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Capezzuoli T, Aslan B, Vannuccini S, Orlandi G, La Torre F, Sorbi F, Fambrini M, Petraglia F. Recurrence of Uterine Fibroids After Conservative Surgery or Radiological Procedures: a Narrative Review. Reprod Sci 2024; 31:1171-1178. [PMID: 38110820 DOI: 10.1007/s43032-023-01418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
The present narrative review aims to discuss the available data on the incidence and the risk factors of uterine fibroids (UFs) recurrence after different types of conservative surgical or radiologic procedures in women wishing to preserve their uterus. UFs are the most common benign tumors in women all over the world. Clinical presentation, including abnormal uterine bleeding (AUB), pelvic pain, bulky symptoms, and infertility affect patients' quality of life, and a large variety of conservative treatments are available especially for those with desire of pregnancy. Fertility sparing surgery, by either laparoscopy, hysteroscopy or laparotomy, or radiological interventions (uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound), are the most common therapeutic approaches. However, the genetic or acquired predisposition to UFs remain despite the treatments, and the recurrences are frequently described in a large percentage of patients. The most relevant risk factors for recurrence of UFs are young age at the first surgery, incomplete fibroid resection, the presence of multiple lesions, an enlarged uterus, and the coexistence with other pelvic diseases. The discussion on the possible medical strategy to reduce the recurrence is an open field of clinical investigation, in particular by using hormonal drugs.
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Affiliation(s)
- Tommaso Capezzuoli
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Batuhan Aslan
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Silvia Vannuccini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Gretha Orlandi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Francesco La Torre
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Flavia Sorbi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Massimiliano Fambrini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy.
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Habouchi MA, Tabouche M, Hamadache C, Ait Chalal R, Oukaour L, Aimeur C, Gang-Ny A, Vidal V. Feasibility of the FairEmbo Concept to Treat Women Postpartum Hemorrhage: Embolization with Suture Fragments. Cardiovasc Intervent Radiol 2024; 47:520-523. [PMID: 38112752 DOI: 10.1007/s00270-023-03626-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Affiliation(s)
- M A Habouchi
- Radiology Department CHU Bab El Oued, Faculté de Médecine d'Alger, Algiers, Algeria.
| | - M Tabouche
- Radiology Department CHU Mustapha, Faculté de Médecine d'Alger, Algiers, Algeria
| | - C Hamadache
- Radiology Department CHU Mustapha, Faculté de Médecine d'Alger, Algiers, Algeria
| | - R Ait Chalal
- Radiology Department CHU Bab El Oued, Faculté de Médecine d'Alger, Algiers, Algeria
| | - L Oukaour
- Radiology Department CHU Bab El Oued, Faculté de Médecine d'Alger, Algiers, Algeria
| | - C Aimeur
- Radiology Department CHU Mustapha, Faculté de Médecine d'Alger, Algiers, Algeria
| | - A Gang-Ny
- Radiology Departement, Hôpital La Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - V Vidal
- Radiology Departement, Hôpital La Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Nimma IR, Brahmbhatt P, Nimma S, Stancampiano F. Pantoea agglomerans bacteraemia after uterine artery embolisation: an unusual pathogen. BMJ Case Rep 2024; 17:e258345. [PMID: 38442980 PMCID: PMC10916084 DOI: 10.1136/bcr-2023-258345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
A woman in her 40s presented to the emergency department (ED) with a 3-week history of nausea, vomiting and diarrhoea. Blood cultures were positive for Serratia and Pantoea agglomerans spp. One month before her ED visit, she underwent targeted uterine artery embolisation with particles by an interventional radiologist. Uterine artery embolisation is considered a safe alternative to surgical removal of fibroids or hysterectomy. The patient was initially treated with targeted antibiotics for a large infected uterine fibroid but ultimately required a hysterectomy for source control. To our knowledge, this is the first documented case of P. agglomerans infecting a uterine fibroid.
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Affiliation(s)
- Induja Reddy Nimma
- Internal Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
| | - Pavan Brahmbhatt
- Radiology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
| | - Sindhuja Nimma
- Anesthesiology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
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Medema AM, Zanolli NC, Cline B, Pabon-Ramos W, Martin JG. Comparing magnetic resonance imaging and ultrasound in the clinical evaluation of fibroids prior to uterine artery embolization. Curr Probl Diagn Radiol 2024; 53:308-312. [PMID: 38267343 DOI: 10.1067/j.cpradiol.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Uterine artery embolization has become established as a frontline treatment for uterine leiomyomata. In planning embolization, preprocedural imaging can further characterize pathology and anatomy, but it may also reveal coexisting diagnoses that have the potential to change clinical management. The purpose of this study is to compare the diagnostic outcomes of ultrasound and MRI performed for patients prior to undergoing embolization. METHODS The study cohort consisted of 199 patients who underwent uterine artery embolization at a single academic institution between 2013 and 2018. Prior to embolization, all patients had an MRI confirming a leiomyomata diagnosis. Additionally, 118 patients underwent transvaginal ultrasound within five years prior to MRI. MRI findings were analyzed and, when applicable, compared to prior ultrasound impressions to assess for the incidence of new findings. The diagnoses of interest were adenomyosis, hydrosalpinx, predominantly infarcted leiomyomata, and large intracavitary leiomyomata. Data were collected from retrospective chart review and included demographics, symptomology, and imaging reports. RESULTS 199 patients ultimately underwent embolization for treatment of MRI-confirmed leiomyomata. Of 118 patients who also had an ultrasound within five years prior to their MRI, 26 (22.0%) received a second gynecologic diagnosis based on MRI findings that was not previously seen on ultrasound. Of 81 patients who only had an MRI before embolization, 19 (23.5%) received a second gynecologic diagnosis not previously documented. The most common coexisting pathology was adenomyosis, presenting in 34 (17.1%) patients with leiomyomata, followed by large intracavitary leiomyomata (8, 4.0%), infarcted leiomyomata (7, 3.5%), and hydrosalpinx (6, 3.0%),. CONCLUSIONS When considering uterine artery embolization for the treatment of symptomatic leiomyomata, preprocedural MRI is superior to ultrasound in detecting coexisting pathologies, including adenomyosis and hydrosalpinx. It can also better characterize leiomyomata, including identifying lesions as intracavitary or infarcted. These findings have the potential to alter clinical management or contraindicate embolization entirely.
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Affiliation(s)
- Alexis M Medema
- Duke University School of Medicine, Box 3808, Durham, NC 27710, USA
| | - Nicole C Zanolli
- Duke University School of Medicine, Box 3808, Durham, NC 27710, USA
| | - Brendan Cline
- Department of Radiology, Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
| | - Waleska Pabon-Ramos
- Department of Radiology, Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
| | - Jonathan G Martin
- Department of Radiology, Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
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Ito H, Nakai M, Yunaiyama D, Shirota N, Kobayashi T, Yasutomi M, Kikuchi T, Kinoshita Y, Takara Y, Tanaka T, Saguchi T, Saito K. Efficacy of uterine artery embolization (UAE) for uterine fibroids according to FIGO classification: a single-center experience. Jpn J Radiol 2024; 42:174-181. [PMID: 37815695 DOI: 10.1007/s11604-023-01492-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE This study aims to retrospectively evaluate the outcomes of uterine artery embolization (UAE) for uterine fibroids (UFs), specifically submucosal UFs, according to the International Federation of Gynecology and Obstetrics (FIGO) classification of UFs. MATERIALS AND METHODS Forty-two patients with symptomatic UFs underwent UAE with Embosphere® between July 2016 and November 2021. MRI was performed before, at 3 and 6 months after the UAE. At each examination, the volume of UF was measured, and the percentage volume reduction rate (VRR) was calculated. The technical success rate (TSR), symptom improvement rate (SIR), regrowth rate (RR) after 6 months, and adverse events (AEs) were examined; VRR was compared between patients with submucosal UFs (FIGO types 0-2, group A), those with submucosal contacts (FIGO type 3, group B), and those without submucosal UFs (FIGO types 4-7, group C). Statistical analysis was performed on the difference in VRR between groups A, B, and C at 3 and 6 months after UAE. The relationship with hormone levels before UAE and VRR was evaluated. RESULTS Thirty-seven of the 42 patients were evaluated. Overall, VRR was 37.0% at 3 months and 52.1% at 6 months; TSR, SIR, and RR were 100%, 95.2%, and 5.4%, respectively; VRR at 6 months was 80.7% for group A (n = 7), 57.8% for group B (n = 13), and 37.1% for group C (n = 17). Significant differences were found between A and C (p < 0.001) and B and C (p = 0.023). Hormone levels before UAE had no effect on VRR. There was no significant AEs other than grade 3 pulmonary embolism in one patient. CONCLUSION UAE was effective for submucosal FIGO types 0-3. UAE was especially useful as an option for FIGO type 3 with a low protrusion rate that is difficult to treat with transcervical resection.
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Affiliation(s)
- Hiroe Ito
- Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Motoki Nakai
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan.
| | - Daisuke Yunaiyama
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Natsuhiko Shirota
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Takehiro Kobayashi
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Mika Yasutomi
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Takayuki Kikuchi
- Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Yuta Kinoshita
- Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Yuki Takara
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Taro Tanaka
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Toru Saguchi
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
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Wu Q, Motaghi M, Tang H, Hazhirkarzar B, Shaghaghi M, Ghadimi M, Baghdadi A, Rezvani R, Mohseni A, Borhani A, Madani SP, Afyouni S, Zandieh G, Kamel IR. Outcome prediction for symptomatic patients with fibroids who underwent uterine artery embolization. Clin Imaging 2024; 105:110028. [PMID: 38039750 DOI: 10.1016/j.clinimag.2023.110028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE To predict the clinical outcome of symptomatic patients with uterine leiomyomas who underwent uterine artery embolization (UAE), based on clinical and radiological features. METHODS Patients with symptomatic uterine leiomyomas who underwent UAE from March 2010 to September 2019 were consecutively included in this retrospective study. Patients with persistent or recurrent symptoms and those who needed repeated UAE, myomectomy, or hysterectomy following the initial treatment were considered to have a poor outcome after UAE. The total and enhancing volume of the dominant leiomyoma in each location and uterine volume were obtained before and after UAE. Univariate and multivariate Cox proportional hazard analyses were used to evaluate the parameters that could predict poor outcome. RESULTS A total of 116 patients (mean age, 45 ± 5 years) were included. Forty-six patients (46/116, 39.7%) showed poor outcome. Cox regression analysis showed higher hazard of poor outcome for younger patients vs. older patients (HR: 0.92, p-value: 0.01), patients with adenomyosis vs. patients without adenomyosis (HR: 2.47, p-value < 0.01), patients with adenomyosis thickness > 2.5 cm before UAE vs. patients without adenomyosis (HR: 4.2, p-value < 0.01) and for patients with intramural fibroid enhancement volume > 440 cm3 compared to patients with no intramural fibroids (p-value: 0.06). Multivariate Cox regression analysis including age, the thickness of adenomyosis, and intramural leiomyoma volume of enhancement before UAE was chosen as the best model to predict the outcome. CONCLUSIONS Pretreatment clinical and MRI features could identify patients with a higher risk for poor outcome after UAE.
