty
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA
| | - Max Padgett
- Department of Radiology, University of California, Irvine, Orange, CA
| | - Kari Nelson
- Department of Radiology, University of California, Irvine, Orange, CA
| | - Maureen P Kohi
- Department of Radiology, University of California, San Francisco, San Francisco, CA.
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Abstract
The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Bartholin gland cysts are common complaints that often require procedural intervention. This article discusses these diagnoses and appropriate evaluation and management in the emergency department.
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Affiliation(s)
- Sarah Mahonski
- Heritage Valley Health System, 1000 Dutch Ridge Road, Beaver, PA 15009, USA
| | - Kami M Hu
- Emergency/Internal/Critical Care Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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Meyer-Wilmes P, Powerski M, Fischbach F, Omari J, Damm R, Pech M. Transarterial embolisation for the treatment of acute gynecological cancer bleeding. Arch Gynecol Obstet 2019; 300:1391-1397. [PMID: 31576453 DOI: 10.1007/s00404-019-05316-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/21/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Acute bleeding in patients with gynecological cancer may result in serious life-threatening complications. In these situations, immediate diagnostic and appropriate treatment is a challenge for attending physicians. Accordingly, transarterial embolisation (TAE) has been described as an increasing and effective treatment alternative to surgery and radiotherapy. METHODS In the present retrospective study, 25 patients were included who underwent a TAE in the period from January 2006 to June 2013 due to acute gynecological cancer bleeding. The objective of this study was to assess the efficiency and outcome of TAE. RESULTS The primary technical success rate was 92.0% (n = 23). 21 patients were analyzed in the 30-day follow-up. The clinical success rate was achieved in 90.5% (n = 19). A clinical failure due to rebleeding was observed in 9.5% (n = 2). No associations were revealed between rebleeding and technical/clinical factors. Within 30 days after the last TAE, the complication and mortality rates were 0.0% and 5.0% (n = 1), respectively. CONCLUSION TAE was found as an effective and safe treatment in the clinical setting of acute gynecological cancer bleeding. An important component of efficient management is an early and interdisciplinary care. Optimal treatment can be achieved by close cooperation between gynecologists, radiotherapists and interventional radiologists.
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Affiliation(s)
- Philipp Meyer-Wilmes
- Department of Gynecology and Obstetrics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
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Prophylactic abdominal aortic balloon occlusion in patients with pernicious placenta previa during cesarean section: a systematic review and meta-analysis from randomized controlled trials. Arch Gynecol Obstet 2019; 300:1131-1145. [PMID: 31535297 DOI: 10.1007/s00404-019-05297-4] [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: 05/30/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Pernicious placenta previa induces severe hemorrhage during cesarean section. Abdominal aorta balloon occlusion (AABO) is considered as an effective operation for patients with pernicious placenta previa. The aim of this study was to investigate the clinical application of abdominal aortic balloon occlusion in the placenta previa and cesarean section by systematic review and meta-analysis. METHODS MEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WAN-FANG DATA and CQVIP were searched from inception to Jan. 15th, 2019. Operative time, intraoperative blood loss volume, postoperative hospitalization duration, intraoperative blood transfusion volume, hysterectomy rate, lower extremity thrombosis rate, ICU admission rate, adverse reaction rate, neonatal birth weight, Apgar 1-min and 5-min scores were regarded as the endpoints. Randomized controlled trials (RCT) were used for meta-analysis. RESULTS Fourteen articles were retrieved from total 650 articles, and the results of meta-analysis showed that application of intraoperative AABO had the ability to reduce the operative time (WMD = - 16.581, 95% CI - 26.690 to - 6.472; P = 0.001), the intraoperative blood loss volume (WMD = - 1202.69, 95% CI - 1732.25 to - 673.12; P < 0.001), the intraoperative blood transfusion volume (WMD = - 1202.69, 95% CI - 1732.25 to - 673.12; P < 0.001). The hysterectomy rate (RR = 0.279, 95% CI 0.164-0.474; P < 0.001), postoperative hospitalization duration (WMD = - 1.423, 95% CI - 2.070 to - 0.776; P < 0.001) and the balloon preset time (WMD = - 13.793, 95% CI - 15.341 to - 12.244; P < 0.001; I2 = 0.0%) were also reduced in AABO group. CONCLUSIONS Application of AABO in patients with pernicious placenta previa is safe and effective, which is worthy of clinical promotion.
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Mei Y, Zhao H, Zhou H, Jing H, Lin Y. Comparison of infrarenal aortic balloon occlusion with internal iliac artery balloon occlusion for patients with placenta accreta. BMC Pregnancy Childbirth 2019; 19:147. [PMID: 31046694 PMCID: PMC6498491 DOI: 10.1186/s12884-019-2303-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was designed to compare the role of infrarenal aortic artery balloon occlusion (IAABC) with internal iliac artery balloon occlusion (IIABOC). METHODS One hundred seventy-four cases with placenta accreta were retrospectively analyzed.74 cases who had IAABC were in group A, while the others who had IIABOC were in group B. RESULTS Amount of estimated blood loss (EBL), the rate of major blood loss, the rate of blood transfusion and uterine packing, length of hospitalization were not different in both groups. The rate of uterine artery embolization (UAE), balloon occlusion time, operation time and fetus radiation dose in group A were less than those in group B. CONCLUSIONS IAABC resulted in better clinical outcomes than IIABOC.
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Affiliation(s)
- Youwen Mei
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Hu Zhao
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Hui Zhou
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Huaibo Jing
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China.
