Raffaella Niola1, Francesco Giurazza2, Giuseppe Nazzaro1, Mattia Silvestre3, Gennaro Nasti1, Maria Antonella Di Pasquale1, Giuseppe Albano1, Liliana Valentino1, Fabio Sirimarco1, Franco Maglione1. 1. Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy. 2. Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy; Radiology Department, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo 200, Rome 00198, Italy. Electronic address: francescogiurazza@hotmail.it. 3. Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy; Radiology Department, Università degli Studi di Napoli Federico II, Naples, Italy.
Abstract
PURPOSE: To assess the safety and outcomes of uterine artery embolization (UAE) performed before delivery in patients with placental implant anomalies at high risk for peripartum or postpartum hemorrhage. MATERIALS AND METHODS: From January 2013 to January 2015, 50 consecutive patients with placental implant anomalies at 35-36 weeks of pregnancy were recruited. UAE was performed superselectively by injecting reabsorbable pledgets. We applied 5 dosimeters to patients' backs to measure the uterine radiation dose, considered to be the same radiation dose that the fetus received. Newborns were assessed immediately after birth and at 6-month follow-up. RESULTS: All procedures were technically successful. Of patients, 64% did not require transfusions. Mean blood units transfused was 0.7 U (range, 0-4 U). No patient was transferred to the intensive care unit. Hysterectomy was performed in 13 patients (26%). Mean fluoroscopy operative time was 3 minutes 42 seconds (range, 1 min 21 s-6 min 58 s), and mean uterine radiation dose was 15.61 mGy (range, 8.15-38.18 mGy). Mean time between embolization and delivery was 6 minutes 4 seconds (range, 4 min 18 s-8 min 12 s). The 1-minute and 5-minute Apgar scores were 8-9 in all newborns; 8 newborns were lost to follow-up at 6 months. A normal cognitive outcome was evident in all 42 children studied. CONCLUSIONS: UAE before delivery appeared to reduce bleeding during cesarean sections in this consecutive series of patients with placental implant anomalies. In the hands of experienced staff, radiation dose to the fetus was minimal.
PURPOSE: To assess the safety and outcomes of uterine artery embolization (UAE) performed before delivery in patients with placental implant anomalies at high risk for peripartum or postpartum hemorrhage. MATERIALS AND METHODS: From January 2013 to January 2015, 50 consecutive patients with placental implant anomalies at 35-36 weeks of pregnancy were recruited. UAE was performed superselectively by injecting reabsorbable pledgets. We applied 5 dosimeters to patients' backs to measure the uterine radiation dose, considered to be the same radiation dose that the fetus received. Newborns were assessed immediately after birth and at 6-month follow-up. RESULTS: All procedures were technically successful. Of patients, 64% did not require transfusions. Mean blood units transfused was 0.7 U (range, 0-4 U). No patient was transferred to the intensive care unit. Hysterectomy was performed in 13 patients (26%). Mean fluoroscopy operative time was 3 minutes 42 seconds (range, 1 min 21 s-6 min 58 s), and mean uterine radiation dose was 15.61 mGy (range, 8.15-38.18 mGy). Mean time between embolization and delivery was 6 minutes 4 seconds (range, 4 min 18 s-8 min 12 s). The 1-minute and 5-minute Apgar scores were 8-9 in all newborns; 8 newborns were lost to follow-up at 6 months. A normal cognitive outcome was evident in all 42 children studied. CONCLUSIONS: UAE before delivery appeared to reduce bleeding during cesarean sections in this consecutive series of patients with placental implant anomalies. In the hands of experienced staff, radiation dose to the fetus was minimal.
Authors: Francesco Giurazza; Giuseppe Albano; Liliana Valentino; Emiliano Schena; Tiziana Capussela; Maria Antonella Di Pasquale; Francesco Di Pietto; Rosaria De Ritis; Gennaro Nasti; Giuseppe Scognamiglio; Raffaella Niola Journal: Radiol Med Date: 2017-07-29 Impact factor: 3.469
Authors: Philippe Soyer; Maxime Barat; Romaric Loffroy; Matthias Barral; Raphael Dautry; Vincent Vidal; Olivier Pellerin; Francois Cornelis; Maureen P Kohi; Anthony Dohan Journal: Quant Imaging Med Surg Date: 2020-06
Authors: Francesco Giurazza; Fabio Corvino; Andrea Paladini; Antonio Borzelli; Domenico Scognamiglio; Giulia Frauenfelder; Giuseppe Albano; Fabio Sirimarco; Raffaella Niola Journal: Case Rep Vasc Med Date: 2017-11-22