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Affiliation(s)
- Qingxia Wu
- Department of Medical Imaging, Henan Key Laboratory of Neurological Imaging, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, Henan, China; Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mina Motaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hao Tang
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maryam Ghadimi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Azarakhsh Baghdadi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roya Rezvani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alireza Mohseni
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ali Borhani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seyedeh Panid Madani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shadi Afyouni
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ghazal Zandieh
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Li H, Cheng W, Wen J, Peng J, Wu S, Zhao Y, Xia W. Clinical analysis of prophylactic uterine artery embolization combined with double balloon catheter for second-trimester pregnancy termination in cases of complete placenta previa: A retrospective study. Medicine (Baltimore) 2023; 102:e36240. [PMID: 38013334 PMCID: PMC10681560 DOI: 10.1097/md.0000000000036240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
Complete placenta previa often causes significant bleeding in a short period during second-trimester pregnancy termination. This can destabilize the mother's circulation, threatening her life. Furthermore, the condition is complicated by an immature cervix, making it a challenging clinical problem. The aim of this study was to investigate the effect of prophylactic uterine artery embolization (UAE) combined with double balloon catheter (DBC) deal with those cases. A total of 7 patients who underwent pregnancy termination in the second-trimester in Maternal and Child Health Hospital of Hubei Province between March 1st, 2021 and August 31st, 2023 were retrospectively analyzed in this study. All patients were diagnosed with complete placenta previa status and placenta accreta spectrum, and were treated with prophylactic UAE combined with DBC, and/or dilation and evacuation. All the patients received mifepristone, and 5 of them underwent medical termination with ethacridine lactate. Following prophylactic UAE combined with DBC, 6 patients underwent dilation and evacuation, which was monitored by ultrasound. And one patient experienced natural delivery of their fetus and placenta. Only one patient (patient 3) developed an intrapartum fever after prolonged duration of 18 hours from ethacridine to UAE and 56 hours from UAE to DBC. The amount of intrapartum hemorrhage ranged from 20 mL to 300 mL. The combined therapy of prophylactic UAE and DBC is a preferred option for patients with complete placenta previa undergoing second-trimester pregnancy termination. The use of dilation and evacuation may depend on the cervical condition, bleeding, or infection.
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Affiliation(s)
- Hao Li
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenxing Cheng
- Wuhan University of Science and Technology, Wuhan, China
| | - Jiao Wen
- Wuhan University of Science and Technology, Wuhan, China
| | - Jing Peng
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiyao Wu
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weina Xia
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Shlansky-Goldberg RD. Invited Editorial Comment for Cardiovascular Interventional Radiology on the Article Entitled: Predictors and Clinical Outcome of Fibroid Expulsion after Uterine Artery Embolization. Cardiovasc Intervent Radiol 2023; 46:1594-1595. [PMID: 37794180 DOI: 10.1007/s00270-023-03569-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Richard D Shlansky-Goldberg
- Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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Wang Z, Chang Y, Li S. Efficacy and Safety of High-intensity Focused Ultrasound Compared with Uterine Artery Embolization in Cesarean Section Pregnancy: A Meta-analysis. J Minim Invasive Gynecol 2023; 30:931-932. [PMID: 37586477 DOI: 10.1016/j.jmig.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Zuoying Wang
- Department of Gynaecology, Baiyin City Maternal and Child Health Care Hospital, Baiyin City 730900, Gansu, China
| | - Yan Chang
- Department of Gynaecology, The First People's Hospital of Baiyin, Baiyin City 730900, Gansu, China
| | - Shuxia Li
- Department of Gynaecology, The First People's Hospital of Baiyin, Baiyin City 730900, Gansu, China.
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Li H, Tan H. Regarding "Efficacy and Safety of High-intensity Focused Ultrasound Compared with Uterine Artery Embolization in Cesarean Section Pregnancy: A Meta-analysis". J Minim Invasive Gynecol 2023; 30:931. [PMID: 37643660 DOI: 10.1016/j.jmig.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Hongchun Li
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, 445000, China
| | - Haiyan Tan
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, 445000, China.
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Sasakura Y, Katsumori T, Nishizawa K, Nishimura T, Yoshikawa T, Takahata A, Yamada K. Incidence and changes in endometrial-leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis. Eur Radiol 2023; 33:8157-8164. [PMID: 37284865 DOI: 10.1007/s00330-023-09794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To investigate whether the number and size of endometrial-leiomyoma fistulas (ELFs) change following uterine artery embolization (UAE) for leiomyoma and the correlation between ELFs and vaginal discharge (VD). MATERIALS & METHODS This study was a retrospective analysis of 100 patients who underwent UAE at a single institution between May 2016 and March 2021. They all underwent MRI at baseline, 4 months, and 1 year after UAE. The number and size of the ELFs were compared with the MRI images each time. The ELF tumor characteristics and the correlation between the ELFs and VD were assessed. Additional gynecologic interventions due to VD associated with ELFs were evaluated. RESULTS No ELF was observed at baseline. Ten ELFs were noted in nine patients at 4 months, and 35 ELFs were noted in 32 patients 1 year after UAE. The ELFs significantly increased over time (p = 0.004, baseline vs. 4 months; p < 0.001, 4 months vs. 1 year). The ELF size did not significantly change over time (p = 0.941). The tumors developing ELFs after UAE were mainly located at the submucosal or intramural area contacting the endometrium at baseline, with a mean size of 7.1 (2.6) cm. Nineteen patients (19%) had VD 1 year after UAE. There was no significant correlation between VD and the number of ELFs (p = 0.80). No patients underwent additional gynecologic interventions due to VD associated with ELFs. CONCLUSION ELFs increased in number and did not disappear over time after UAE in most tumors. CLINICAL RELEVANCE STATEMENT Despite the MR imaging findings, within the limited data of this study, ELFs were not seemingly associated with clinical symptoms, including VD. KEY POINTS • Endometrial-leiomyoma fistula (ELF) is a complication of uterine artery embolization (UAE). • ELFs increased in number over time after UAE and did not disappear in most tumors. • Most tumors developing ELFs after UAE were located near/contacted the endometrium and were larger.
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Affiliation(s)
- Yasuteru Sasakura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan.
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Kaori Nishizawa
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Tomoaki Nishimura
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Tatsuya Yoshikawa
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Akiko Takahata
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan
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Pietura R, Wozniak S, Toborek M, Kwolek K, Pietron N. Three natural pregnancies following embolization of both uterine arteries due to pseudoaneurysms associated with the gestational trophoblastic disease - long-term follow-up. Ginekol Pol 2023; 95:316-317. [PMID: 37801617 DOI: 10.5603/gpl.96571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 10/08/2023] Open
Affiliation(s)
- Radoslaw Pietura
- Department of Radiography, Medical University of Lublin, Poland
- Department of Diagnostic Imaging, Public University Hospital No. 1 in Lublin, Poland
| | - Slawomir Wozniak
- 3rd Chair and Department of Gynecology, Independent Public Teaching Hospital No 4, Lublin, Poland
| | - Michal Toborek
- Department of Radiography, Medical University of Lublin, Poland
- Department of Diagnostic Imaging, Public University Hospital No. 1 in Lublin, Poland
| | - Kinga Kwolek
- Department of Diagnostic Imaging, Public University Hospital No. 1 in Lublin, Poland.
- Department of Radiography, Medical University of Lublin, Poland.
| | - Natalia Pietron
- Department of Radiography, Medical University of Lublin, Poland
- Department of Diagnostic Imaging, Public University Hospital No. 1 in Lublin, Poland
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Gao F, Lu Y, Guo X, Gao J, Wang W, Cheng J, Fu L. Complex Blood Supply Patterns in Cesarean Scar Pregnancy: Insights from Digital Subtraction Angiography Imaging. Med Sci Monit 2023; 29:e940133. [PMID: 37653724 PMCID: PMC10478579 DOI: 10.12659/msm.940133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/31/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Understanding the blood supply pattern of cesarean scar pregnancy (CSP) can effectively help to determine the best choice of treatment. The aim of this study was to investigate the blood supply pattern and outcomes of patients with CSP through digital subtraction angiography (DSA) imaging. MATERIAL AND METHODS This was a retrospective cohort study. Patients were divided into 2 groups according to the type of CSP. The DSA images of these patients were reviewed, including the type of blood supply, dominant vessel, and collateral blood supply to the gestational sac. The clinical outcomes were analyzed between the 2 groups. RESULTS Thirty-seven patients with type I and 29 patients with type II CSP were enrolled in this study. Type II CSP showed a higher proportion of rich blood supply than type I (44.83% vs 29.72%, P>0.05). Compared with type II CSP, type I CSP tended to have bilateral dominant blood supply predominance (67.57% vs 41.38%, P<0.05). The incidence of collateral blood supply was 5.41% in the type I CSP group and 31.03% in the type II CSP group (P<0.05). In the type II CSP group, multiple collateral blood vessels were found in 4 patients. The superior vesicle artery was the most common source of collateral blood supply in both groups. Two patients with type II CSP suffered massive bleeding during surgery after uterine artery embolization (UAE). None of the patients received a hysterectomy. CONCLUSIONS UAE is safe and effective for both types of CSP. The blood supply pattern is more complex and abnormal in type II CSP. More attention should be paid to the collateral blood supply to achieve complete embolization during the UAE procedure in the case of type II CSP.
