Placental vascularity and resorption delay after conservative management of invasive placenta: MR imaging evaluation

Abstract

MR imaging provides useful information after conservative management of invasive placenta and may help predict delay for complete placental resorption.

Optimal strategies for conservative management of placenta accreta: a review of the literature

“…Duration of spontaneous placental regression is observed at a median of 13.5 weeks (range: 4-60 weeks) after delivery. 33) Although pelvic embolization may promote placental resorption, 92) this tendency was not observed in our experience. 93) Further studies are needed to draw definite conclusions.…”

“…The approach varies from laparotomy to a vaginal approach. Some 68,76,87,92) have succeeded in preserving the uterus, while others 29,33,89,93,96) were obligated to perform hysterectomy. We often use metronidazole vaginal suppositories for infection prophylaxis.…”

“…Intriguingly, the timing of a fall in hCG to undetectable levels did not differ much in cases treated conservatively, despite differences in the initial placental volume or approach used to control hemorrhage (e.g., with or without arterial embolization). 93) Consequently, we do not perform uterine artery embolization to facilitate depletion of placental blood supply, though Soyer et al reported that decreased placental vascularity was accelerated via embolization 92) and El-Messidi et al attempted a repeat elective uterine artery embolization to reduce the ongoing risk of bleeding. 95) Instead, we use oral methylergometrine maleate (0.75 mg per day) until the disappearance of placental flow to enhance uterine contraction and, hopefully, promote elimination of blood perfusion into the retained placenta.…”

“…A considerable number of patients frequently suffer infections accompanied by high fever, 33,68,89,92,93,96) which is commonly treated with antibiotics. As for patients complicated with sepsis resistant to antibiotics therapy, 29,76,87) removal of the retained placenta is mandatory.…”

Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

“…A fluid form of gelatin sponge (i.e., slurry) can be obtained by mixing tiny cubicles with iodinated contrast material [65]. This form should be used in women with retained placenta to induce thrombosis of intervillous spaces [24,66]. The use of slurry of gelatin sponge should be avoided in other situations because of reported cases of uterine necrosis with this specific material [60,67,68], although some authors have reported safe and effective TAE with slurry [65].…”