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Wang M, Ballah D, Wade A, Taylor AG, Rizzuto G, Li B, Lucero J, Chen LM, Kohi MP. Uterine Artery Embolization following Cesarean Delivery but prior to Hysterectomy in the Management of Patients with Invasive Placenta. J Vasc Interv Radiol 2019; 30:687-691. [PMID: 30922797 PMCID: PMC10468213 DOI: 10.1016/j.jvir.2018.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate outcomes of patients with placenta accreta spectrum (PAS) disorders who underwent uterine artery embolization (UAE) following cesarean delivery but before hysterectomy. MATERIALS AND METHODS A retrospective review of patients with PAS treated with cesarean-hysterectomy (C-hyst) was performed. Patients in the UAE group underwent UAE after cesarean delivery but before hysterectomy; patients in the control group underwent C-hyst alone. Estimated blood loss (EBL), transfusion requirements, length of intensive care unit (ICU) stay, and adverse events were evaluated. RESULTS The study included 31 patients, 7 in the UAE group and 24 in the control group. Median EBL, transfusion requirements, and length of ICU stay in the UAE group compared with control group were 1,500 mL (range, 500-2,000 mL) vs 2,000 mL (range, 1,000-4,500 mL) (P = .04), 150 mL (range, 0-650 mL) vs 550 mL (range, 0-3,125 mL) (P = .10), and 0 d (range, 0-1 d) vs 0.5 d (range, 0-2 d) (P = .07). All patients in the UAE group had placenta increta; patients in the control group had placenta accreta (29%), increta (54%), and percreta (17%) (P = .10). Subgroup analysis of patients with placenta increta demonstrated that the UAE group had a significant decrease in median EBL (P = .004), transfusion requirements (P = .009), and length of ICU stay (P = .04). No adverse events following UAE were noted. CONCLUSIONS UAE following cesarean delivery but before hysterectomy in patients with placenta increta appears to be safe and effective in decreasing EBL, transfusion requirements, and length of ICU stay compared with C-hyst alone.
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Affiliation(s)
- Melinda Wang
- Weill Cornell Medical College, New York, New York
| | - Deddeh Ballah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Alana Wade
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Andrew G Taylor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Gabrielle Rizzuto
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | - Benjamin Li
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Jennifer Lucero
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
| | - Lee-May Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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Guida M, Maffucci D, Iannuzzi G, Giordano M, Luciano G, Di Benedetto L, Cantarella R, Rescigno A, Giugliano L. Successful pregnancy after uterine artery embolization for uterine arterovenous malformation: a rare case report. Int J Womens Health 2018; 10:745-750. [PMID: 30538584 PMCID: PMC6254590 DOI: 10.2147/ijwh.s182131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective This paper reports on a rare case of pregnancy after uterine artery embolization (UAE) for uterine arteriovenous malformation (AVM). Debate exists about persistence of fertility in women after UAE. Adverse effects of this technique can modify both uterine echostructure, inducing necrosis and infarction, endometrial atrophy and uterine artery rupture, and ovarian reserve, causing persistent amenorrhea. Ovarian reserve appears to be affected by UAE in pre-menopausal women. However, younger ovaries (according to biological ovarian age) exhibit a greater capacity for recovery after ovarian damage. Therefore, larger studies are needed for more conclusive results. Case report A 28-year-old woman was admitted to our department due to life-threatening uterine bleeding, resulting in tachycardia, pallor, and sweating. The patient came with a history of two spontaneous miscarriages. After sonography and computed tomography, AVMs were identified at uterine fundus and anterior wall. Conclusion The pathogenesis of infertility after UAE is not yet known. The peculiarity of this case was that, only few months later, the patient became pregnant and gave birth to a live fetus at 37 weeks with cesarean delivery.
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Affiliation(s)
- M Guida
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - D Maffucci
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - G Iannuzzi
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - M Giordano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - G Luciano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - L Di Benedetto
- Università degli studi di Roma "La Sapienza" - Dipartimento di Scienze Medico-Chirurgiche e di Medicina Traslazionale - Facoltà di Medicina e Psicologia Azienda Ospedaliera Sant' Andrea, Rome, Italy
| | - R Cantarella
- Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - A Rescigno
- Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - L Giugliano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
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14
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Chen CS, Park S, Shin JH, Nouri Y, Kim JW, Yoon HK, Ko GY. Endovascular treatment for the control of active vaginal bleeding from uterine cervical cancer treated with radiotherapy. Acta Radiol 2018; 59:1336-1342. [PMID: 29448806 DOI: 10.1177/0284185118758133] [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: 11/16/2022]
Abstract
Background Endovascular treatment has become a significant therapeutic option for the management of intractable bleeding in gynecologic malignancies. However, the endovascular treatment types were almost never mentioned when active bleeding from different arteries was identified. Purpose To present angiographic details and evaluate clinical efficacy of endovascular treatments to control active vaginal bleeding in uterine cervical cancer patients treated with radiotherapy. Material and Methods In this retrospective study, six, consecutive cervical cancer patients treated with radiotherapy who underwent endovascular treatment for active vaginal bleeding were included. Angiographic findings, endovascular treatment details, and clinical outcomes were obtained. Results Ten endovascular procedures were technically successful, in which bleeding arteries were the internal iliac artery/its branches (n = 5), external iliac artery (EIA) (n = 3), uterine artery (n = 1), and superior rectal artery (n = 1), and bleeding manifested as contrast extravasation (n = 6), pseudoaneurysm (n = 1), or both (n = 3). Three of the four repeated procedures showed different bleeding sites from the primary ones. Stent graft was inserted to preserve the patency of the bleeding EIA in two patients. For another EIA rupture, both proximal and distal embolization were performed, followed by femoral-to-femoral bypass to preserve blood flow. Bleeding control within one month was achieved in 80% (8/10). One minor complication, mild transient pelvic pain, occurred in one patient. Conclusions Various endovascular treatment was feasible and effective to control active vaginal bleeding from cervical cancer. Repeated procedures showed commonly different bleeding foci and stent graft insertion was effective for preserving the patency of the large bleeding artery.