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Affiliation(s)
- Feng Gao
- Department of Radiology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Yu Lu
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Xiaoqing Guo
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Jie Gao
- Department of Radiology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Wenjing Wang
- Department of Radiology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Jiejun Cheng
- Department of Radiology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Le Fu
- Department of Radiology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, PR China
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Machado P, Gillmore K, Tan A, Gonsalves C, Forsberg F. Contrast-Enhanced Ultrasound and High Sensitive Doppler for Monitoring Outcomes of Uterine Artery Embolization. Acad Radiol 2023; 30 Suppl 2:S211-S219. [PMID: 37330354 PMCID: PMC10524109 DOI: 10.1016/j.acra.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
RATIONALE AND OBJECTIVES To monitor fibroid microvascularity using contrast-enhanced ultrasound (CEUS) and a new high-sensitive Doppler mode (SMI) for assessment of uterine artery embolization (UAE) outcomes. MATERIALS AND METHODS Forty women with symptomatic uterine fibroids scheduled for UAE were enrolled in this Institutional Review Board-approved study. Subjects underwent three examinations (day 0, 15, and 90 post-UAE) with Color Doppler (CDI), power Doppler (PDI), color and monochrome SMI (cSMI and mSMI), and CEUS imaging of the fibroids. Clips were assessed by two radiologists classifying fibroids based on their vascularity. Fibroid fractional vascularity (FV; % of enhanced pixels within the fibroid) and flow intensity (as mean brightness level of the enhanced pixels) were quantified. Results were analyzed using repeated measures ANOVA and nonparametric Wilcoxon sign rank tests. Inter-reader agreement was assessed with κ-values. RESULTS There was overall agreement between readers for all imaging modalities and examination times (P = .25; κ = 0.70). The FV analysis showed statistically significant differences between CEUS and the Doppler imaging modes (CDI, PDI, cSMI, and mSMI) for the three examination times were compared (P < .0001). The comparison using CDI, PDI, and cSMI showed no statistically significant difference (P = .53). The flow intensity analysis comparison between the Doppler imaging modes (CDI, PDI, cSMI and mSMI) and examination times showed statistically significant differences between all the Doppler imaging modalities (P = .02), except for the 90days post-UAE (P = .34). When the comparison was made for CDI, PDI, and cSMI there was no statistically significant differences (P < .47). CONCLUSION CEUS and SMI can accurately evaluate fibroid microvascularity, and therefore, can be a noninvasive and accurate method for monitoring outcomes following UAE treatment.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, 132 S 10th St, Main 763M, Philadelphia, PA 19107 (P.M., K.G., A.T., C.G., F.F.).
| | - Kathleen Gillmore
- Department of Radiology, Thomas Jefferson University, 132 S 10th St, Main 763M, Philadelphia, PA 19107 (P.M., K.G., A.T., C.G., F.F.); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (K.G.)
| | - Allison Tan
- Department of Radiology, Thomas Jefferson University, 132 S 10th St, Main 763M, Philadelphia, PA 19107 (P.M., K.G., A.T., C.G., F.F.)
| | - Carin Gonsalves
- Department of Radiology, Thomas Jefferson University, 132 S 10th St, Main 763M, Philadelphia, PA 19107 (P.M., K.G., A.T., C.G., F.F.)
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, 132 S 10th St, Main 763M, Philadelphia, PA 19107 (P.M., K.G., A.T., C.G., F.F.)
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Anchan RM, Spies JB, Zhang S, Wojdyla D, Bortoletto P, Terry K, Disler E, Milne A, Gargiulo A, Petrozza J, Brook O, Srouji S, Morton CC, Greenberg J, Wegienka G, Stewart EA, Nicholson WK, Thomas L, Venable S, Laughlin-Tommaso S, Diamond MP, Maxwell GL, Marsh EE, Myers ER, Vines AI, Wise LA, Wallace K, Jacoby VL. Long-term health-related quality of life and symptom severity following hysterectomy, myomectomy, or uterine artery embolization for the treatment of symptomatic uterine fibroids. Am J Obstet Gynecol 2023; 229:275.e1-275.e17. [PMID: 37244458 DOI: 10.1016/j.ajog.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Few studies have directly compared different surgical procedures for uterine fibroids with respect to long-term health-related quality of life outcomes and symptom improvement. OBJECTIVE We examined differences in change from baseline to 1-, 2-, and 3-year follow-up in health-related quality of life and symptom severity among patients who underwent abdominal myomectomy, laparoscopic or robotic myomectomy, abdominal hysterectomy, laparoscopic or robotic hysterectomy, or uterine artery embolization. STUDY DESIGN The COMPARE-UF registry is a multiinstitutional prospective observational cohort study of women undergoing treatment for uterine fibroids. A subset of 1384 women aged 31 to 45 years who underwent either abdominal myomectomy (n=237), laparoscopic myomectomy (n=272), abdominal hysterectomy (n=177), laparoscopic hysterectomy (n=522), or uterine artery embolization (n=176) were included in this analysis. We obtained demographics, fibroid history, and symptoms by questionnaires at enrollment and at 1, 2, and 3 years posttreatment. We used the UFS-QoL (Uterine Fibroid Symptom and Quality of Life) questionnaire to ascertain symptom severity and health-related quality of life scores among participants. To account for potential baseline differences across treatment groups, a propensity score model was used to derive overlap weights and compare total health-related quality of life and symptom severity scores after enrollment with a repeated measures model. For this health-related quality of life tool, a specific minimal clinically important difference has not been determined, but on the basis of previous research, a difference of 10 points was considered as a reasonable estimate. Use of this difference was agreed upon by the Steering Committee at the time when the analysis was planned. RESULTS At baseline, women undergoing hysterectomy and uterine artery embolization reported the lowest health-related quality of life scores and highest symptom severity scores compared with those undergoing abdominal myomectomy or laparoscopic myomectomy (P<.001). Those undergoing hysterectomy and uterine artery embolization reported the longest duration of fibroid symptoms with a mean of 6.3 years (standard deviation, 6.7; P<.001). The most common fibroid symptoms were menorrhagia (75.3%), bulk symptoms (74.2%), and bloating (73.2%). More than half (54.9%) of participants reported anemia, and 9.4% women reported a history of blood transfusion. Across all modalities, total health-related quality of life and symptom severity score markedly improved from baseline to 1-year with the largest improvement in the laparoscopic hysterectomy group (Uterine Fibroids Symptom and Quality of Life: delta= [+] 49.2; symptom severity: delta= [-] 51.3). Those undergoing abdominal myomectomy, laparoscopic myomectomy, and uterine artery embolization also demonstrated significant improvement in health-related quality of life (delta= [+]43.9, [+]32.9, [+]40.7, respectively) and symptom severity (delta= [-]41.4, [-] 31.5, [-] 38.5, respectively) at 1 year, and the improvement persisted from baseline for uterine-sparing procedures during second (Uterine Fibroids Symptom and Quality of Life: delta= [+]40.7, [+]37.4, [+]39.3 SS: delta= [-] 38.5, [-] 32.0, [-] 37.7 and third year (Uterine Fibroids Symptom and Quality of Life: delta= [+] 40.9, [+]39.9, [+]41.1 and SS: delta= [-] 33.9, [-]36.5, [-] 33.0, respectively), posttreatment intervals, however with a trend toward decline in degree of improvement from years 1 and 2. Differences from baseline were greatest for hysterectomy; however, this may reflect the relative importance of bleeding in the Uterine Fibroids Symptom and Quality of Life, rather than clinically meaningful symptom recurrence among women undergoing uterus-sparing treatments. CONCLUSION All treatment modalities were associated with significant improvements in health-related quality of life and symptom severity reduction 1-year posttreatment. However, abdominal myomectomy, laparoscopic myomectomy and uterine artery embolization indicated a gradual decline in symptom improvement and health-related quality of life by third year after the procedure.
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Affiliation(s)
- Raymond M Anchan
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Biostatistics, Yale School of Public Health, New Haven CT.
| | - James B Spies
- Department of Radiology, Georgetown University School of Medicine, Washington, DC
| | - Shuaiqi Zhang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY
| | - Kathryn Terry
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily Disler
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ankrish Milne
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Antonio Gargiulo
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - John Petrozza
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Olga Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Serene Srouji
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Cynthia C Morton
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, United Kingdom
| | - James Greenberg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Elizabeth A Stewart
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN
| | - Wanda K Nicholson
- Department of Obstetrics & Gynecology, Center for Women's Health Research, and Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laine Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | | | - Shannon Laughlin-Tommaso
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA
| | - G Larry Maxwell
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA
| | - Erica E Marsh
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Kedra Wallace
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS
| | - Vanessa L Jacoby
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA; Department of Radiology, Georgetown University School of Medicine, Washington, DC
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Lee S, Stewart EA. New treatment options for nonsurgical management of uterine fibroids. Curr Opin Obstet Gynecol 2023; 35:288-293. [PMID: 37144584 PMCID: PMC10330353 DOI: 10.1097/gco.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Uterine fibroids is a common problem in reproductive-age individuals, frequently causing abnormal uterine bleeding, bulk symptoms, and adverse reproductive outcomes. Traditionally, almost half of the women with symptomatic fibroids received surgery for definitive treatment. There are a growing number of nonsurgical options for treatment that have become available for patients who desire conservative treatment or those with contraindications to surgery. RECENT FINDINGS The introduction of oral gonadotropin-releasing hormone antagonists in combination with low-dose physiologic hormonal therapy demonstrated improvement in heavy menstrual bleeding, pain, and quality of life with preservation of bone density and a modest reduction in uterine volume with few hypogonadal side effects. Magnetic resonance-guided focused ultrasound surgery and uterine artery embolization continue to be minimally invasive procedural alternatives to hysterectomy that are safe and effective. SUMMARY As more options for conservative management of uterine fibroids became available, it is important to counsel patients on possible options based on the size, location, and number of the fibroids as well as severity of the symptoms, plans for pregnancy, how close they are to menopause and their treatment goals.
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Affiliation(s)
- SiWon Lee
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth A. Stewart
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
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MacGregor B, Munro MG, Lumsden MA. Therapeutic options for the management of abnormal uterine bleeding. Int J Gynaecol Obstet 2023; 162 Suppl 2:43-57. [PMID: 37538018 DOI: 10.1002/ijgo.14947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Just as the investigation of abnormal uterine bleeding (AUB) is approached systematically using the two FIGO systems for AUB in the reproductive years, treatment options can be considered similarly. Therapeutic options fall into two categories-medical and surgical-and while medical management is typically regarded as first-line therapy, there are several exceptions defined by the presenting cause or causes, mainly when infertility is a concurrent issue. In the early 1990s, up to 60% of women underwent a hysterectomy for the symptom of heavy menstrual bleeding (HMB), but this figure has decreased. The number of women undergoing a hysterectomy for benign disorders continues to decline, along with an increase in hysterectomies performed using minimally invasive techniques. Discussions about therapeutic options are tailored to the individual patient, and we include the risks and benefits of each option, including no management, to enable the patient to make an informed choice. The different types of treatment options and the factors affecting decision-making are considered in this article.
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Affiliation(s)
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
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Munoz JL, Blankenship LM, Ramsey PS, McCann GA. Implementation and outcomes of a uterine artery embolization and tranexamic acid protocol for placenta accreta spectrum. Am J Obstet Gynecol 2023; 229:61.e1-61.e7. [PMID: 36965865 DOI: 10.1016/j.ajog.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Placenta accreta spectrum disorders are a continuum of placental pathologies with significant maternal morbidity and mortality. Morbidity is related to the overall degree of placental adherence, and thus patients with placenta increta or percreta represent a high-risk category of patients. Hemorrhage and transfusion of blood products represent 90% of placenta accreta spectrum morbidity. Both tranexamic acid and uterine artery embolization independently decrease obstetrical hemorrhage. OBJECTIVE This study aimed to provide an evidence-based intraoperative protocol for placenta accreta spectrum management. STUDY DESIGN This study was a pre- and postimplementation analysis of concomitant uterine artery embolization and tranexamic acid in cases of patients with antenatally suspected placenta increta and percreta over a 5-year period (2018-2022). For comparison, a 5-year (2013-2017) preimplementation group was used to assess the impact of the uterine artery embolization and tranexamic acid protocol for placenta accreta spectrum. Patient demographics and clinically relevant outcomes were obtained from electronic medical records. RESULTS A total of 126 cases were managed by the placenta accreta spectrum team, of which 66 had suspected placenta increta/percreta over the 10-year time period. Two patients were excluded from the postimplementation cohort because they did not undergo both interventions. Thus, 30 (30/64; 47%) were treated after implementation of the uterine artery embolization and tranexamic acid protocol for placenta accreta spectrum, and 34 (34/64; 53%) preimplementation patients did not undergo uterine artery embolization or tranexamic acid infusion. With the uterine artery embolization and tranexamic acid protocol, operative times were longer (416 vs 187 minutes; P<.01), and patients were more likely to receive general anesthesia (80% vs 47%; P<.01). However, blood loss was reduced by 33% (2000 vs 3000 cc; P=.03), overall blood transfusion rates decreased by 51% (odds ratio, 0.05 [95% confidence interval, 0.001-0.20]; P<.01), and massive blood transfusion (>10 units transfused) was reduced 5-fold (odds ratio, 0.17 [95% confidence interval, 0.02-0.17]; P=.02). Postoperative complication rates remained unchanged (4 vs 10 events; P=.14). Neonatal outcomes were equivalent. CONCLUSION The uterine artery embolization and tranexamic acid protocol for placenta accreta spectrum is an effective approach to the standardization of complex placenta accreta spectrum cases that results in optimal perioperative outcomes and reduced maternal morbidity.
