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Predelivery uterine arteries embolization in patients affected by placental implant anomalies

  • VASCULAR AND INTERVENTIONAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study is to report on a single center experience of managing patients affected by placenta previa major and/or accretism by embolizing uterine arteries immediately before the cesarean delivery to reduce blood loss and secondary the rate of hysterectomies.

Materials and methods

Sixty-nine patients have been prospectively enrolled. Inclusion criteria were radiological diagnosis of placenta anomalies and risk factors for peri/postpartum hemorrhage. The delivery was electively scheduled between the 35th week and the 36th week of pregnancy. The embolization procedure was performed in the gynecological operating room with a mobile C-arm by injecting calibrated microparticles 500–700 μm. A contrast-enhanced MRI was acquired in a subgroup of 10 patients 6 months after the delivery to evaluate the uterine wall status.

Results

Hysterectomy had been performed in 43.5%; 52.2% did not require blood transfusions; 1.2 blood units per patient had been meanly transfused. The mean fluoroscopy beam-on time was 195 s per patient. The mean uterine dose was 26.75 mGy. No pH anomalies were measured from the umbilical cord blood; the Apgar score at 5 min was ≥8. The analysis of the neuro-developmental milestones showed normal cognitive development in all children at 6 months. The uterine wall enhancement evaluated with contrast-enhanced MRI 6 months after the embolization procedure showed preserved myometrial perfusion without area of necrosis.

Conclusions

In this series of patients, the predelivery uterine arteries’ embolization was a safe and effective procedure; this may represent a technical alternative that interventional radiologists can consider when facing this challenging scenario.

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References

  1. Gielchinsky Y, Mankuta D, Rojansky N, Laufer N, Gielchinsky I, Ezra Y (2004) Perinatal outcome of pregnancies complicated by placenta accreta. Obstet Gynecol 104:527–530

    Article  PubMed  Google Scholar 

  2. Wu S, Kocherginsky M, Hibbard JU (2005) Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 192:1458–1461

    Article  PubMed  Google Scholar 

  3. Jauniaux E, Jurkovic D (2012) Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta 33:244–251

    Article  CAS  PubMed  Google Scholar 

  4. Eller AG, Porter TF, Soisson P, Silver RM (2009) Optimal management strategies for placenta accreta. BJOG 116:648–654

    Article  CAS  PubMed  Google Scholar 

  5. Eshkoli T, Weintraub AY, Sergienko R, Sheiner E (2013) Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol 208:219.e211–219.e217

    Google Scholar 

  6. Committee on Obstetric Practice (2002) ACOG committee opinion. Placenta accreta. Number 266, January 2002. American College of Obstetricians and Gynecologists. Int J Gynecol Obstet 77:77–78

    Article  Google Scholar 

  7. Pan Y, Zhou X, Yang Z, Cui S, De W, Sun L (2017) Retrospective cohort study of prophylactic intraoperative uterine artery embolization for abnormally invasive placenta. Int J Gynecol Obstet 137(1):45–50

    Article  Google Scholar 

  8. Van Overhagen H, Reekers JA (2015) Uterine artery embolization for symptomatic leiomyomata. Cardiovasc Interv Radiol 38:536–542

    Article  Google Scholar 

  9. Pelage JP, Fohlen A, Le Pennec V (2014) Role of arterial embolization in the management of postpartum hemorrhage. J Gynecol Obstet Biol Reprod 43:1063–1082

    Article  Google Scholar 

  10. D’Souza DL, Kingdom JC, Amsalem H et al (2015) Conservative management of invasive placenta using combined prophylactic internal iliac artery balloon occlusion and immediate postoperative uterine artery embolization. Can Assoc Radiol J 66:179–184

    Article  PubMed  Google Scholar 

  11. Pei R, Wang G, Wang H, Huang X, Yan X, Yan X (2017) Efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa. Cardiovasc Interv Radiol 40:375–380

    Article  Google Scholar 

  12. Diop AN, Chabrot P, Bertrand A et al (2010) Placenta accreta: management with uterine artery embolization in 17 cases. J Vasc Interv Radiol 21:644–648

    Article  PubMed  Google Scholar 

  13. Duan XH, Wang YL, Han XW, Chen ZM, Chu QJ, Wang L, Hai DD (2015) Caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation for the management of placenta accreta. Clin Radiol 70(9):932–937

    Article  PubMed  Google Scholar 

  14. Izbizky G, Meller C, Grasso M et al (2015) Feasibility and safety of prophylactic uterine artery catheterization and embolization in the management of placenta accreta. J Vasc Interv Radiol 26:162–169

    Article  PubMed  Google Scholar 

  15. Niola R, Giurazza F, Nazzaro G, Silvestre M, Nasti G, Di Pasquale MA, Albano G, Valentino L, Sirimarco F, Maglione F (2016) Uterine artery embolization before delivery to prevent postpartum hemorrhage. J Vasc Interv Radiol 27(3):376–382

    Article  PubMed  Google Scholar 

  16. Tan CH, Tay KH, Sheah K, Kwek K, Wong K et al (2007) Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta. AJR Am J Roentgenol 189:1158–1163

    Article  PubMed  Google Scholar 

  17. Gonsalves M, Belli A (2010) The role of interventional radiology in obstetric hemorrhage. Cardiovasc Interv Radiol 33:887–895

    Article  CAS  Google Scholar 

  18. Soncini E, Pelicelli A, Larini P, Marcato C, Monaco D et al (2007) Uterine artery embolization in the treatment and prevention of postpartum hemorrhage. Int J Gynaecol Obstet 96:181–185

