Francesco Giurazza1, Giuseppe Albano2, Liliana Valentino3, Emiliano Schena4, Tiziana Capussela5, Maria Antonella Di Pasquale5, Francesco Di Pietto6, Rosaria De Ritis6, Gennaro Nasti7, Giuseppe Scognamiglio7, Raffaella Niola7. 1. Interventional Radiology Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy. francescogiurazza@hotmail.it. 2. Gynecology and Obstetric Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy. 3. Neonatology Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy. 4. BioMedical Instrumentation and Measurements Lab, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo 200, 00100, Rome, Italy. 5. Physic Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy. 6. Radiology Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy. 7. Interventional Radiology Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy.
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.
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.
Authors: Lawrence T Dauer; Raymond H Thornton; Donald L Miller; John Damilakis; Robert G Dixon; M Victoria Marx; Beth A Schueler; Eliseo Vañó; Aradhana Venkatesan; Gabriel Bartal; Dimitrios Tsetis; John F Cardella Journal: J Vasc Interv Radiol Date: 2011-11-23 Impact factor: 3.464
Authors: Julius Chapiro; Rafael Duran; MingDe Lin; John D Werner; Zhijun Wang; Rüdiger Schernthaner; Lynn Jeanette Savic; Mark L Lessne; Jean-François Geschwind; Kelvin Hong Journal: J Vasc Interv Radiol Date: 2015-01-28 Impact factor: 3.464
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