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Affiliation(s)
- Jessian L Munoz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
| | - Logan M Blankenship
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Texas Health Science Center at San Antonio, University Health System, San Antonio, TX
| | - Patrick S Ramsey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Texas Health Science Center at San Antonio, University Health System, San Antonio, TX
| | - Georgia A McCann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Texas Health Science Center at San Antonio, University Health System, San Antonio, TX
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He Y, Liu M, Yang YJ, Li L, Huang Q, Liu L. Prophylactic uterine artery embolization during cesarean delivery for management of hemorrhage in complete placenta previa: An observational study. Medicine (Baltimore) 2023; 102:e34052. [PMID: 37327290 PMCID: PMC10270538 DOI: 10.1097/md.0000000000034052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
Complete placenta previa is a major cause of morbidity and mortality in pregnant women and fetuses. This study aimed to evaluate whether prophylactic uterine artery embolization (PUAE) could reduce bleeding in patients with complete placenta previa. We retrospectively analyzed patients with complete placenta previa admitted to Taixing People's Hospital for elective cesarean delivery between January 2019 and December 2020. The women were treated with PUAE (PUAE group, n = 20) or without (control group, control, n = 20). Risk factors for bleeding (age, gestational age, pregnancy times, delivery times, cesarean delivery times), intraoperative blood loss, hemoglobin difference before and after surgery, transfusions volume, hysterectomy cases, major maternal complication cases, neonatal birth weight, neonatal Apgar score in 1 minute, postoperative hospitalization time were compared between 2 groups. There were no significant differences on risk factors for bleeding, neonatal birth weight, neonatal Apgar score in 1 minute, postoperative hospitalization time between 2 groups. However, the intraoperative blood loss, hemoglobin before and after operation, transfusion volume in the PUAE group was significantly lower than the control. There was no case of hysterectomy or major maternal complications in both groups. PUAE during cesarean may be an effective and safe strategy to reduce intraoperative blood loss and transfusion volume for patients with complete placenta previa.
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Affiliation(s)
- Yun He
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
| | - Min Liu
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
| | - Ya Jing Yang
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
| | - Li Li
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
| | - Qing Huang
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
| | - Lanhua Liu
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
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Amoah A, Quinn SD. Uterine-preserving treatments or hysterectomy reintervention after myomectomy or uterine artery embolisation: A retrospective cohort study of long-term outcomes. BJOG 2023; 130:823-831. [PMID: 36706789 DOI: 10.1111/1471-0528.17412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess comparative rates of further uterine-preserving procedures (UPP) or hysterectomy reintervention, after myomectomy or uterine artery embolisation (UAE). DESIGN Population-based, retrospective cohort study. SETTING England. POPULATION Women who underwent myomectomy or UAE between 2010 and 2015 under the NHS. METHODS Data was abstracted from NHS Health Episode Statistics datasets. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional-hazards regression. MAIN OUTCOMES MEASURES 30-day readmission, UPP and hysterectomy reintervention rates. RESULTS 9443 and 6224 women underwent elective myomectomy or UAE, respectively. After 118 136 total person-years of follow-up, the rate of hysterectomy was 8.34 and 20.98 per 1000 patient years for myomectomy or UAE, respectively. There was a 2.4-fold increased risk of undergoing hysterectomy after UAE when compared with myomectomy in adjusted models (HR 2.38 [95% CI 2.10-2.66]) [adjusted for age, ethnicity, multiple deprivation index, geographical region and comorbidities]. The HR for undergoing a UPP reintervention was 1.44 (95% CI 1.29-1.60) in favour of myomectomy. The rate of hysterectomy was increased 22% following UAE compared with laparoscopic myomectomy (0.97-1.52). Age may influence reintervention rates, and there was variation in hysterectomy risk when stratified by geographical region. CONCLUSIONS After a median of 7 years of follow-up, there is a 2.4-fold increased rate of hysterectomy and 44% increased risk of UPPs as reintervention after UAE, relative to myomectomy. These findings will aid pre-procedure counselling for women with fibroids. Future work should investigate the effect of other outcome modifiers, such as fertility intentions and fibroid anatomical characteristics.
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Zhang Y, Xu Y, Zhang X, Zheng B, Hu W, Yuan G, Si G. 8Spheres conformal microspheres as embolic agents for symptomatic uterine leiomyoma therapy in uterine artery embolization (UAE): A prospective clinical trial. Medicine (Baltimore) 2023; 102:e33099. [PMID: 36862859 PMCID: PMC9981361 DOI: 10.1097/md.0000000000033099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
To evaluate the treatment efficacy of uterine artery embolization (UAE) using 8Spheres conformal microspheres for symptomatic uterine leiomyoma. In this prospective observational study, 15 patients were enrolled and underwent UAE by 2 experienced interventionalists from September 1, 2018, to September 1, 2019. All patients underwent menstrual bleeding scores, the symptom severity domain of the Uterine Fibroid Symptom and Quality of Life questionnaire scores (with lower scores indicating mild symptoms), pelvic contrast-enhanced magnetic resonance imaging, ovarian reserve tests (estradiol, prolactin, testosterone, follicle-stimulating, luteinizing, and progesterone), and other appropriate preoperative examinations within 1 week before UAE. During follow-up, menstrual bleeding scores and the symptom severity domain of the Uterine Fibroid Symptom and Quality of Life questionnaire scores were recorded at 1, 3, 6, and 12 months after UAE to assess the efficacy of symptomatic uterine leiomyoma. Pelvic contrast-enhanced magnetic resonance imaging was performed 6 months after the interventional therapy. Biomarkers of ovarian reserve function were reviewed at 6 and 12 months after treatment. All 15 patients successfully underwent UAE, without severe adverse effects. Six patients experienced abdominal pain, nausea, or vomiting, all of which improved significantly after symptomatic treatment. The menstrual bleeding scores declined from baseline (350.2 ± 61.9 mL) to (131.8 ± 42.7 mL), (140.3 ± 42.4 mL), (68.0 ± 22.8 mL), and (64.43 ± 17.0 mL) at 1, 3, 6, and 12 months, respectively. The symptom severity domain scores at 1, 3, 6, and 12 months postoperatively were significantly lower and statistically significant compared to the preoperative scores. The uterus and dominant leiomyoma volumes decreased from baseline (340.0 ± 35.8 cm3), (100.6 ± 24.3 cm3) to (266.6 ± 30.9 cm3), (56.1 ± 17.3 cm3) at 6 months after UAE, respectively. Moreover, the ratio of leiomyoma volumes and uterus decreased from (27.4 ± 4.5%) to (18.7 ± 3.9%). At the same time, there was no significant effect on changes in the biomarkers of ovarian reserve levels. Only the changes in testosterone levels before and after UAE were statistically significant (P < .05). 8Spheres conformal microspheres are ideal embolic agents for UAE therapy. This study showed that 8Spheres conformal microsphere embolization for symptomatic uterine leiomyoma could effectively relieve heavy menstrual bleeding, improve the symptom severity of patients, reduce the volume of leiomyoma, and have no significant effect on ovarian reserve function.
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Affiliation(s)
- Yiwen Zhang
- Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Yanneng Xu
- Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Xun Zhang
- Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Bo Zheng
- Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Wei Hu
- Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Gang Yuan
- Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Guangyan Si
- Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- *Correspondence: Guangyan Si, Department of Interventional Radiology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China (e-mail )
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22
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Dai Y, Peng Y, Shi Q, Jin P, Wang Z. Comparison of menstruation recovery after ultrasound-guided suction curettage in patients with cesarean scar pregnancy pretreated using high-intensity focused ultrasound and uterine artery embolization. Int J Hyperthermia 2023; 40:2241686. [PMID: 37698065 DOI: 10.1080/02656736.2023.2241686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVES To investigate the menstruation recovery after two therapeutic regimens, high-intensity focused ultrasound (HIFU) or uterine artery embolization (UAE) combined with ultrasound-guided suction curettage, for premenopausal women with cesarean scar pregnancy (CSP). MATERIALS AND METHODS Seventy patients with CSP treated with HIFU followed by ultrasound-guided suction curettage and 63 patients with CSP treated with UAE followed by ultrasound-guided suction curettage in our hospital were retrospectively reviewed. The treatment parameters and the menstrual blood loss (MBL) volume at 6 months after the two therapeutic regimens were compared between the two groups. RESULTS There was no significant difference in treatment results between the two groups. With regard to postoperative MBL volume, 5 out of 70 patients in the HIFU group and 22 out of 63 patients in UAE group exhibited a reduction in MBL, respectively. Multivariate logistic regression revealed that hypomenorrhea was more likely to occur in the UAE group than in the HIFU group (UAE group vs. HIFU group; OR 11.328, 95% CI 3.158-55.871; p < 0.001). CONCLUSION Compared to UAE, HIFU has less influence on postoperative MBL volume, which may be a fertility-sparing option for patients with CSP.
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Affiliation(s)
- Yu Dai
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, P.R. China
- Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Yan Peng
- Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, P.R. China
- School of Public Health and Management, Chongqing Medical University, Chongqing, People's Republic of China
| | - Ping Jin
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, P.R. China
- Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, P.R. China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, P.R. China
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Wolgemuth T, Suresh N, Holder K, Milad MP. Informational Preferences of Women Seeking Treatment for Symptomatic Uterine Fibroids: A Qualitative Study. J Minim Invasive Gynecol 2022; 30:284-289. [PMID: 36528257 DOI: 10.1016/j.jmig.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/22/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE To establish the informational needs and preferences of women navigating treatment options for symptomatic uterine fibroids. DESIGN Qualitative study using semistructured interviews. SETTING Academic institution. PATIENTS Participants had a diagnosis of symptomatic uterine fibroids with an active treatment plan. INTERVENTIONS Semistructured video interviews were conducted with female patients undergoing treatment for symptomatic uterine fibroids (n = 20). Women were recruited from the outpatient Center for Complex Gynecology in Chicago, IL. Interviews were recorded and transcribed verbatim. A codebook was developed based on the interview transcripts, and the finalized coding was used to conduct a thematic analysis. MEASUREMENTS AND MAIN RESULTS Four distinct themes emerged from the interviews: (1) Social supports-including social media-play an important role in informing patients' treatment choices; (2) Patients spend significant energy seeking additional information beyond their obstetrician-gynecologist; (3) Patients prioritize receiving full and complete information from their provider; and (4) Patients experience information-related delays in receiving care. CONCLUSION Patients seeking care for symptomatic uterine fibroids have strong preferences about both the quality and extent of information they receive from their gynecologists. Physicians treating these conditions must adapt to changing informational desires and consider expanding physician engagement with patients' social media needs.
