Stepwise Treatment for Abnormally Invasive Placenta with Placenta Previa

Placenta accreta spectrum (PAS) disorder often causes a large amount of intraoperative bleeding in a short period which makes maternal circulation unstable and threatens life. As a countermeasure, two-stage surgery combined with selective uterine arterial embolization (UAE), named “stepwise treatment” was introduced in 2003. At a cesarean section (CS), only the baby is delivered and the placenta is left in situ. The transcatheter angiographic UAE is performed on the operation day, followed by the total hysterectomy on 5 to 7 days after CS. The difficulty in the operative procedures for hysterectomy and the amount of bleeding can be reduced by the added effect of the blood flow interruption by UAE and the uterine involution. Although there are not many indication cases, this is the prudent operation that should be considered for the most severe PAS case such as total placenta increta/percreta with placenta previa.In this article, the practical procedures and tips of stepwise treatment are described.

Color Doppler Ultrasound in Uterine Arterial Embolization

ObjectiveTo observe and analyze the effect of color doppler ultrasonography (CDU) in uterine arterial embolization (UAE).Methods160 cases of patients with uterine fibroid were selected in this study. CDU were performed on all patients before UAE as well as 5-9 days and 3- 6 months after UAE, so as to observe the shape, size and ultrasonogram of the uterus and uterine fibroid, and the blood flow changes of the uterine fibroid. In addition, analysis was carried out on the improvement of the clinical symptoms 3 months to 6 months after UAE.Results5-9 days and 3-6 months after UAE, the blood flow of uterine fibroid was significantly reduced or even disappeared, with P <0.05; according to the observation carried out 3-6 months after UAE, irregular menstruation and uterine fibroid compression were significantly relieved; the uterine size and the uterine fibroid volume were significantly decreased;high-level echo was generated inside of the uterine fibroid, which was then gradually reduced into slightly higher echo, equal echo and low echo. High-level echo was found around the uterine fibroid.ConclusionIt is safe and reliable for the patients with symptomatic uterine fibroid to take UAE. The application of CDU can also provide a good basis and has great significance.

Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation

Although it is widely accepted that uterine artery embolization (UAE) is an effective therapeutic strategy for postpartum hemorrhage (PPH), no consensus has been reached regarding the efficacy of UAE in patients with PPH with disseminated intravascular coagulation (DIC). This single-center retrospective cohort study included patients treated with UAE using NBCA for PPH between 2010 and 2015. The patients were divided into DIC and non-DIC groups, according to the obstetrical DIC score and the overt DIC diagnostic criteria issued by the International Society of Thrombosis and Haemostasis (ISTH), and their clinical outcomes were compared. There were 28 patients treated with UAE using NBCA. Complete hemostasis was achieved by UAE in 19 of 28 patients. In eight of nine patients with unsuccessful hemostasis, surgical hemostatic interventions were performed after UAE, and hemostasis was achieved in seven patients. UAE using NBCA showed no significant intergroup differences in complete hemostasis according to the presence or absence of DIC based on obstetrical DIC score (70% versus 62.5%, P=1.000) or ISTH DIC score (54.5% versus 76.5%, P=0.409). UAE using NBCA may be a useful first-choice treatment for PPH with DIC.