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Affiliation(s)
- Cheng Shi Chen
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Sohee Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yasir Nouri
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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15
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Clinical pearls part 3: anaesthetic management of abnormally invasive placentation. Curr Opin Anaesthesiol 2018; 31:280-289. [PMID: 29652744 DOI: 10.1097/aco.0000000000000601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Abnormal placentation is a clinical condition seen increasingly in the pregnant population. It is associated with significant morbidity and mortality, which may be mitigated through robust multidisciplinary care for these patients. The role of maternal critical care for these patients has largely been ignored in the literature. RECENT FINDINGS Advances in pharmacological management of bleeding with recent publications of large multicentre trials in addition to new technologies in the management of massive obstetric haemorrhage (MOH) have revolutionized the management of abnormal placentation. These include the use of tranexamic acid, interventional radiology, cell saver technology, and point-of-care coagulation tests. The role of maternal critical care for the optimization of postoperative complications and physiological derangements has not been considered widely in the literature. This article summarizes the current evidence for interventions and suggests a protocol for the management of these high-risk patients. SUMMARY A robust protocol outlining the key elements of the management of placenta accreta, including optimizing postoperative care, should be in place to promote desired outcomes.
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16
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Qiu Z, Hu J, Wu J, Chen L. Prophylactic temporary abdominal aorta balloon occlusion in women with placenta previa accretism during late gestation. Medicine (Baltimore) 2017; 96:e8681. [PMID: 29145299 PMCID: PMC5704844 DOI: 10.1097/md.0000000000008681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To evaluate the clinical efficacy of prophylactic temporary balloon occlusion of the abdominal aorta in patients with placenta previa accretism during cesarean section. METHODS Twenty-three consecutive patients, prenatally confirmed with placenta previa accretism were retrospectively analyzed in our center from August 2012 to October 2014. All 23 subjects underwent cesarean section with prophylactic balloon occlusion of the abdominal aorta. RESULTS All of the 23 subjects experienced singleton pregnancies leading to the birth of live infants. Of these subjects, the following problems were diagnosed: placenta accrete (n = 10), placenta increte (n = 10), and placenta precrete (n = 3). Mean intraoperative hemorrhage was 1170.0 mL. Fifteen patients received red blood cell transfusion with a mean transfusion volume of 2.3 units. The incidence of hysterectomy was 21.74% (5/23) with blood loss ranging from 2000 to 5000 mL (mean 3360.0 mL). One complication encountered in this retrospective study was lower extremity arterial thrombosis. Eighteen patients were followed-up by telephone to 14 months following discharge, all babies were noted to be healthy. CONCLUSION Prophylactic abdominal aorta balloon occlusion (ABO) was relatively safe in the treatment of patients with placenta previa accretism. This approach could represent a key aspect in a multidisciplinary algorithm in reducing hemorrhage in abnormal placentation.
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Affiliation(s)
- Zhongyuan Qiu
- Obstectic & Gynecology, Fujian Medical University Union Hospital
- Obstectic & Gynecology, the Third Affiliated Hospital of Fujian Medical University
| | - Jifen Hu
- Obstetrics & Gynecology, the First Affiliated Hospital of Fujian Medical University, China
| | - Jianbo Wu
- Obstetrics & Gynecology, the First Affiliated Hospital of Fujian Medical University, China
| | - Lihong Chen
- Obstetrics & Gynecology, the First Affiliated Hospital of Fujian Medical University, China
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17
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Lee PS, Kempner S, Miller M, Dominguez J, Grotegut C, Ehrisman J, Previs R, Havrilesky LJ, Broadwater G, Ellestad SC, Secord AA. Multidisciplinary approach to manage antenatally suspected placenta percreta: updated algorithm and patient outcomes. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2017; 4:11. [PMID: 28852530 PMCID: PMC5567476 DOI: 10.1186/s40661-017-0049-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the significant morbidity and mortality associated with placenta percreta, alternative management options are needed. Beginning in 2005, our institution implemented a multidisciplinary strategy to patients with suspected placenta percreta. The purpose of this study is to present our current strategy, maternal morbidity and outcomes of patients treated by our approach. METHODS From 2005 to 2014, a retrospective cohort study of patients with suspected placenta percreta at an academic tertiary care institution was performed. Treatment modalities included immediate hysterectomy at the time of cesarean section (CHYS), planned delayed hysterectomy (interval hysterectomy 6 weeks after delivery) (DH), and fertility sparing (uterine conservation) (FS). Prognostic factors of maternal morbidity were identified from medical records. Complications directly related to interventional procedures and DH was recorded. Descriptive statistics were utilized. RESULTS Of the 21 patients with suspected placenta percreta, 7 underwent CHYS, 13 underwent DH, and 1 had FS with uterine preservation. Of the 20 cases that underwent hysterectomy, final pathology showed 11 increta, 7 percreta, and 2 inconclusive. 19/20 cases underwent interventional radiology (IR) procedures. Selective embolization was utilized in 14 cases (2/7 CHYS; 12/13 DH). The median time from cesarean section (CS) to DH was 41 [26-68] days. There were no cases of emergent hysterectomy, delayed hemorrhage, or sepsis in the DH group. Both estimated blood loss and number of packed red blood cell transfusions were significantly higher in the CHYS group. 3/21 cases required massive transfusion (2 CHYS, 1 FS) with median total blood product transfusion of 13 units [12-15]. The four IR-related complications occurred in the DH group. Incidence of postoperative complications was similar between both groups. Median hospital length of stay (LOS) after CHYS was 4 days [3-8] compared to DH cohort: 7 days [3-33] after CS and 4 days [1 -10] after DH. The DH cohort had a higher rate of hospital readmission of 54% (7/13) compared to 14% (1/7) CHYS, most commonly due to pain. There were no maternal deaths. CONCLUSION This multidisciplinary strategy may appear feasible; however, further investigation is warranted to evaluate the effectiveness of alternative approaches to cesarean hysterectomy in cases of morbidly adherent placenta.