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Affiliation(s)
- Tierney Wolgemuth
- Department of Obstetrics and Gynecology, Northwestern University (Drs. Wolgemuth and Milad), Chicago, IL.
| | - Nila Suresh
- Northwestern University Feinberg School of Medicine (Drs. Suresh and Holder), Chicago, IL
| | - Kai Holder
- Northwestern University Feinberg School of Medicine (Drs. Suresh and Holder), Chicago, IL
| | - Magdy P Milad
- Department of Obstetrics and Gynecology, Northwestern University (Drs. Wolgemuth and Milad), Chicago, IL
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24
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Bailleul A, Azaïs H, Koual M, Simon V, Vulser C, Bats AS, Sapoval M. [How I do… uterine artery embolization for the treatment of a symptomatic uterine myoma]. Gynecol Obstet Fertil Senol 2022; 50:638-642. [PMID: 35470128 DOI: 10.1016/j.gofs.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Affiliation(s)
- A Bailleul
- Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 75015 Paris, France
| | - H Azaïs
- Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 75015 Paris, France; Inserm UMR-S 1147, université de Paris, centre de recherche des cordeliers, Paris, France; Faculté de médecine Paris-Descartes, université de Paris, 75006 Paris, France
| | - M Koual
- Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 75015 Paris, France; Faculté de médecine Paris-Descartes, université de Paris, 75006 Paris, France; Inserm UMR-S 1124, université de Paris, centre universitaire des Saints-Pères, Paris, France
| | - V Simon
- Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 75015 Paris, France; Faculté de médecine Paris-Descartes, université de Paris, 75006 Paris, France
| | - C Vulser
- Unité d'évaluation et de traitement de la douleur, hôpital européen Georges-Pompidou (HEGP), 75015 Paris, France
| | - A-S Bats
- Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou (HEGP), 75015 Paris, France; Inserm UMR-S 1147, université de Paris, centre de recherche des cordeliers, Paris, France; Faculté de médecine Paris-Descartes, université de Paris, 75006 Paris, France
| | - M Sapoval
- Faculté de médecine Paris-Descartes, université de Paris, 75006 Paris, France; Service de radiologie interventionnelle vasculaire et oncologique, hôpital européen Georges-Pompidou (HEGP), 75015 Paris, France; Inserm PARC HEGP UMR 970, Paris, France.
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25
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Shi J, Ge YR, Ni J, Dong X. The Role of Transvaginal Two-Dimensional Ultrasound Combined With Color Doppler in the Evaluation of Ovarian Function and Fertility After Uterine Artery Embolization. J Ultrasound Med 2022; 41:1575-1583. [PMID: 34609766 DOI: 10.1002/jum.15844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Our study seeks to assess the value of transvaginal two-dimensional ultrasound combined with color Doppler in evaluating ovarian function and reproductive function after uterine artery embolization (UAE). METHODS Totally 64 cases with cesarean scar pregnancy (CSP) were collected. Their information was recorded, including baseline information, intraoperative and postoperative information, preoperative and postoperative uterine receptivity, and preoperative and postoperative levels of sex hormones in serum. Finally, the patients were followed up to observe whether they were pregnant after treatment. RESULTS In comparison with 24 hours after UAE, decreases were found in endometrial blood flow pulsatility index (PI), endometrial thickness, ovarian artery peak end-systolic velocity (Vs), ovarian artery resistance index (RI), and the ratio of Vs to peak end-diastolic velocity (S/D) 1 and 3 months after embolization, while Vd increased markedly 3 months after embolization. In addition, in terms of sex hormones, a significant increase was revealed in the level of follicle-stimulating hormone, while the reduction in the levels of luteinizing hormone (LH), estrogen (E2), prolactin (PRL), and progesterone (P) in the first month and the third month of menstrual resumption compared with those before treatment. From the follow-up data, there were 50 cases of pregnancy, including 45 cases of intrauterine pregnancy, 2 cases of tubal pregnancy, and 3 cases of recurrent CSP. CONCLUSION UAE is a safe and effective method to prevent massive hemorrhage of CSP. Transvaginal two-dimensional ultrasound combined with color Doppler can more accurately evaluate its therapeutic effect and provide a basis for effective treatment.
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Affiliation(s)
- Jing Shi
- Department of Ultrasound Medicine, Guiyang Children's Hospital, Guiyang Maternal and Child Health Hospital, Guiyang, Guizhou, China
| | - Yu Rong Ge
- Department of Ultrasound Medicine, Guiyang Children's Hospital, Guiyang Maternal and Child Health Hospital, Guiyang, Guizhou, China
| | - Jiana Ni
- Department of Ultrasound Medicine, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Xueqin Dong
- Department of Ultrasound Medicine, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
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Vyas N, Poonja N, Shetty B, Rai S. Pulmonary thromboembolism and its complications in a patient in labour. BMJ Case Rep 2022; 15:e248469. [PMID: 35232745 PMCID: PMC8889244 DOI: 10.1136/bcr-2021-248469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/04/2022] Open
Abstract
Venous thromboembolic event in pregnancy is a rare but dreaded complication. When it occurs in labour, it presents with sudden severe fetal distress and maternal haemodynamic compromise. We present to you a case where in patient was taken up for emergency caesarean section for severe fetal distress. Intraoperative ECG showed right heart strain. Hence, an immediate bedside echocardiography was done in medical intensive care unit and it picked up a swirling thrombus in right atrium which immediately got dislodged to pulmonary vessels. Postcaesarean, we faced challenge of controlling active bleeding from atonic uterus with non-surgical techniques (Bakri balloon tamponade and uterine artery embolisation) before considering anticoagulation therapy for pulmonary embolism. The patient recovered well after anticoagulation treatment.
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Affiliation(s)
- Neetha Vyas
- OBG, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Neetha Poonja
- OBG, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Balika Shetty
- OBG, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Supriya Rai
- OBG, KS Hegde Medical Academy, Mangalore, Karnataka, India
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27
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Geng Z, Zhang Q, Jia P, Miao J, Lin Q. Severe vaginal bleeding due to vaginal metastasis from renal cell carcinoma with inferior vena cava tumor thrombus: A case report. Medicine (Baltimore) 2022; 101:e28586. [PMID: 35060522 PMCID: PMC8772633 DOI: 10.1097/md.0000000000028586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Renal cell carcinoma (RCC) is the most common type of kidney cancer and is the second most common urologic neoplasm. Vaginal metastasis from RCC is extremely rare clinically. PATIENT CONCERNS A 56-year-old woman presented with intermittent vaginal bleeding that had persisted for 1 month. Enhanced computed tomography examination suggested a vaginal mass (3 × 2 × 2 cm), right kidney tumor (15 × 12 × 10 cm), and an inferior vena cava tumor thrombus. During gynecologic examination, the mass was necrotic and caused uncontrollable vaginal bleeding. DIAGNOSES Based on clinical and imaging examinations and the pathology, she was diagnosed as vaginal metastasis from RCC. INTERVENTIONS The patient received percutaneous transcatheter arterial embolization to stop uncontrollable vaginal bleeding, and then treated with targeted therapy. OUTCOMES Vaginal bleeding disappeared after interventional embotherapy. However, disease progressed, and the patient died 9 months later. LESSONS In cases of vaginal bleeding, the possibility of metastatic renal cell carcinoma should be considered. Percutaneous transcatheter arterial embolization is an effective and novel treatment for uncontrollable vaginal bleeding caused by vaginal metastasis of RCC.
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Affiliation(s)
- Zhihai Geng
- Department of Urology, Taizhou First People's Hospital, Zhejiang Province, China
| | - Qinghua Zhang
- Department of Urology, Taizhou First People's Hospital, Zhejiang Province, China
| | - Peng Jia
- Department of Radiology and Interventional Medicine, Taizhou First People's Hospital, Zhejiang Province, China
| | - Jia Miao
- Department of Urology, Taizhou First People's Hospital, Zhejiang Province, China
| | - Qian Lin
- Department of Urology, Taizhou First People's Hospital, Zhejiang Province, China
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28
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Nocum DJ, Robinson J, Halaki M, Båth M, Thompson JD, Thompson N, Moscova M, Liang E, Mekiš N, Reed W. Predictors of radiation dose for uterine artery embolisation are angiography system-dependent. J Radiol Prot 2022; 42:011502. [PMID: 34985415 DOI: 10.1088/1361-6498/ac480b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
This study sought to achieve radiation dose reductions for patients receiving uterine artery embolisation (UAE) by evaluating radiation dose measurements for the preceding generation (Allura) and upgraded (Azurion) angiography system. Previous UAE regression models in the literature could not be applied to this centre's practice due to being based on different angiography systems and radiation dose predictor variables. The aims of this study were to establish whether radiation dose is reduced with the upgraded angiography system and to develop a regression model to determine predictors of radiation dose specific to the upgraded angiography system. A comparison between Group I (Allura,n= 95) and Group II (Azurion,n= 95) demonstrated a significant reduction in kerma-area product (KAP) and Ka, r (reference air kerma) by 63% (143.2 Gy cm2vs 52.9 Gy cm2;P< 0.001,d= 0.8) and 67% (0.6 Gy vs 0.2 Gy;P< 0.001,d= 0.8), respectively. The multivariable linear regression (MLR) model identified the UAE radiation dose predictors for KAP on the upgraded angiography system as total fluoroscopy dose, Ka, r, and total uterus volume. The predictive accuracy of the MLR model was assessed using a Bland-Altman plot. The mean difference was 0.39 Gy cm2and the limits of agreement were +28.49 and -27.71 Gy cm2, and thus illustrated no proportional bias. The resultant MLR model was considered system-dependent and validated the upgraded angiography system and its advance capabilities to significantly reduce radiation dose. Interventional radiologist and interventional radiographer familiarisation of the system's features and the implementation of the newly established MLR model would further facilitate dose optimisation for all centres performing UAE procedures using the upgraded angiography system.