    Article  CAS  PubMed  Google Scholar 

  19. Rebonato A, Maiettini D, Rossi M, Mosca S (2016) Endovascular management of abnormal placental implantation deliveries: expanding IR boundaries. J Vasc Interv Radiol 27(7):1102–1103

    Article  PubMed  Google Scholar 

  20. Dauer LT, Thornton RH, Miller DL et al (2012) Radiation management for interventions using fluoroscopic or computed tomographic guidance during pregnancy: a joint guideline of the Society of Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe with endorsement by the Canadian Interventional Radiology Association. J Vasc Interv Radiol 23:19–32

    Article  PubMed  Google Scholar 

  21. Tapiovaara M, Siiskonen T (2017) PCXMC: a Monte Carlo program for calculating patient doses in medical X-ray examinations, 2nd edn. https://www.julkari.fi/bitstream/handle/10024/124342/stuk-a231.pdf?sequence=1. Accessed 20 Feb 2017

  22. Chapiro J, Duran R, Lin M et al (2015) Three-dimensional quantitative assessment of uterine fibroid response after uterine artery embolization using contrast-enhanced MR imaging. J Vasc Interv Radiol 26(5):670–678

    Article  PubMed  PubMed Central  Google Scholar 

  23. Siddiqui N, Nikolaidis P, Hammond N, Miller FH (2013) Uterine artery embolization: pre- and post-procedural evaluation using magnetic resonance imaging. Abdom Imaging 38:1161–1177

    Article  PubMed  Google Scholar 

  24. Verma SK, Gonsalves CF, Baltarowich OH et al (2010) Spectrum of imaging findings on MRI and CT after uterine artery embolization. Abdom Imaging 35(1):118–128

    Article  PubMed  Google Scholar 

  25. Dilauro MD, Dason S, Athreya S (2012) Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: literature review and analysis. Clin Radiol 67:515–520

    Article  CAS  PubMed  Google Scholar 

  26. Brotman S, Soderstrom CA, Oster-Granite M et al (1981) Management of severe bleeding in fractures of the pelvis. Surg Gynaecol Obstet 153:823–826

    CAS  Google Scholar 

  27. VIII report on pregnancies, Italian Ministry of Health http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=459. Accessed 20 Feb 2017

  28. Costantino M, Lee J, Mc Cullough M, Nsrouli-Maktabi H, Spies JB (2010) Bilateral versus unilateral femoral access for uterine artery embolization: results of a randomized comparative trial. J Vasc Interv Radiol 21:829–835

    Article  PubMed  Google Scholar 

  29. Bourjeily G, Chalhoub M, Phornphutkul C, Alleyne TC, Woodfield CA, Chen KK (2010) Neonatal thyroid function: effect of a single exposure to iodinated contrast medium in utero. Radiology 256:744–750

    Article  PubMed  Google Scholar 

  30. Rajaram S, Exley CE, Fairlie F, Matthews S (2012) Effect of antenatal iodinated contrast agent on neonatal thyroid function. Br J Radiol 85:e238–e242

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kochi MH, Kaloudis EV, Ahmed W, Moore WH (2012) Effect of in utero exposure of iodinated intravenous contrast on neonatal thyroid function. J Comput Assist Tomogr 36:165–169

    Article  PubMed  Google Scholar 

  32. Manninen AL, Ojala K, Nieminen MT, Perala J (2014) Fetal radiation dose in prophylactic uterine arterial embolization. Cardiovasc Interv Radiol 37:942–948

    Article  Google Scholar 

  33. International Commission on Radiological Protection (2017) Pregnancy and medical radiation. Ann ICRP 2000;30:iii–viii,1–43. http://www.icrp.org/publication.asp?id=ICRP%20Publication%2084. Accessed 20 Feb 2017

  34. Balayla J, Bondarenko HD (2013) Placenta accreta and the risk of adverse maternal and neonatal outcomes. J Perinat Med 41:141–149

    Article  PubMed  Google Scholar 

  35. Niola R, Giurazza F, Torbica A, Schena E, Silvestre M, Maglione F (2017) Predelivery uterine arteries embolization in patients with placental implant anomalies: a cost-effective procedure. Radiol Med 122(1):77–79

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Interventional Radiology Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy

    Francesco Giurazza, Gennaro Nasti, Giuseppe Scognamiglio & Raffaella Niola

  2. Gynecology and Obstetric Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy

    Giuseppe Albano

  3. Neonatology Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy

    Liliana Valentino

  4. BioMedical Instrumentation and Measurements Lab, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo 200, 00100, Rome, Italy

    Emiliano Schena

  5. Physic Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy

    Tiziana Capussela & Maria Antonella Di Pasquale

  6. Radiology Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy

    Francesco Di Pietto & Rosaria De Ritis

Authors
  1. Francesco Giurazza
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  2. Giuseppe Albano
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  3. Liliana Valentino
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  9. Gennaro Nasti
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  10. Giuseppe Scognamiglio
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  11. Raffaella Niola
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Corresponding author

Correspondence to Francesco Giurazza.

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The authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Giurazza, F., Albano, G., Valentino, L. et al. Predelivery uterine arteries embolization in patients affected by placental implant anomalies. Radiol med 123, 71–78 (2018). https://doi.org/10.1007/s11547-017-0796-9

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  • DOI: https://doi.org/10.1007/s11547-017-0796-9

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