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Affiliation(s)
- Paula S. Lee
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina 27710 USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Hospital, Durham, USA
- Duke Cancer Institute, Durham, USA
| | - Samantha Kempner
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina 27710 USA
| | - Michael Miller
- Department of Interventional Radiology, Duke University Hospital, Durham, USA
| | | | - Chad Grotegut
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina 27710 USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Hospital, Durham, USA
| | - Jessie Ehrisman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Hospital, Durham, USA
| | - Rebecca Previs
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina 27710 USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Hospital, Durham, USA
- Duke Cancer Institute, Durham, USA
| | - Laura J. Havrilesky
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina 27710 USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Hospital, Durham, USA
- Duke Cancer Institute, Durham, USA
| | | | - Sarah C. Ellestad
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina 27710 USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Hospital, Durham, USA
| | - Angeles Alvarez Secord
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina 27710 USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Hospital, Durham, USA
- Duke Cancer Institute, Durham, USA
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18
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Wang Z, Li X, Pan J, Chen J, Shi H, Zhang X, Liu W, Yang N, Jin Z, Xiang Y. Bleeding from gestational trophoblastic neoplasia: embolotherapy efficacy and tumour response to chemotherapy. Clin Radiol 2017; 72:992.e7-992.e11. [PMID: 28673447 DOI: 10.1016/j.crad.2017.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/12/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
AIM To evaluate retrospectively the impact of selective arterial embolisation (SAE) on the prognosis of patients with gestational trophoblastic neoplasia (GTN). MATERIALS AND METHODS A retrospective analysis of the records of all patients with GTN between January 2005 and January 2015 was performed. Forty-one patients (mean age, 28.9 ± 7.6 years) with massive vaginal haemorrhage from GTN (including 27 cases of choriocarcinoma and 14 cases of invasive mole) were treated with SAE. The complications, control of haemorrhage, and outcome of chemotherapy were reviewed retrospectively. RESULTS SAE successfully controlled the haemorrhage for 38 patients (92.7%). All patients with successful SAE received systemic chemotherapy without recurrent massive bleeding during the period of chemotherapy. The average number of chemotherapy cycles was 9.8 for every patient. Complete remission (CR) was achieved in 34 patients (89.5%), two patients had partial remission, and two patients died. Two patients with CR required repeated embolisation for recurrence of massive bleeding 30 and 47 months after the first embolisation procedure due to uterine arteriovenous malformation (AVM). CONCLUSIONS SAE can effectively control haemorrhage from GTN and these patients had good response to systemic chemotherapy following successful SAE. Uterine bleeding may recur due to uterine AVMs, even following complete embolisation and CR of GTN.
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Affiliation(s)
- Z Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - X Li
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - J Pan
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - J Chen
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - H Shi
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - X Zhang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - W Liu
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - N Yang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Z Jin
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Y Xiang
- Department of Gynaecology and Obstetrics, Peking Union Medical College Hospital, Beijing, 100730, China
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19
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Chu Q, Shen D, He L, Wang H, Zhao X, Chen Z, Wang Y, Zhang W. Anesthetic management of cesarean section in cases of placenta accreta, with versus without abdominal aortic balloon occlusion: study protocol for a randomized controlled trial. Trials 2017; 18:240. [PMID: 28549439 PMCID: PMC5446702 DOI: 10.1186/s13063-017-1977-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 05/04/2017] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Qinjun Chu
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Dan Shen
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Long He
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Hongwei Wang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Xianlan Zhao
- Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Zhimin Chen
- Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Yanli Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China.
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20
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Barral PA, Saeed-Kilani M, Tradi F, Dabadie A, Izaaryene J, Soussan J, Bartoli JM, Vidal V. Transcatheter arterial embolization with ethylene vinyl alcohol copolymer (Onyx) for the treatment of hemorrhage due to uterine arteriovenous malformations. Diagn Interv Imaging 2017; 98:415-421. [DOI: 10.1016/j.diii.2016.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/05/2016] [Accepted: 09/17/2016] [Indexed: 12/11/2022]
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21
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Çaypınar SS, Güraslan H, Şentürk B, Cengiz H, Yaşar L. Salvage therapy in acute life-threatening vaginal bleeding of cervical cancer: Hypogastric artery embolization. Taiwan J Obstet Gynecol 2017; 55:607-8. [PMID: 27590393 DOI: 10.1016/j.tjog.2015.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 10/21/2022] Open
Affiliation(s)
- Sema Süzen Çaypınar
- Department of Gynecology and Obstetrics, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey.
| | - Hakan Güraslan
- Department of Gynecology and Obstetrics, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Baki Şentürk
- Department of Gynecology and Obstetrics, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Hüseyin Cengiz
- Department of Gynecology and Obstetrics, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Levent Yaşar
- Department of Gynecology and Obstetrics, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
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22
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Xie L, Wang Y, Luo FY, Man YC, Zhao XL. Prophylactic use of an infrarenal abdominal aorta balloon catheter in pregnancies complicated by placenta accreta. J OBSTET GYNAECOL 2017; 37:557-561. [PMID: 28366073 DOI: 10.1080/01443615.2017.1291588] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lan Xie
- Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China
| | - Yan Wang
- Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China
| | - Fang-Yuan Luo
- Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China
| | - Yi-Cun Man
- Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China
| | - Xiao-Lan Zhao
- Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China
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23
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Wang Z, Li X, Pan J, Zhang X, Shi H, Yang N, Jin Z. Uterine Artery Embolization for Management of Primary Postpartum Hemorrhage Associated with Placenta Accreta. ACTA ACUST UNITED AC 2017; 31:228-232. [PMID: 28065219 DOI: 10.1016/s1001-9294(17)30005-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective To evaluate the efficacy and safety of uterine artery embolization (UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women (mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients (94%) during follow-up period (median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion Uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.