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Affiliation(s)
- Don J Nocum
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John Robinson
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Halaki
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Magnus Båth
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - John D Thompson
- Department of Radiography, School of Health and Society, University of Salford, Salford M6 6PU, United Kingdom
| | - Nadine Thompson
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Moscova
- Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Eisen Liang
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- Sydney Fibroid Clinic, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - Nejc Mekiš
- Medical Imaging and Radiotherapy Department, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Warren Reed
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Abstract
BACKGROUND Uterine artery pseudoaneurysm (UAP) is a rare but potentially life-threatening cause of hemorrhage. Nonetheless, its knowledge could be insufficient among obstetricians, gynecologists, and radiologists. We aimed to clarify the clinical characteristics, management, and outcomes of UAP. METHODS We retrospectively analyzed nine female patients diagnosed with UAP at our institute between 2013 and 2020. RESULTS Seven cases presented with a history of traumatic surgery including cesarean section, dilation and curettage, laparoscopic myomectomy, and cervical conization. Two cases occurred after spontaneous vaginal delivery and second-trimester pregnancy termination. The main symptom was heavy/massive/prolonged vaginal bleeding. All patients were first evaluated by color Doppler ultrasonography and three cases were confirmed by magnetic resonance imaging. Severn patients underwent transarterial embolization (TAE) of the uterine arteries, and two were managed conservatively. All patients had good outcomes. CONCLUSIONS UAP can develop after traumatic pelvic operations and non-traumatic delivery/abortion. It may be more common than previously considered. The risk of rupture may be correlated with multiple factors other than the mass size. TAE of the uterine artery could be an effective management strategy for ruptured UAP. However, some cases can resolve spontaneously without TAE, suggesting that conservative management can be employed in some women.
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Affiliation(s)
- Tingting Wu
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang province, People's Republic of China
| | - Beibei Lin
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang province, People's Republic of China
| | - Kui Li
- Department of Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jinying Ye
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang province, People's Republic of China
| | - Ruijin Wu
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang province, People's Republic of China
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30
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Samanci C, Ozkose B, Ustabasioglu FE, Erol BC, Sirolu S, Yılmaz F, Ozkose ZG, Yılmaz H, Kara SC, Kicik Caliskan R, Gulsen F. The Diagnostic Value of Superb Microvascular Imaging in Prediction of Uterine Artery Embolization Treatment Response in Uterine Leiomyomas. J Ultrasound Med 2021; 40:2607-2615. [PMID: 33599335 DOI: 10.1002/jum.15647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/17/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We aimed to determine if superb microvascular imaging (SMI) can predict response to uterine artery embolization (UAE) as compared with power Doppler ultrasound. METHODS The blood flow and the volume of the dominant leiomyoma was evaluated by power Doppler ultrasonography (PDUS) and SMI 1 day before and 3 months after the UAE procedure. SMI and PDUS blood flow were classified to 4 grades of vascularity. The change in fibroid volume in Grades 0-2 (hypovascular group) was compared to the hypervascular Grade 3 group. RESULTS Twenty-eight women (mean age, 40.9 years; range, 33-53 years) were examined with PDUS and SMI before and 3 months after UAE. The volume reduction was statistically significantly higher hypervascular group (P < .05). When we accept 30% or more volume reduction as a good response to UAE, the positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of SMI were 100, 64, 73.6, 100, and 82.1%, respectively. There was excellent agreement between the two blinded observers in SMI measurements. CONCLUSIONS SMI, with its high reproducibility, provides further microvessel information than PDUS in uterine fibroids. It may be a useful tool in prediction of response to UAE treatment and improve counseling and patient selection for UAE versus medical or surgical treatment options.
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Affiliation(s)
- Cesur Samanci
- Cerrahpasa Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Burak Ozkose
- Obstetrics and Gynecology Department, Yeni Yüzyıl University Gaziosmanpaşa Hospital, Istanbul, Turkey
| | | | - Burak Caglar Erol
- Cerrahpasa Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Sabri Sirolu
- Cerrahpasa Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Fatma Yılmaz
- Radiology Department, Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Gedik Ozkose
- Obstetrics and Gynecology Department, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Hatice Yılmaz
- Obstetrics and Gynecology Department, Istanbul Kagithane State Hospital, Istanbul, Turkey
| | - Sahra Cavuşoğlu Kara
- Obstetrics and Gynecology Department, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Raziye Kicik Caliskan
- Obstetrics and Gynecology Department, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Fatih Gulsen
- Cerrahpasa Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
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31
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Nocum DJ, Robinson J, Halaki M, Båth M, Mekiš N, Liang E, Thompson N, Moscova M, Reed W. UTERINE ARTERY EMBOLISATION: CONTINUOUS QUALITY IMPROVEMENT REDUCES RADIATION DOSE WHILE MAINTAINING IMAGE QUALITY. Radiat Prot Dosimetry 2021; 196:159-166. [PMID: 34595527 DOI: 10.1093/rpd/ncab145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/01/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to introduce a continuous quality improvement (CQI) program for radiation dose optimisation during uterine artery embolisation (UAE) and assess its impact on dose reduction and image quality. The CQI program investigated the effects of optimising radiation dose parameters on the kerma-area product (KAP) and image quality when comparing a 'CQI intervention' group (n = 50) and 'Control' group (n = 50). Visual grading characteristics (VGC) analysis was used to assess image quality, using the 'Control' group as a reference. A significant reduction in KAP by 17% (P = 0.041, d = 0.2) and reference air kerma (Ka, r) by 20% (P = 0.027, d = 0.2) was shown between the two groups. The VGC analysis resulted in an area under the VGC curve (AUCVGC) of 0.54, indicating no significant difference in image quality between the two groups (P = 0.670). The implementation of the CQI program and optimisation of radiation dose parameters improved the UAE radiation dose practices at our centre. The dose reduction demonstrated no detrimental effects on image quality.
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Affiliation(s)
- Don J Nocum
- San Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - John Robinson
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Halaki
- Discipline of Exercise and Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Nejc Mekiš
- Medical Imaging and Radiotherapy Department, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Eisen Liang
- San Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- Sydney Adventist Hospital Clinical School, Faculty of Medicine and Health, University of Sydney, Wahroonga, NSW, Australia
| | - Nadine Thompson
- San Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- Sydney Adventist Hospital Clinical School, Faculty of Medicine and Health, University of Sydney, Wahroonga, NSW, Australia
| | - Michelle Moscova
- School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Warren Reed
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Oleksik TP, Pluta K, Issat T, Jakimiuk A, Wierzba W. The use of super-selective uterine artery branch embolization and methotrexate in cervical pregnancy - case reports and literature review. Ann Agric Environ Med 2021; 28:521-524. [PMID: 34558279 DOI: 10.26444/aaem/127926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cervical ectopic pregnancy (CEP) is one of the rarest types of ectopic pregnancy. Early detection of such cases increases the chances of conservative treatment and fertility preservation. Within 6 weeks of each other, 2 women were admitted to the OB/GYN Department with cervical ectopic pregnancies. They were successfully treated with a double dose of methotrexate and super-selective uterine artery branch embolization (SUABE). Taking into account health and economic considerations, for instance the optimal recovery time, and lower costs of operating theater time, laboratory testing and outpatient observation, it seems that safe, minimally invasive, fertility-saving, effective systemic administration of MTX in combination with SUABE, can be a rational alternative to cervical ectopic pregnancy treatment.
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Affiliation(s)
- Tomasz P Oleksik
- Department of Obstetrics and Gynecology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Kamil Pluta
- Department of Obstetrics and Gynecology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Tadeusz Issat
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Warsaw, Poland
| | - Artur Jakimiuk
- Center for Reproductive Health, Institute of Mother and Child, Poland
| | - Waldemar Wierzba
- University of Humanites and Economics, Łódź, Satellite Campus in Warsaw, Poland
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Abstract
Overview of: Manyonda I, Belli AM, Lumsden MA, et al Uterine-artery embolization or myomectomy for uterine fibroids. N Engl J Med 2020;383(5):440-451.
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Shetty GS, Kamath GD, Srinivasan P. Transvaginal ultrasound-guided direct thrombin injection for the treatment of intramyometrial pseudoaneurysm in a young female with uterine hemorrhage after failed uterine artery embolization. J Clin Ultrasound 2021; 49:385-389. [PMID: 32929773 DOI: 10.1002/jcu.22919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/28/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
Uterine artery pseudoaneurysm is an uncommon but important cause of severe uterine bleeding in the postpartum or postsurgical setting. The standard treatment options are endovascular uterine artery embolization and bilateral surgical internal iliac artery ligation for uterus conservation or hysterectomy. We report the case of a young female with hemorrhage from an intramyometrial pseudoaneurysm following repeated curettage and hysteroscopic excision of retained products of conception. Uterus preservation was of priority, and the patient underwent uterine artery embolization; however, the pseudoaneurysm persisted due to ovarian artery collaterals. The pseudoaneurysm was subsequently treated with transvaginal ultrasound-guided direct thrombin injection. The case highlights the advantages and disadvantages of the treatment options in such clinically challenging cases emphasizing the seldom employed direct injection of thrombin for the treatment of pseudoaneurysms.
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Affiliation(s)
- Gurucharan S Shetty
- Department of Imaging & Interventional Radiology, Fortis Hospital and Cancer Institute, Bangalore, India
| | - Gayathri D Kamath
- Department of Obstetrics & Gynecology, Fortis Hospital and Cancer Institute, Bangalore, India
| | - Pradeep Srinivasan
- Department of Imaging & Interventional Radiology, Fortis Hospital and Cancer Institute, Bangalore, India
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Ma J, Brown B, Liang E. Long-term durability of uterine artery embolisation for treatment of symptomatic adenomyosis. Aust N Z J Obstet Gynaecol 2021; 61:290-296. [PMID: 33583017 PMCID: PMC8248413 DOI: 10.1111/ajo.13304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Failing conservative therapies, uterine artery embolisation (UAE) has been proposed as a uterine-sparing option for treatment of symptomatic adenomyosis. UAE appears effective at short-term; however long-term durability is less well established. AIMS To evaluate the long-term clinical efficacy of UAE for treatment of adenomyosis. MATERIALS AND METHODS One hundred and four women with initial clinical success following UAE for adenomyosis (results previously published) were further followed with a two-part online survey. Part one inquired about menopause, symptom recurrence, need for further intervention and overall satisfaction. Part two comprised the Uterine Fibroid Symptom and health-related Quality of Life (UFS-QOL) questionnaire. Maintenance of clinical success was defined as remaining 'happy' or 'very happy' with overall outcome, no recurrence of symptoms, or need for further intervention. RESULTS Of those women with initial success, 91/104 (88%) participated in this long-term study at mean 52 months following UAE. Maintenance of clinical success was demonstrated in 82/91 (90%) women. For the remaining 9/91 (10%) women, mean time to failure was 31 months. There were 53/91 (58%) women who reached menopause at mean age of 51.5 years, occurring at mean 30 months post-UAE. UFS-QOL demonstrated significant decrease in symptom severity from 58.9 to 20.0 (P < 0.001); and significant increase in QOL from 40.3 to 86.3 (P < 0.001). CONCLUSIONS Long-term durability of UAE for treatment of adenomyosis was demonstrated, with cumulative success rate of 80% at mean 52 months. UAE did not appear to bring forward menopause. UAE should be considered as an alternative to hysterectomy to treat adenomyosis.
