Abstract
The emergence of interventional radiology procedures has provided significant benefit to the management of certain obstetrical and gynecologic patients. Using percutaneous minimally invasive techniques, interventional radiologists are able to reduce patient discomfort and surgical morbidity as well as perform procedures under sedation instead of general anesthesia. Interventional radiology procedures focus on the treatment of uterine leiomyomas, postpartum hemorrhage, placenta accreta, and pelvic congestion syndrome and the placement of inferior vena cava filters in pregnancy. In addition, interventional radiologists manage several nonvascular pathologies including fallopian tube recanalization, drainage of pelvic abscesses and fluid collections, and image-guided biopsy of ovarian or adnexal lesions. Major challenges with obstetric procedures include the need to minimize patient and fetal radiation dose and the desire to maintain future fertility. This chapter will provide an introduction to the obstetric and gynecologic procedures used for intervention in their pathologies listed above as well as fallopian tube recanalization. Drainage of pelvic abscesses and fluid collections as well as image-guided biopsy of pelvic lesions is discussed broadly in the biopsy and drainage chapter of this book.
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References
Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolization to treat uterine myomata. Lancet. 1995;46(8976):671–2.
Buttram Jr VC, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril. 1981;36(4):433–45.
Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188:100–7.
Lopera J, Suri R, Kroma GM, Garza-Berlanga A, Thomas J. Role of interventional procedures in obstetrics/gynecology. Radiol Clin N Am. 2013;51:1049–66.
Stovall DW, Parrish SB, Van Voorhis BJ, Hahn SJ, Sparks AE, Syrop CH. Uterine leiomyomas reduce the efficacy of assisted reproduction cycles: results of a matched follow-up study. Hum Reprod. 1998;13(1):192–7.
Rein MS, Barbieri RL, Friedman AJ. Progesterone: a critical role in the pathogenesis of uterine myomas. Am J Obstet Gynecol. 1995;172(1 pt 1):14–8.
Stokes LS, Wallace MJ, Godwin RB, Kundu S, Cardella JF. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomas. J Vasc Interv Radiol. 2010;21:1153–63.
Abbara S, Nikolic B, Pelage JP, Banovac F, Spies JB. Frequency and extent of uterine perfusion via ovarian arteries observed during uterine artery embolization for leiomyomas. Am J Roentgenol. 2007;188:1558.
Burn PR, McCall JM, Chinn RJ, Vashisht A, Smith JR, Healy JC. Uterine fibroleiomyoma: MR imaging appearance before and after embolization of uterine arteries. Radiology. 2000;214:729–34.
Ganeshan A, Nazir SA, Hon LQ, et al. The role of interventional radiology in obstetric and gynaecology practice. Eur J Radiol. 2010;73:404–11.
Bratby MJ, Ramachandran N, Sheppard N, Kyriou J, Munneke GM, Belli AM. Prospective study of elective bilateral versus unilateral femoral arterial puncture for uterine artery embolization. Cardiovasc Intervent Radiol. 2007;30:1139–43.
Schirf BE, Vogelzang RL, Christman HB. Complications of uterine fibroid embolization. Semin Intervent Radiol. 2006;23(2):143–9.
Martin J, Bhanot K, Athreya S. Complications and reinterventions in uterine artery embolization for symptomatic uterine fibroids: a literature review and meta analysis. Cardiovasc Intervent Radiol. 2013;36:395–402.
SOGC Clinical Practice Guidelines. Uterine fibroid embolization (UFE). Int J Gynaecol Obstet. 2005;89(3):305–18.
Pacagnella RC, Souza JP, Durocher J, et al. A systematic review of the relationship between blood loss and clinical signs. PLoS ONE. 2013;8(3):e57594.
Feinberg BB, Resnik E, Hurt WG, Bump RC, Kubota R, Cho SR. Angiographic embolization in the management of late postpartum haemorrhage. J Reprod Med. 1987;32(12):921–31.
Jouppila P. Postpartum haemorrhage. Curr Opin Obstet Gynecol. 1995;7(6):446–50.
Ledee N, Ville Y, Musset D, Mercier F, Frydman R, Fernandez H. Management in intractable obstetric haemorrhage: an audit study on 61 cases. Eur J Obstet Gynecol Reprod Biol. 2001;94(2):189–96.
Chang J, Elam-Evans LD, Berg CJ, et al. Pregnancy-related mortality surveillance – United States, 1991 – 1999. MMWR Surveill Summ. 2003;52(SS02):1–8.
Mousa HA, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev. 2007;1(Issue 1):CD003249.
Josephs SC. Obstetric and gynecologic emergencies: a review of indications and interventional techniques. Semin Intervent Radiol. 2008;25(4):337–46.
Royal College of Obstetricians and Gynecologists (RCOG). The role of emergency and elective interventional radiology in postpartum haemorrhage. www.rcog.org.uk/files/rcog-corp/uploaded-files/GoodPractice6RoleEmergency2007.pdf (2007).
Martin J, Abraham T. Uterine artery embolization for post-partum hemorrhage. McMaster Univ Med J. 2014;11(1):21–6.
Gipson MG, Smith MT. Endovascular therapies for primary postpartum hemorrhage: techniques and outcomes. Semin Intervent Radiol. 2013;30:333–9.
Boulleret C, Chahid T, Gallot D, et al. Hypogastric arterial selective and superselective embolization for severe postpartum hemorrhage: a retrospective review of 36 cases. Cardiovasc Intervent Radiol. 2004;27:344–8.
Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum haemorrhage; what to do when medical treatment fails. Obstet Gynecol Surv. 2007;62:540–7.
Breen JL, Nuebecker R, Gregori CA, Franklin Jr JE. Placenta accreta, increta, and percreta: survey of 40 cases. Obstet Gynecol. 1977;49:43–7.
Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):515–20.
Ballas J, Hull AD, Saenz C, et al. Preoperative intravascular balloon catheters and surgical outcomes in pregnancies complicated by placenta accreta: a management paradox. Am J Obstet Gynecol. 2012;207(3):e1–5.
Guy GP, Peisner DB, Timor-Trisch IE. Ultrasonographic evaluation of uteroplacental blood flow patterns of abnormally located and adherent placentas. Am J Obstet Gynecol. 1990;163(3):723–7.
Hong TM, Tseng HS, Lee RC, Wang JH, Chang CY. Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage. Clin Radiol. 2004;59(1):96–101.
Clausen C, Lonn L, Langhoff-Roos J. Management of placenta percreta: a review of published cases. Acta Obst Gynecol Scand. 2013;93:138–43.
Dilauro MD, Dason S, Athreya S. Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: literature review and analysis. Clin Radiol. 2012;67(6):515–20.
Tanaka Y, Tajima H. Falloposcopic tuboplasty as an option for tubal infertility: an alternative to in vitro fertilization. Fertil Steril. 2011;95(1):441–3.
Mitty HA, Sterling KM, Alvarez M, Gendler R. Obstetric haemorrhage: prophylactic and emergency arterial catheterization and embolotherapy. Radiology. 1993;188(1):183–7.
Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87(3):321–7.
Beard RW, Pearce S, Highman JH, Reginald PW. Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet. 1984;324(8409):946–9.
Leiber LM, Thouveny F, Bouvier A, et al. MRI and venographic aspects of pelvic venous insufficiency. Diagn Interv Imaging. 2014;94:1091–102. Advance online publication. doi:10.1016/j.diii.2014.01.012.
Durham JD, Machlan L. Pelvic congestion syndrome. Semin Intervent Radiol. 2013;30(4):372–80.
Hocquelet A, Le Bras Y, Balian E, et al. Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome. Diagn Interv Imaging. 2014;95:301–6.
Nasser F, Cavalcante RN, Affonso BB, Messina ML, Carnevale FC, de Gregorio MA. Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome. Int J Gynaecol Obstet. 2014;125:65–8.
Ignacio EA, Dua IV R, Sarin S, et al. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol. 2008;25(4):361–8.
Venbrux AC, Chang AH, Kim HS, et al. Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain. J Vasc Interv Radiol. 2002;13(2pt. 1):171–8.
Kim HS, Malhotra AD, Rowe PC, Lee JM, Venbrux AC. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2006;17(2 pt. 1):289–97.
Rane N, Leyon JJ, Littlehales T, Ganeshan A, Crowe P, Uberoi R. Pelvic congestion syndrome. Curr Probl Diagn Radiol. 2013;42(4):135–40.
Harvey JJ, Hopkins J, McCafferty IJ, Jones RG. Inferior vena cava filters: what radiologists need to know. Clin Radiol. 2013;68(7):721–32.
Cura M, Martinez N, Cura A, Dalsaso TJ, Elmerhi F. Arteriovenous malformations of the uterus. Acta Radiol. 2009;50(7):823–9.
Vijayakumar A, Srinivas A, Chandrashekar BM, Vijayakumar A. Uterine vascular lesions. Rev Obstet Gynecol. 2013;6(2):69–79.
O’Brien P, Neyastani A, Buckley AR, Chang SD, Legiehn GM. Uterine arteriovenous malformations: from diagnosis to treatment. J Ultrasound Med. 2006;25:1387–92.
Grivell RM, Reid KM, Mellor A. Uterine arteriovenous malformations: a review of the current literature. Obstet Gynecol Surv. 2005;60(11):761–7.
Arora R, Achla B, Pinkee S, Purba G, Bharti M. Arteriovenous malformations of the uterus. N Z Med J. 2004;117(1206):U1182.
Timmerman D, Wauters J, Van Calenbergh S, et al. Color Doppler imaging is a useful tool for the diagnosis and management of uterine vascular malformations. Ultrasound Obstet Gynecol. 2003;21:570–7.
Ghai S, Rajan DK, Asch MR, Muradali D, Simons ME, TerBrugge KG. Efficacy of embolization in traumatic uterine vascular malformations. J Vasc Interv Radiol. 2003;14(11):1401–8.
Yang JJ, Xiang Y, Wan XR, Yang XY. Diagnosis and management of uterine arteriovenous fistulas with massive vaginal bleeding. Int J Gynecol Obstet. 2005;89(2):114–9.
Kwon JH, Kim GS. Obstetric iatrogenic arterial injuries of the uterus: diagnosis with US and treatment with transcatheter arterial embolization. Radiographics. 2002;22(1):35–46.
Serafini P, Batzofin J. Diagnosis of female infertility. A comprehensive approach. J Reprod Med. 1989;34(1):29–40.
Corbellis L, Argano F, Castaldi MA, et al. Selective salpingography: preliminary experience of an office operative option for proximal tubal recanalization. Eur J Obstet Gynecol Reprod Biol. 2012;163(1):62–6.
Honore GM, Holden AE, Schenken RS. Pathophysiology and management of proximal tubal blockage. Fertil Steril. 1999;71(5):785–95.
Hou HY, Chen YQ, Li TC, Hu CX, Chen X, Yang ZH. Outcome of laparoscopy –guided hysteroscopic tubal catheterization for infertility due to proximal tubal obstruction. J Minim Invasive Gynecol. 2014;21(2):272–8.
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Milovanovic, L. (2016). Interventional Radiology in Women’s Health. In: Athreya, S. (eds) Demystifying Interventional Radiology. Springer, Cham. https://doi.org/10.1007/978-3-319-17238-5_16
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DOI: https://doi.org/10.1007/978-3-319-17238-5_16
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