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Affiliation(s)
- Zhiwei Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiaoguang Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jie Pan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiaobo Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Haifeng Shi
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Ning Yang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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24
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Parker R, Wuerdeman M, Grant M, Kitley C. Novel approach to uterine artery pseudoaneurysm embolization for delayed post-partum hemorrhage. J Obstet Gynaecol Res 2016; 42:1870-1873. [DOI: 10.1111/jog.13140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/27/2016] [Accepted: 07/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ross Parker
- Department of Radiology; Madigan Army Medical Center; Tacoma Washington USA
| | - Marc Wuerdeman
- Department of Radiology; Madigan Army Medical Center; Tacoma Washington USA
| | - Matthew Grant
- Department of Radiology; Madigan Army Medical Center; Tacoma Washington USA
| | - Charles Kitley
- Department of Radiology; Madigan Army Medical Center; Tacoma Washington USA
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25
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Koganemaru M, Nonoshita M, Iwamoto R, Kuhara A, Nabeta M, Kusumoto M, Kugiyama T, Kozuma Y, Nagata S, Abe T. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration. Cardiovasc Intervent Radiol 2016; 39:1159-64. [PMID: 26902704 DOI: 10.1007/s00270-016-1309-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE We evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration. MATERIALS AND METHODS We reviewed seven cases of patients (mean age 30.9 years; range 27-35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery's architecture, technical and clinical success rates, and complications. RESULTS The vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases. CONCLUSION Postpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.
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Affiliation(s)
- Masamichi Koganemaru
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Masaaki Nonoshita
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Ryoji Iwamoto
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Asako Kuhara
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masakazu Nabeta
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masashi Kusumoto
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoko Kugiyama
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yutaka Kozuma
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Woodhams R. The role of interventional radiology in primary postpartum hemorrhage. HYPERTENSION RESEARCH IN PREGNANCY 2016. [DOI: 10.14390/jsshp.hrp2015-016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Reiko Woodhams
- Department of Diagnostic Radiology, Kitasato University School of Medicine
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Eskandari A, Mukherjee A, McHugh J. Transarterial embolization for management of severe postcoital bleeding. SAGE Open Med Case Rep 2016; 4:2050313X16662803. [PMID: 27551425 PMCID: PMC4976789 DOI: 10.1177/2050313x16662803] [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: 02/17/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management. Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion. Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils. Conclusion: Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.
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Affiliation(s)
- Armen Eskandari
- Internal Medicine Program, Riverside County Regional Medical Center, Department of Internal Medicine, University of California Riverside School of Medicine, Moreno Valley, CA, USA
| | - Ashis Mukherjee
- Department of Cardiovascular Medicine, St. Bernardine Medical Center and University of California Riverside School of Medicine, San Bernardino, CA, USA
| | - John McHugh
- Department of Obstetrics and Gynecology, St. Bernardine Medical Center, San Bernardino, CA, USA
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Prophylactic abdominal aorta balloon occlusion during caesarean section: a retrospective case series. Int J Obstet Anesth 2015; 27:3-8. [PMID: 26775894 DOI: 10.1016/j.ijoa.2015.12.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 11/16/2015] [Accepted: 12/05/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The management of patients with morbidly adherent placenta has been described using vascular balloon catheters placed in the iliac arteries, but rarely in the aorta. This case series presents our experience with prophylactic lower abdominal aorta balloon occlusion in 45 women. METHODS The records of patients in our centre who underwent caesarean section between May 2013 and June 2014 were retrospectively analysed for the use of prophylactic lower abdominal aorta balloon occlusion. RESULTS Forty-five cases were identified. All patients had a morbidly adherent placenta, including placenta accreta (n=22), placenta increta (n=20) and placenta percreta (n=3). A subtotal hysterectomy was performed in four cases. Eleven of the 45 patients received red blood cell transfusion of a mean of 1.7 units. Mean preoperative and postoperative haemoglobin concentrations were 10.1g/dL and 9.4g/dL, respectively. Mean estimated blood loss was 835mL [range 200-6000mL]. The incidence of complications was 4.4% (2/45), including one case of lower extremity arterial thrombosis and one case of ischaemic injury to the femoral nerve. Follow up at one year was completed in 22 patients at which time all babies were well. CONCLUSIONS Prophylactic lower abdominal aorta balloon occlusion has the potential to reduce intraoperative blood loss, transfusion and hysterectomy rate in patients with morbidly adherent placenta undergoing caesarean section. Careful patient selection is critical as the technique may be associated with potentially serious complications.