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Affiliation(s)
- Jolande Ma
- Sydney Medical SchoolUniversity of SydneyNew South WalesAustralia
- Sydney Adventist Hospital Clinical SchoolUniversity of SydneyNew South WalesAustralia
| | - Bevan Brown
- Sydney Adventist Hospital Clinical SchoolUniversity of SydneyNew South WalesAustralia
- Sydney Fibroid ClinicNew South WalesAustralia
| | - Eisen Liang
- Sydney Adventist Hospital Clinical SchoolUniversity of SydneyNew South WalesAustralia
- Sydney Fibroid ClinicNew South WalesAustralia
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Perkins S, Drews E, Li G, Martin J. Endovascular treatment of postpartum haemorrhage in a woman with genitourinary and vascular congenital malformations. BMJ Case Rep 2021; 14:14/3/e240608. [PMID: 33758047 PMCID: PMC7993248 DOI: 10.1136/bcr-2020-240608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old woman presented with postpartum haemorrhage necessitating uterine artery embolisation. Prior to embolisation, angiography demonstrated the presence of a persistent sciatic artery (PSA). Due to the possibility of embolic particles inadvertently traveling to the lower extremity via this variant arterial pathway, care was taken to only embolise the uterine artery. PSAs are uncommon but important vascular pathways to screen for during pelvic intervention and are associated with other genitourinary anomalies.
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Affiliation(s)
- Scott Perkins
- Interventional Radiology, Duke University Health System, Durham, North Carolina, USA
| | - Elena Drews
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Gabriel Li
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Jonathan Martin
- Interventional Radiology, Duke University Health System, Durham, North Carolina, USA
- Duke University School of Medicine, Durham, North Carolina, USA
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Gupta A, Sagili H, Krishnan N, Dasari P. Pseudoaneurysm of uterine artery complicating caesarean section: a rare cause of intractable secondary postpartum haemorrhage managed with uterine artery embolisation. BMJ Case Rep 2021; 14:14/3/e239851. [PMID: 33753382 PMCID: PMC7986651 DOI: 10.1136/bcr-2020-239851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 27-year-old woman presented 6 weeks after an uncomplicated lower segment caesarean section with excessive bleeding per vagina. On examination, she had mild pallor with a pulse rate of 86 beats per minute and blood pressure of 116/80 mm Hg, uterus well involuted with closed cervical os and bleeding demonstrated through the cervix. A transvaginal ultrasonography with colour Doppler revealed a normal size uterus with an empty cavity and a hypoechoic area with blood flow within it in the left side of the uterus with a prominent arterial feeder vessel. A CT angiogram confirmed the diagnosis of a 1.3×0.7 cm pseudoaneurysm of the uterine artery near the left cornua of the uterus. After failed attempts to control the bleeding with antifibrinolytics, bilateral uterine arteries were embolised using gel foam. Post procedure, bleeding resolved immediately. A follow-up transvaginal ultrasound after a year revealed no evidence of the pseudoaneurysm and her fertility was preserved.
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Affiliation(s)
- Aishvarya Gupta
- Obstetrics and Gynecology, Indraprastha Apollo Hospital, New Delhi, India
- Obstetrics and Gynaecology, JIPMER, Puducherry, Pondicherry, India
| | - Haritha Sagili
- Obstetrics and Gynaecology, JIPMER, Puducherry, Pondicherry, India
| | | | - Papa Dasari
- Obstetrics and Gynaecology, JIPMER, Puducherry, Pondicherry, India
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Mu Q, Liu Y, Wang S, Luan S, Li J, Fan J. Cervical heterotopic pregnancy: A case report. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:212-216. [PMID: 33678661 PMCID: PMC10929780 DOI: 10.11817/j.issn.1672-7347.2021.190712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Indexed: 11/03/2022]
Abstract
Heterotopic pregnancies are rare and difficult to be diagnosed early. A patient with combined intrauterine pregnancy and cervical pregnancy was admitted in Qingdao Municipal Hospital in 2019. The patient complained of abnormal vaginal bleeding after menopause and was misdiagnosed as simple intrauterine pregnancy. She underwent artificial abortion and suffered intraoperative hemorrhage. To stop bleeding, she received the treatment of uterine artery embolization immediately. Afterwards, cervical residual pregnancy tissues started necrosis, blood β-human chorionic gonadotropin level and the cervix appearance gradually returned to normal. This report suggests that cervical heterotopic pregnancy inclines to be mis diagnosed. Correct diagnosis should be made as soon as possible. Selective uterine artery embolization is an effective measure to prevent and treat massive bleeding.
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Affiliation(s)
- Qingling Mu
- Department of Gynecology and Obstetrics, Qingdao Municipal Hospital, Qingdao Shandong 266000.
| | - Ying Liu
- Department of Gynecology and Obstetrics, Qingdao Municipal Hospital, Qingdao Shandong 266000
| | - Shuping Wang
- Department of Gynecology and Obstetrics, Qingdao West Coast New District People's Hospital, Qingdao Shandong 266400, China
| | - Shaohong Luan
- Department of Gynecology and Obstetrics, Qingdao Municipal Hospital, Qingdao Shandong 266000
| | - Jing Li
- Department of Gynecology and Obstetrics, Qingdao Municipal Hospital, Qingdao Shandong 266000
| | - Jun Fan
- Department of Gynecology and Obstetrics, Qingdao Municipal Hospital, Qingdao Shandong 266000.
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Cornman-Homonoff J, Zhou ZN, Fenster TB, Schiffman MH. Combination uterine artery embolization and hysteroscopic resection for a symptomatic uterine leiomyoma: A collaborative single-session approach for better patient care. Clin Imaging 2021; 77:111-116. [PMID: 33667943 DOI: 10.1016/j.clinimag.2021.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/09/2021] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Abstract
Uterine artery embolization (UAE) for symptomatic uterine fibroids is accompanied by transcervical fibroid expulsion in 3-15% of cases. It can be a source of significant patient distress, may require reintervention for removal, and is the most common reason for hospital readmission following UAE. Conversely, the success of hysteroscopic resection decreases with increasing fibroid size while the risk of complications increases. Because certain fibroid features identifiable on preoperative imaging predict need for eventual hysteroscopic resection, it is possible to prospectively identify such patients and employ an alternative management strategy. We present such an approach, illustrated in the case of a woman with a pedunculated broad-based uterine fibroid successfully managed via combination UAE and immediate hysteroscopic resection.
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Affiliation(s)
- Joshua Cornman-Homonoff
- The Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale New Haven Hospital, New Haven, CT, USA.
| | - Zhen Ni Zhou
- The Department of Obstetrics and Gynecology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Tamatha B Fenster
- The Department of Obstetrics and Gynecology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Marc H Schiffman
- The Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
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O'Reilly MK, Chick JFB, Lee MJ, Geoghegan T. Endometrial assessment of premenopausal women prior to uterine artery embolization: A cross sectional survey of Interventional Radiologists. Clin Imaging 2021; 76:42-45. [PMID: 33549918 DOI: 10.1016/j.clinimag.2021.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/28/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Michael K O'Reilly
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA.
| | | | - Michael J Lee
- Department of Interventional Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Tony Geoghegan
- Department of Interventional Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Himiniuc LM, Murarasu M, Toma B, Popovici R, Grigore AM, Scripcariu IS, Oancea M, Grigore M. Transradial Embolization, an Underused Type of Uterine Artery Embolization Approach: A Systematic Review. ACTA ACUST UNITED AC 2021; 57:medicina57020083. [PMID: 33498309 PMCID: PMC7909283 DOI: 10.3390/medicina57020083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: The most utilized approach for the embolization of uterine arteries is the transfemoral path. However, the transradial approach (TRA) has been gaining popularity among cardiologic interventions in the last years but only few studies have shown its applicability in uterine myoma treatment. The objective of this paper is to assess the feasibility, safety and efficacy of TRA when compared with the transbrachial, transulnar or transfemoral approach (TFA) for uterine arteries embolization (UAE). Materials and methods: A systematic review of the literature that analyzes the TRA for UAE it was carried out, in order to assess its safety and effectiveness. It was systematically searched the literature (Google Scholar, PubMed/MEDLINE, Cochrane Library and Embase) using the words ''uterine artery embolization''/''uterine embolization'' and ''transradial''/''radial''. All the relevant papers published until March 2020 were retrieved and analyzed. Results: Ten studies were considered eligible for this topic. TRA is a comparable method with TFA for uterine artery embolization. Conclusions: These studies allowed us to conclude that TRA is as safe and efficient as TFA. Its advantages include few complications, shorter hospitalization period, and rapid mobilization but a steeper learning curve has the disadvantage of a longer learning curve compared to TFA. Yet, these findings are built on few reports and more research is needed.
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Affiliation(s)
- Loredana Maria Himiniuc
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
- Obstetrics and Gynecology Clinical Hospital “Cuza Voda”, 700038 Iasi, Romania;
| | - Mara Murarasu
- Obstetrics and Gynecology Clinical Hospital “Cuza Voda”, 700038 Iasi, Romania;
| | - Bogdan Toma
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
- Obstetrics and Gynecology Clinical Hospital “Cuza Voda”, 700038 Iasi, Romania;
- Correspondence: (B.T.); (M.O.); Tel.: +40-746-054-647 (B.T.); +40-744-374-782 (M.O.)
| | - Razvan Popovici
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
| | - Ana-Maria Grigore
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
| | - Ioana-Sadiye Scripcariu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
| | - Mihaela Oancea
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Iuliu Hateganu”, 400012 Cluj-Napoca, Romania
- Correspondence: (B.T.); (M.O.); Tel.: +40-746-054-647 (B.T.); +40-744-374-782 (M.O.)
| | - Mihaela Grigore
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
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Buntrock A, Hansen K, Peck S, Von Wald T. A Case of Uterine Arteriovenous Malformation Treated With Uterine Artery Embolization. S D Med 2021; 74:14-16. [PMID: 33691051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Uterine arteriovenous malformation (AVM) is a rare condition that is potentially life-threatening. There are limited published reports on this condition. This is a case report of a 25-year-old woman who presented with a symptomatic AVM. We review the differential diagnoses, evaluation, and treatment options. Conservative treatment with interventional radiology can be considered in select women who desire fertility preservation.
