Ces radiol. 2024, 78(1):7-11 | DOI: 10.55095/CesRadiol2024/001

Uterine artery embolisation in symptomatic patients with retained focal abnormally invasive placentaOriginal article

David Brustman1, Vendelín Chovanec1, Jan Raupach1, Miroslav Lojík1, Zdeněk Bělobrádek1, Ondřej Renc1, Antonín Krajina1, Ivana Musilová-Kacerovská2, Marian Kacerovský2
1 Radiologická klinika FN, Hradec Králové
2 Porodnická a gynekologická klinika FN, Hradec Králové

Aim: To point out the possibility of endovascular treatment of postpartumhaemorrhage due to remnants of focal abnormally invasive placenta usingselective uterine artery embolization (UAE) after failure of the expectantmanagement.

Methods: This article deals with the evaluation of the results of fourpatients (29-38 y.o.), who underwent from January 2022 to February 2023selective transarterial embolization of uterine arteries at ourangio-intervention department at the University Hospital Hradec Králové.Based on a multidisciplinary consensus of sonographically detected residues offocal abnormally invasive placenta with typical hypervascularization, it wasdecided to perform uni-/bilateral embolization of a. uterina with amicrocatheter using polyvinyl alcohol embolization particles, possibly incombination with gelatin foam, eventually in combination with gelatin foam.

Results: During follow-up, none of the patients experienced an episode ofrecurrent bleeding.
There were no periprocedural complications during embolization, no earlypostproprocedural complications were observed. Two patients underwent surgicalrevision of the uterine cavity with extirpation of devascularized residualtissue.

Conclusions: Based on our experience so far, uterine artery embolisation is asafe and relatively technically undemanding method supplementing the managmentof symptomatic patients with residues of focal abnormally invasive placenta.

Keywords: uterine artery embolization, postpartum haemorrhage, placentaaccreta spectrum disorder, PAS
Grants and funding:

Výzkum byl podpořen Grantovou agenturou Univerzity Karlovy (SVV UK, projekt LFHK č. 260657).

Published: March 1, 2024  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Brustman D, Chovanec V, Raupach J, Lojík M, Bělobrádek Z, Renc O, et al.. Uterine artery embolisation in symptomatic patients with retained focal abnormally invasive placenta. Ces radiol. 2024;78(1):7-11. doi: 10.55095/CesRadiol2024/001.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. World Health Organisation. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: World Health Organization, March 2023. Dostupné z: www.who.int/publications/i/item/9789240068759
    2. Biele C, Radtke L, Kaufner L, et al. Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study. J Perinat Med. 2022; 50(8): 1078-1086. Go to original source... Go to PubMed...
    3. Perlman NC, Carusi DA. Retained placenta after vaginal delivery: risk factors and management. Int J Womens Health 2019; 11: 527-534. Go to original source... Go to PubMed...
    4. Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One 2012; 7(12): e52893. Go to original source... Go to PubMed...
    5. Akol AD, Weeks AD. Retained placenta: will medical treatment ever be possible? Acta Obstet Gynecol Scand. 2016; 95(5): 501-504. Go to original source... Go to PubMed...
    6. Lee MHM. Surgical Management of Retained Placental Tissue with the Hysteroscopic Morcellation Device. Gynecol Minim Invasive Ther. 2019; 8(1): 33-35. Go to original source... Go to PubMed...
    7. Brown BJ, Heaston DK, Poulson AM, Gabert HA, Mineau DE, Miller FJ Jr. Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol. 1979; 54(3): 361-365.
    8. Mitty HA, Sterling KM, Alvarez M, Gendler R. Obstetric hemorrhage: prophylactic and emergency arterial catheterization and embolotherapy. Radiology 1993; 188(1): 183-187. Go to original source... Go to PubMed...
    9. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health 2021; 6(6): e005671. Go to original source... Go to PubMed...
    10. Alabdulghani F, O'Brien A, Brophy D. Application of cone-beam computed tomography angiography in a uterine fibroid embolization procedure: A case report. Radiol Case Rep. 2017; 13(1): 130-134. Go to original source... Go to PubMed...
    11. Takeda A, Koike W, Katayama T. Uterine artery chemoembolization followed by hysteroscopic resection for management of retained placenta accreta with marked vascularity after evacuation of first-trimester miscarriage in angular pregnancy: A case report. Case Rep Womens Health 2021; 32: e00360. Go to original source... Go to PubMed...
    12. Toor SS, Jaberi A, Macdonald DB, McInnes MD, Schweitzer ME, Rasuli P. Complication rates and effectiveness of uterine artery embolization in the treatment of symptomatic leiomyomas: a systematic review and meta-analysis. AJR Am J Roentgenol. 2012; 199(5): 1153-1163. Go to original source... Go to PubMed...
    13. Soro MP, Denys A, de Rham M, Baud D. Short & long term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review. Eur Radiol. 2017; 27(2): 749-762. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content