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Endovascular management of postpartum hemorrhage of placental origin. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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30
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Vascular uterine abnormalities: Comparison of imaging findings and clinical outcomes. Eur J Radiol 2015; 84:2485-91. [DOI: 10.1016/j.ejrad.2015.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/08/2015] [Accepted: 10/02/2015] [Indexed: 11/21/2022]
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Foetal Radiation Dose During Prophylactic Occlusion Balloon Placement for Morbidly Adherent Placenta. Cardiovasc Intervent Radiol 2015; 38:1487-93. [DOI: 10.1007/s00270-015-1102-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/26/2015] [Indexed: 01/10/2023]
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32
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Soyer P, Dohan A, Dautry R, Guerrache Y, Ricbourg A, Gayat E, Boudiaf M, Sirol M, Ledref O. Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications. Cardiovasc Intervent Radiol 2015; 38:1068-81. [DOI: 10.1007/s00270-015-1054-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/07/2015] [Indexed: 12/21/2022]
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33
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Kim YM. Treatment of uterine leiomyoma: how to choose a therapeutic method? JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.12.1147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yong Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Broekman EA, Versteeg H, Vos LD, Dijksterhuis MG, Papatsonis DN. Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa. Int J Gynaecol Obstet 2014; 128:118-21. [DOI: 10.1016/j.ijgo.2014.08.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/20/2014] [Accepted: 10/21/2014] [Indexed: 11/26/2022]
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Yamamoto N, Koga K, Akahane M, Wada-Hiraike O, Fujii T, Osuga Y. Temporary balloon occlusion of the uterine arteries to control hemorrhage during hysterectomy in a case of uterine arteriovenous fistula. J Obstet Gynaecol Res 2014; 41:314-8. [DOI: 10.1111/jog.12515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 06/05/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Naoko Yamamoto
- Department of Obstetrics and Gynecology; School of Medicine; The University of Tokyo; Tokyo Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology; School of Medicine; The University of Tokyo; Tokyo Japan
| | - Masaaki Akahane
- Department of Radiology; The University of Tokyo; Tokyo Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology; School of Medicine; The University of Tokyo; Tokyo Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology; School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology; School of Medicine; The University of Tokyo; Tokyo Japan
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Spontaneous Hemoperitoneum due to Rupture of Uterine Varicose Veins during Labor Successfully Treated by Percutaneous Embolization. Case Rep Obstet Gynecol 2014; 2014:580384. [PMID: 25114819 PMCID: PMC4119914 DOI: 10.1155/2014/580384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/19/2014] [Accepted: 06/16/2014] [Indexed: 01/18/2023] Open
Abstract
Hemoperitoneum during pregnancy is a rare but potentially lethal clinical condition. Improvements in antenatal and intrapartum care, especially in surgical and anesthetic techniques, have reduced maternal mortality; perinatal mortality remains very high (31%). Treatment is based on the systemic correction of hypovolemia and immediate surgery via laparotomy or laparoscopy in cases in the first trimester of pregnancy for hemostatic purposes. Sometimes, hysterectomy is needed. A 35-year-old Asiatic primigravid woman at 37 weeks' gestation with otherwise uneventful pregnancy came to the hospital referring abrupt-onset lumbar and abdominal pain. A bleeding uterine superficial varicocele of about 7 cm was found on the left uterine horn during Caesarean section. Interventional radiologic embolization of both uterine arteries was successfully performed. Posterior evolution of the patient was favorable. Percutaneous vascular embolization of the uterine arteries is an effective alternative treatment for many obstetrical and gynecological causes of bleeding. The main advantage of this technique is the low rate of serious complications and the preservation of reproductive function. To our knowledge, this is the first case of spontaneous intrapartum hemoperitoneum treated with this technique. An early diagnosis and a rapid indication of this therapeutic option are essential. Hemodynamic stability is needed to decide this conservative management.
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Gipson MG, Smith MT. Endovascular therapies for primary postpartum hemorrhage: techniques and outcomes. Semin Intervent Radiol 2014; 30:333-9. [PMID: 24436559 DOI: 10.1055/s-0033-1359726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Interventional radiologists are often consulted for acute management of hemorrhagic complications in obstetric and gynecologic patients. The aim of this article is to review the common indications for vascular embolization in obstetric and gynecologic emergencies, specifically in the setting of primary postpartum hemorrhage, and to discuss the technique and outcomes of endovascular treatment.
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Affiliation(s)
- Matthew G Gipson
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado
| | - Mitchell T Smith
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado
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Takeda A, Koike W, Imoto S, Nakamura H. Three-dimensional computerized tomographic angiography for diagnosis and management of intractable postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol 2014; 176:104-11. [PMID: 24630300 DOI: 10.1016/j.ejogrb.2014.02.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/31/2014] [Accepted: 02/13/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report our experience on the value of dynamic three-dimensional computerized tomographic (CT) angiography for immediate diagnosis and management of intractable postpartum hemorrhage (PPH). STUDY DESIGN Retrospective study of all cases of PPH examined by three-dimensional CT angiography between January 2007 and August 2013 in a single center. In each case, emergency dynamic CT was taken at the early arterial, late arterial and venous phases to identify the extravasated contrast agent that represents active hemorrhage. Images for three-dimensional CT angiography were reconstituted from multiplanar CT images. Based on these findings, management procedures were individually determined and those outcomes were compared with angiographic, surgical and clinical findings. RESULTS Twenty-nine cases with primary PPH and 19 cases with secondary PPH were examined. In primary PPH, extravasation in the early arterial phase was noted in 12 cases. Those included vulvovaginal hematoma (n=4), invasive placenta (n=2), retained placenta (n=2), uterine atony (n=1), retroperitoneal hematoma (n=1), retrovesical hematoma (n=1) and rectus sheath hematoma after cesarean section (n=1). Of these, ten cases were treated by transcatheter arterial embolization (TAE) of the offending vessels with or without additional therapies. In secondary PPH, extravasation was identified in 14 cases. Those included invasive placenta (n=8), uterine artery pseudoaneurysm (n=3), uterine arteriovenous fistula (n=2), and subinvolution of placenta bed (n=1), which were treated by TAE of the offending vessels with or without additional therapies. Successful hemostasis with fertility preservation was achieved in all cases. Complications were not identified except for a case of placenta increta that developed secondary amenorrhea after TAE of both uterine arteries. In subsequent gestation after TAE of both uterine arteries, normal vaginal delivery (n=4), uncomplicated cesarean delivery (n=3), cesarean delivery followed by recurrent arteriovenous fistula (n=1) and spontaneous miscarriage followed by recurrent invasive placenta (n=1) were identified. CONCLUSIONS This case series emphasizes that three-dimensional CT angiography has significant diagnostic value when the appropriate procedure for management of PPH was immediately determined to avoid potential maternal morbidity and mortality.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
