High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta

Abstract

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

High‐intensity focused ultrasound combined with hysteroscopic resection for the treatment of placenta accreta

“…Fu et al reported 22 cases of PA treated by HIFU. 22 After HIFU treatment, blood perfusion of placental tissues significantly dropped, or even disappeared. Twenty cases of placental tissue did not need curettage but five cases did.…”

A comparison of results following the treatment of placenta accreta and placenta increta using high-intensity focused ultrasound followed by hysteroscopic resection

“…The goal of HIFU treatment in the management of placenta accreta is to reduce the risk of severe hemorrhage during D&C [13]. Several studies with a small number of subjects have demonstrated the efficiency and safety of HIFU treatment for placenta accreta after vaginal delivery [14][15][16][17][18]. The results from these studies showed that the blood supply of the residual placental tissue either significantly decreased or disappeared after HIFU (Figure 2(D)).…”

High-intensity focused ultrasound combined procedures treatment of retained placenta accreta with marked vascularity after abortion or delivery

“…As a noninvasive treatment technique, the application of HIFU on the management of PA has been reported in several preliminary studies in recent years [5][6][7]. During HIFU ablation, the ultrasound beams generated from the transducer can penetrate through abdominal skin, subcutaneous tissue and the bladder, then focused at the targeted PA lesion.…”

“…A previous study has also shown that HIFU can destroy small vessels with a diameter of less than 2 mm [15][16][17][18], which could reduce the chances of hemorrhage related to PA. Although there are several clinical studies that have shown the effectiveness and safety of HIFU in treating PA [5][6][7][8]. Ye et al [5] reported that, two patients had uterine perforation during the first operation of the 25 patients and one converted into laparoscopic operation which was found whole layers of the uterus that underwent HIFU therapy, became thin and brittle, and the lesion in the uterus was resected and sutured.…”

“…PA is an important obstetric problem in medical practice and the preservation of the uterus remains a clinical challenge in the management of retained PA with marked vascularity. Over the past decade, ultrasound-guided high-intensity focused ultrasound (USgHIFU) has been used to treat PA [5][6][7][8], however, such combined procedures: HIFU combined with systemic MTX followed by ultrasound-guided curettage or hysteroscopic resection, have never been systemically studied.…”