Uterine artery embolisation (UAE) was first described as a treatment for symptomatic leiomyomas in 1995 by Ravina et al. 1 and has since become established as a valid nonsurgical management option for a woman wishing to conserve her uterus. It involves targeted disruption to the blood supply of the uterus using embolic material such as polyvinyl alcohol particles and subsequent necrosis of the fibroids. However, although there has been great interest in the use of this technique in women wishing to preserve their fertility, it is unclear whether subsequent pregnancy is safe. This uncertainty relates to the relative dearth of published data compounded by the lack of adequate controls; women undergoing UAE tend to have larger, more symptomatic fibroids in comparison with the usual control groups, who are frequently derived from series of women with infertility. 2 To date, over 200 pregnancies following UAE have been reported in the literature. 3 Early pregnancy, in particular, appears to be adversely affected with an increased spontaneous miscarriage rate over the general population (38.5 versus 10-15%) 3 and over other women with uterine fibroids matched for age and fibroid location (35.2 versus 16.5%). 2 A recent systematic review compared pregnancies after UAE with pregnancies in women with untreated fibroids, data informing the review were generally from small retrospective, uncontrolled series. The meta-analysis reported that women who had previously had UAE were more likely to be delivered by caesarean section (66 versus 48.5%; odds ratio [OR] 2.1; 95% CI 1.4-2.9) and were six times more likely to experience postpartum haemorrhage (PPH) (13.9 versus 2.5%; OR 6.4; 95% CI 3.5-11.7). Rates of preterm delivery (14 versus 16%; OR 0.9; 95% CI 0.5-1.5), fetal growth restriction (7.3 versus 11.7%; OR 0.6; 95% CI 0.3-1.3) and malpresentation (10.4 versus 13%; OR 0.8; 95% CI 0.4-1.5) were similar. 2 Despite the lack of large, controlled prospective series or randomised studies, the observed increase in caesarean delivery and, more notably, in PPH raises concerns over the safety of pregnancy after UAE.The cause of increased blood loss after delivery is unclear from the reported data. However, it has been suggested that this is related to the higher caesarean section rate or to inherent impaired contraction of the fibroid uterus. 2 Of note, however, are the increasing number of case reports in the literature of placenta accreta complicating these pregnancies. [4][5][6][7] We have recently experienced an incident of placenta accreta in a 34-year-old general practitioner who underwent UAE of a 15 · 6-cm posterior wall leiomyoma in 2007, which was subsequently passed per vaginam. At hysteroscopy, performed for the investigation of primary infertility, a large crater was noted in the posterior uterine wall. It was felt that this was likely to prevent spontaneous conception. She later presented with a positive pregnancy test and ultrasound showed a singleton intrauterine pregnancy. She was monitored closely throughout the pr...
SummarySeventeen patients undergoing split-skin graftingeach received3 mglkg of a sterile 1 % lignocainegel applied to an area of rhe donor site equal to 3sq cmlkg. Serial venous bloodsamples were taken for one hour following application andanalysed for serum lignocaine concentration by high pressure liquid chromatography. The concentrations in all the patients were well below those associated with systemic toxicity. Clinical assessment included haemodynamic monitoring during rhe procedure, and postoperative evaluation of possible central nervous effects and of the degree of donor site analgesia obtained. No untoward effects were noted and the degree of analgesia, although difficult to assess, appeared good. Key wordsAnaesthetics. local; lignocaine. Skin; analgesia.The harvesting of split skin for grafting is well recognised as a particularly painful procedure. The topical application of lignocaine in the form of a gel prior to dressing of the donor site is a widely practised but unsubstantiated means to attempt to procure analgesia of the area. Following anecdotal reports of possible systemic toxicity, manifested by cardiac dysrythmia and hypotension, the practice of applying lignocaine gel has fallen into disrepute in some centres. A study was therefore conducted to investigate the probability ofsignificant systemic absorption and to assess the efficacy of the technique in providing analgesia. MethodSeventeen patients scheduled for split-skin grafting under general anaesthesia were visited and examined pre-operatively. Informed consent was obtained in all cases following explanation of the study. Patients with a history of grand ma1 epilepsy, significant cardiac disease or allergy to amide local anaesthetics were excluded from the study. The study had the approval of the local ethical committee.General anaesthesia was provided by a variety of techniques according to the anaesthetist concerned, however the use of lignocaine was not permitted either for infiltration prior to venepuncture or for laryngeal anaesthesia prior to intubation. Following induction of general anaesthesia a wide-bore sampling cannula was inserted into a vein on the dorsum of a hand. Patency was maintained by intermittent flushing with small volumes of heparinised saline.Following the removal of the split-skin graft, sterile 1 YO lignocaine gel in a dose of approximately 3 mg/kg was applied to an area of the donor site equal to 3 sq cm/kg, following which the site was dressed with paraffin gauze. A stop watch was started and a baseline measurement of heart rate and blood pressure taken. If the patient was breathing spontaneously, the respiratory rate was also measured over 30 seconds. The sampling periods after application of gel were at every 2 minutes for 20 minutes, then every 10 minutes for a further 40 minutes. At these times a 2-ml venous sample was obtained without the use of a tourniquet following careful aspiration of the cannula dead space, after which the cannula was again flushed with heparinised saline. Recordings of heart rat...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.