| | - Wataru Koike
- Department of Diagnostic Radiology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Imoto
- Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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Hongsakul K, Songjamrat A, Rookkapan S. Transarterial embolization for the treatment of massive bleeding in gynecologic and obstetric emergencies: a single center experience. Emerg Radiol 2014; 21:333-9. [PMID: 24522752 DOI: 10.1007/s10140-014-1198-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 01/21/2014] [Indexed: 11/30/2022]
Abstract
Delayed treatment of the massive bleeding in gynecologic and obstetric conditions can cause high morbidity and mortality. The aim of this study is to assess the angiographic findings and outcomes of transarterial embolization in cases of massive hemorrhage from underlying gynecological and obstetrical conditions. This is a retrospective study of 18 consecutive patients who underwent transarterial embolization of uterine and/or hypogastric arteries due to massive bleeding from gynecological and obstetrical causes from January 2006 to December 2011. The underlying causes of bleeding, angiographic findings, technical success rates, clinical success rates, and complications were evaluated. Massive gynecological and obstetrical bleeding occurred in 12 cases and 6 cases, respectively. Gestational trophoblastic disease was the most common cause of gynecological bleeding. The most common cause of obstetrical hemorrhage was primary post-partum hemorrhage. Tumor stain was the most frequent angiographic finding (11 cases) in the gynecological bleeding group. The most common angiographic findings in obstetrical patients were extravasation (2 cases) and pseudoaneurysm (2 cases). Technical and final clinical success rates were found in all 18 cases and 16 cases. Collateral arterial supply, severe metritis, and unidentified cervical laceration were causes of uncontrolled bleeding. Only minor complications occurred, which included pelvic pain and groin hematoma. Percutaneous transarterial embolization is a highly effective and safe treatment to control massive bleeding in gynecologic and obstetric emergencies.
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Affiliation(s)
- Keerati Hongsakul
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanit Road, Hat Yai, Songkhla, 90110, Thailand,
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Outcome of pelvic arterial embolization for postpartum hemorrhage: A retrospective review of 117 cases. Obstet Gynecol Sci 2014; 57:17-27. [PMID: 24596814 PMCID: PMC3924745 DOI: 10.5468/ogs.2014.57.1.17] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/10/2013] [Accepted: 07/23/2013] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to evaluate indications, efficacy, and complications associated with pelvic arterial embolization (PAE) for postpartum hemorrhage (PPH). Methods We retrospectively reviewed the medical records of 117 consecutive patients who underwent PAE for PPH between January 2006 and June 2013. Results In our single-center study, 117 women underwent PAE to control PPH refractory to conservative management including uterine massage, use of uterotonic agents, surgical repair of genital tract lacerations, and removal of retained placental tissues. Among 117 patients, 69 had a vaginal delivery and 48 had a Cesarean section. The major indication for embolization was uterine atony (54.7%). Other causes were low genital tract lacerations (21.4%) and abnormal placentation (14.5%). The procedure showed a clinical success rate of 88.0% with 14 cases of PAE failure; there were 4 hemostatic hysterectomies and 10 re-embolizations. On univariate analysis, PAE failure was associated with overt disseminated intravascular coagulation (P=0.009), transfusion of more than 10 red blood cell units (RBCUs, P=0.002) and embolization of both uterine and ovarian arteries (P=0.003). Multivariate analysis showed that PAE failure was only associated with transfusions of more than 10 RBCUs (odds ratio, 8.011; 95% confidence interval, 1.531-41.912; P=0.014) and embolization of both uterine and ovarian arteries (odds ratio, 20.472; 95% confidence interval, 2.715-154.365; P=0.003), which were not predictive factors, but rather, were the results of longer time for PAE. Three patients showed uterine necrosis and underwent hysterectomy. Conclusion PAE showed high success rates, mostly without procedure-related complications. Thus, it is a safe and effective adjunct or alternative to hemostatic hysterectomy, when primary management fails to control PPH.
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Krutman M, Galastri FL, Affonso BB, Nasser F, Travassos FB, Messina MDL, Wolosker N. Revisao de 15 casos submetidos a oclusao temporaria bilateral de arteria iliaca interna em pacientes com alto risco para hemorragia obstetrica. J Vasc Bras 2013. [DOI: 10.1590/jvb.2013.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar os resultados de 15 pacientes com elevado risco de sangramento obstétrico, submetidas ao implante de catéteres balão profilático para oclusão temporária das artérias hipogástricas. MÉTODOS: Uma análise retrospectiva foi realizada com base em prontuários de 15 pacientes submetidas ao implante de catéteres balão profilático, de janeiro/2008 a dezembro/2011. Todas as pacientes incluídas no estudo foram diagnosticadas no período antenatal com doença placentária associada a alto risco de hemorragia obstétrica. RESULTADOS: A média de idade das pacientes estudadas foi de 36 anos (32-42 anos). Nove pacientes eram portadoras de acretismo placentário, quatro possuíam placenta prévia, uma estava com gestação ectópica e uma apresentava miomatose uterina e coagulopatia associada a Lupus Eritematosos Sistêmico. O volume total de contraste utilizado para o procedimento variou entre 20 e 160 ml (média de 84 ml). A média do número total de dias de internação e o número de dias de internação após o procedimento foram, respectivamente, 12,4 e 4,9 dias. Em oito (53%) casos, não houve necessidade de transfusão sanguínea no intraoperatório ou após a cirurgia. A média do número de unidades de sangue transfundida foi 2,06. A única complicação associada ao procedimento foi a trombose arterial de artéria ilíaca externa, observada em dois casos. CONCLUSÃO: A oclusão temporária de artérias hipogástricas é um método seguro e efetivo para controle de hemorragia em pacientes com elevado risco de sangramento obstétrico, quando realizado por equipe experiente. Os resultados deste estudo são observacionais, retrospectivos e não randomizados; portanto, não podemos apoiar o uso rotineiro dessa técnica, mas podemos incluí-la no arsenal de recursos para casos selecionados com potencial para sangramento.