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Affiliation(s)
- Ahna Buntrock
- University of South Dakota Sanford School of Medicine, Vermillion, South Dakota
| | - Keith Hansen
- Sanford Fertility and Reproductive Medicine, Sioux Falls, South Dakota
- Department of Obstetrics and Gynecology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Shannon Peck
- Sanford Interventional Radiology, Sioux Falls, South Dakota
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Tiffany Von Wald
- Sanford Fertility and Reproductive Medicine, Sioux Falls, South Dakota
- Department of Obstetrics and Gynecology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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Yuan Y, Pu D, Zhan P, Zheng Y, Ren Q, Teichmann AT. Focused Ultrasound Ablation Surgery combined with ultrasound-guided suction curettage in the treatment and management of Cesarean Scar Pregnancy. Eur J Obstet Gynecol Reprod Biol 2020; 258:168-173. [PMID: 33444810 DOI: 10.1016/j.ejogrb.2020.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the feasibility, safety, and effectiveness of Focused Ultrasound Ablation Surgery (FUAS) combined with ultrasound-guided suction curettage in the management of Cesarean Scar Pregnancy (CSP). STUDY DESIGN We retrospectively analyzed 52 patients with CSP from April, 2017, to December, 2019. All the patients received one session of FUAS, and suction curettage under ultrasound guidance was performed 1-3 days after FUAS. The intraoperative blood loss in suction curettage, duration of vaginal bleeding after curettage, reproductive outcomes, and adverse effects were recorded and analyzed. RESULTS All the 52 patients completed one session of FUAS combined with suction curettage without serious adverse effects. The mean intraoperative blood loss was 32.81 ± 53.83 mL. 47 (90.38 %) patients had a successful suction curettage with a blood loss of less than 80 mL. 5 (9.62 %) patients had an active bleeding of ≥80 mL; however, the bleeding was stopped effectively by Foley's urinary catheter and no evident bleeding presented when the catheter was removed 24 h later. The mean duration of vaginal bleeding was 7.88 ± 4.24 days. 48 (92.30 %) patients recovered with little vaginal bleeding after curettage. 4 (7.69 %) type III CSP patients experienced late-onset severe bleeding and required UAE or surgery. During 6-36 months of the follow-up period, 12 patients expressed reproductive plan, in which 4 patients delivered by cesarean section, 3 patients had an ongoing pregnancy and 1 patient had an abortion in the early pregnancy. CONCLUSIONS FUAS combined with ultrasound-guided suction curettage is a safe and effective treatment strategy in the management of CSP type I and CSP type II and is particularly advantageous for CSP patients with reproductive requirements. However, further studies are warranted to determine the meticulous inclusion criteria for patients with type III CSP.
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Affiliation(s)
- Yuan Yuan
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan, 644300, China; State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Dali Pu
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan, 644300, China
| | - Ping Zhan
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan, 644300, China
| | - Yongping Zheng
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan, 644300, China
| | - Qianchuan Ren
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan, 644300, China
| | - Alexander T Teichmann
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan, 644300, China.
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Affiliation(s)
| | - Kartik Kansagra
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Tina L Hardley
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
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Caridi TM, Spies JB, Kohi MP. Myomectomy versus Uterine Artery Embolization: More Alike than Different. J Vasc Interv Radiol 2020; 31:1838-1839. [PMID: 33012651 DOI: 10.1016/j.jvir.2020.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Theresa M Caridi
- Department of Radiology, University of Alabama at Birmingham, 619 19(th) Street South, H623 New Hillman Building, Birmingham, AL 35249.
| | - James B Spies
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC
| | - Maureen P Kohi
- Department of Radiology, University of California San Francisco, San Francisco, California
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Affiliation(s)
- Elizabeth A Stewart
- From the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, and the Department of Surgery, Mayo Clinic, Rochester, MN
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Ahmadzia HK, Grotegut CA, James AH. A national update on rates of postpartum haemorrhage and related interventions. Blood Transfus 2020; 18:247-253. [PMID: 32530404 PMCID: PMC7375891 DOI: 10.2450/2020.0319-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is still a leading cause of maternal morbidity in the US. We aimed to reassess national trends in severe and non-severe PPH using recent data. MATERIAL AND METHODS We performed a cross-sectional study using the 2001-2012 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. Delivery-related hospitalisations with PPH were identified using the International Classification of Diseases (9th revision). Rates were calculated per 1,000 delivery hospitalisations. All statistical analyses accounted for the complex sampling design of the data source. RESULTS Rates of non-severe PPH did not change significantly from 2001-2002 to 2011-2012 (25.5 and 24.2 per 1,000; p=0.058). The rates of PPH requiring blood transfusions for caesarean deliveries more than doubled in this time period from 2.0 to 4.8 (p<0.001). The overall rate of PPH with a procedure other than blood transfusion has risen from 0.9 to 1.9. Specifically, rates of hysterectomy (0.5 to 0.7; p<0.001), embolisation (0.3 to 0.5; p<0.001), and uterine tamponade use (0.09 to 0.69; p<0.001) increased over the time period. DISCUSSION Population-based surveillance data show an increasing rate of only severe PPH in the US. Rates of medical/surgical intervention including hysterectomy, embolisation and uterine tamponade use are also rising.
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Affiliation(s)
- Homa K. Ahmadzia
- Department of Obstetrics and Gynaecology, George Washington University, Washington, DC, United States of America
| | - Chad A. Grotegut
- Department of Obstetrics and Gynaecology, Duke University, Durham, NC, United States of America
| | - Andra H. James
- Department of Obstetrics and Gynaecology, Duke University, Durham, NC, United States of America
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Abstract
BACKGROUND Primary postpartum haemorrhage (PPH) is commonly defined as bleeding from the genital tract of 500 mL or more within 24 hours of birth. It is one of the most common causes of maternal mortality worldwide and causes significant physical and psychological morbidity. An earlier Cochrane Review considering any treatments for the management of primary PPH, has been split into separate reviews. This review considers treatment with mechanical and surgical interventions. OBJECTIVES To determine the effectiveness and safety of mechanical and surgical interventions used for the treatment of primary PPH. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (26 July 2019) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of mechanical/surgical methods for the treatment of primary PPH compared with standard care or another mechanical/surgical method. Interventions could include uterine packing, intrauterine balloon insertion, artery ligation/embolism, or uterine compression (either with sutures or manually). We included studies reported in abstract form if there was sufficient information to permit risk of bias assessment. Trials using a cluster-RCT design were eligible for inclusion, but quasi-RCTs or cross-over studies were not. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and risk of bias, independently extracted data and checked data for accuracy. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included nine small trials (944 women) conducted in Pakistan, Turkey, Thailand, Egypt (four trials), Saudi Arabia, Benin and Mali. Overall, included trials were at an unclear risk of bias. Due to substantial differences between the studies, it was not possible to combine any trials in meta-analysis. Many of this review's important outcomes were not reported. GRADE assessments ranged from very low to low, with the majority of outcome results rated as very low certainty. Downgrading decisions were mainly based on study design limitations and imprecision; one study was also downgraded for indirectness. External uterine compression versus normal care (1 trial, 64 women) Very low-certainty evidence means that we are unclear about the effect on blood transfusion (risk ratio (RR) 2.33, 95% confidence interval (CI) 0.66 to 8.23). Uterine arterial embolisation versus surgical devascularisation plus B-Lynch (1 trial, 23 women) The available evidence for hysterectomy to control bleeding (RR 0.73, 95% CI 0.15 to 3.57) is unclear due to very low-certainty evidence. The available evidence for intervention side effects is also unclear because the evidence was very low certainty (RR 1.09; 95% CI 0.08 to 15.41). Intrauterine Tamponade Studies included various methods of intrauterine tamponade: the commercial Bakri balloon, a fluid-filled condom-loaded latex catheter ('condom catheter'), an air-filled latex balloon-loaded catheter ('latex balloon catheter'), or traditional packing with gauze. Balloon tamponade versus normal care (2 trials, 356 women) One study(116 women) used the condom catheter. This study found that it may increase blood loss of 1000 mL or more (RR 1.52, 95% CI 1.15 to 2.00; 113 women), very low-certainty evidence. For other outcomes the results are unclear and graded as very low-certainty evidence: mortality due to bleeding (RR 6.21, 95% CI 0.77 to 49.98); hysterectomy to control bleeding (RR 4.14, 95% CI 0.48 to 35.93); total blood transfusion (RR 1.49, 95% CI 0.88 to 2.51); and side effects. A second study of 240 women used the latex balloon catheter together with cervical cerclage. Very low-certainty evidence means we are unclear about the effect on hysterectomy (RR 0.14, 95% CI 0.01 to 2.74) and additional surgical interventions to control bleeding (RR 0.20, 95% CI 0.01 to 4.12). Bakri balloon tamponade versus haemostatic square suturing of the uterus (1 trial, 13 women) In this small trial there was no mortality due to bleeding, serious maternal morbidity or side effects of the intervention, and the results are unclear for blood transfusion (RR 0.57, 95% CI 0.14 to 2.36; very low certainty). Bakri balloon tamponade may reduce mean 'intraoperative' blood loss (mean difference (MD) -426 mL, 95% CI -631.28 to -220.72), very low-certainty evidence. Comparison of intrauterine tamponade methods (3 trials, 328 women) One study (66 women) compared the Bakri balloon and the condom catheter, but it was uncertain whether the Bakri balloon reduces the risk of hysterectomy to control bleeding due to very low-certainty evidence (RR 0.50, 95% CI 0.05 to 5.25). Very low-certainty evidence also means we are unclear about the results for the risk of blood transfusion (RR 0.97, 95% CI 0.88 to 1.06). A second study (50 women) compared Bakri balloon, with and without a traction stitch. Very low-certainty evidence means we are unclear about the results for hysterectomy to control bleeding (RR 0.20, 95% CI 0.01 to 3.97). A third study (212 women) compared the condom catheter to gauze packing and found that it may reduce fever (RR 0.47, 95% CI 0.38 to 0.59), but again the evidence was very low certainty. Modified B-Lynch compression suture versus standard B-Lynch compression suture (1 trial, 160 women) Low-certainty evidence suggests that a modified B-Lynch compression suture may reduce the risk of hysterectomy to control bleeding (RR 0.33, 95% CI 0.11 to 0.99) and postoperative blood loss (MD -244.00 mL, 95% CI -295.25 to -192.75). AUTHORS' CONCLUSIONS There is currently insufficient evidence from RCTs to determine the relative effectiveness and safety of mechanical and surgical interventions for treating primary PPH. High-quality randomised trials are urgently needed, and new emergency consent pathways should facilitate recruitment. The finding that intrauterine tamponade may increase total blood loss > 1000 mL suggests that introducing condom-balloon tamponade into low-resource settings on its own without multi-system quality improvement does not reduce PPH deaths or morbidity. The suggestion that modified B-Lynch suture may be superior to the original requires further research before the revised technique is adopted. In high-resource settings, uterine artery embolisation has become popular as the equipment and skills become more widely available. However, there is little randomised trial evidence regarding efficacy and this requires further research. We urge new trial authors to adopt PPH core outcomes to facilitate consistency between primary studies and subsequent meta-analysis.
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Affiliation(s)
- Frances J Kellie
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Julius N Wandabwa
- Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| | - Hatem A Mousa
- University Department of Obstetrics and Gynaecology, Fetal and Maternal Medicine Unit, Leicester Royal Infirmary, Leicester, UK
| | - Andrew D Weeks
- Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
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Caridi T. Intra-Arterial Lidocaine Is Not Found to Be Effective for Reducing Pain after Uterine Fibroid Embolization in a Retrospective Study: Now What? J Vasc Interv Radiol 2020; 31:121-122. [PMID: 31864540 DOI: 10.1016/j.jvir.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Theresa Caridi
- Division of Vascular and Interventional Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd, NW, Washington, DC, 20007.
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