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Uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta. Clin Radiol 2012; 67:e71-6. [DOI: 10.1016/j.crad.2012.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 07/18/2012] [Accepted: 07/30/2012] [Indexed: 11/22/2022]
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Dilauro M, Dason S, Athreya S. Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: Literature review and analysis. Clin Radiol 2012; 67:515-20. [DOI: 10.1016/j.crad.2011.10.031] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 10/19/2011] [Accepted: 10/26/2011] [Indexed: 10/14/2022]
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Anesthetic management of patients with placenta accreta and resuscitation strategies for associated massive hemorrhage. Curr Opin Anaesthesiol 2011; 24:274-81. [PMID: 21494133 DOI: 10.1097/aco.0b013e328345d8b7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Placenta accreta is one of the leading causes of peripartum hemorrhage. The goal of this article is to review anesthetic management of parturients with placenta accreta and to examine a modern approach to massive peripartum hemorrhage. RECENT FINDINGS The incidence of placenta accreta is rising in parallel with the increased rate of cesarean delivery. If accreta is diagnosed or suspected preoperatively, anesthetic management can be optimized. Even with the best possible management, the blood loss associated with placenta accreta can resemble that of a major trauma. The use of Damage Control Resuscitation strategies to guide transfusion may improve morbidity and mortality. SUMMARY Careful planning and close communication are essential between anesthesiology, obstetric, interventional radiology, gynecologic oncology, blood bank, and specialized surgical teams when taking care of a patient with placenta accreta.
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Sadashivaiah J, Wilson R, Thein A, McLure H, Hammond CJ, Lyons G. Role of prophylactic uterine artery balloon catheters in the management of women with suspected placenta accreta. Int J Obstet Anesth 2011; 20:282-7. [PMID: 21852107 DOI: 10.1016/j.ijoa.2011.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 06/06/2011] [Accepted: 06/18/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Placenta praevia and accreta are leading causes of major obstetric haemorrhage and peripartum hysterectomy. Detection is largely based on a high index of clinical suspicion, though the diagnostic accuracy of radiological imaging is improving. Interventional radiological techniques can reduce blood loss and the incidence of hysterectomy. METHODS We have reviewed our experience with bilateral prophylactic uterine artery balloon occlusion in the management of women with suspected placenta accreta. Thirteen women at high risk of major haemorrhage due to placenta praevia or suspected placenta accreta were retrospectively studied. Uterine artery balloons were placed prophylactically under neuraxial anaesthesia in the angiography suite followed by caesarean delivery in the obstetric operating theatre. RESULTS Intraoperative blood loss and transfusion requirements were low in our case series. There were no hysterectomies or admissions to the intensive care unit. Fetal bradycardia necessitating immediate caesarean delivery occurred in two women (15.4%). CONCLUSION In our case series in women with suspected placenta accreta, prophylactic use of uterine artery balloons was associated with a low requirement for blood transfusion but with possible increased risk of fetal compromise. Performing the interventional procedure at a different site from the operative room complicated management.
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Affiliation(s)
- J Sadashivaiah
- Department of Obstetric Anaesthesia, St. James' University Hospital, Leeds, UK.
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Machado-Linde F, Capel-Alemán A, Sánchez-Ferrer ML, Cascales-Campos P, Pérez-Carrión A, Ortiz-Vera C, Parrilla-Paricio JJ, Abad-Martínez L. Major post-traumatic non-obstetric large haematoma: transarterial embolisation. Eur J Obstet Gynecol Reprod Biol 2010; 154:118-9. [PMID: 20869803 DOI: 10.1016/j.ejogrb.2010.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 08/17/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
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47
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Webster V, Stewart R, Stewart P. A survey of interventional radiology for the management of obstetric haemorrhage in the United Kingdom. Int J Obstet Anesth 2010; 19:278-81. [DOI: 10.1016/j.ijoa.2009.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 06/15/2009] [Accepted: 10/13/2009] [Indexed: 12/29/2022]
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Abstract
Postpartum hemorrhage is a potentially life-threatening obstetric emergency that requires prompt nursing and medical interventions. In the majority of cases, initial strategies such as fundal massage and uterotonic medications will effectively stop excessive bleeding. Unfortunately, the incidence and severity of postpartum hemorrhage are on the rise and peripartum hysterectomy remains a life-saving intervention in cases of intractable bleeding. As an emerging alternative to hysterectomy, uterine artery embolization (UAE) has demonstrated success rates of more than 90% in controlling postpartum hemorrhage unresponsive to other therapies. Research to date has shown UAE to be a safe, minimally invasive procedure with few reported complications and minimal effects on future fertility. For patients who are hemodynamically stable with access to an interventional radiology suite, UAE is an important consideration in the treatment of severe postpartum bleeding. This article explores the role of UAE as a part of this management algorithm. The technical aspects of this procedure, reported complications, and effects on future fertility are described. The prophylactic use of intra-arterial balloon catheters in the management of abnormal placentation is also discussed.
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