Prophylactic uterine artery embolization in second-trimester pregnancy termination with complete placenta previa

Wang, Yinfeng; Hu, Caibao; Pan, Ningpin; Chen, Chaolu; Wu, Renyi

doi:10.1177/0300060518801455

Cited by 12 publications

(18 citation statements)

References 27 publications

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“…[ 13 ] Studies have shown that preventive uterine artery embolization does not significantly improve the outcomes of pregnancy termination in patients with complete placenta previa, but increases the risk of complications and leads to a longer hospital stay. [ 14 ] Therefore, the application of vascular interventional techniques in obstetrics is a complicated and expensive procedure that also needs additional personnel and equipment. The necessity and safety of vascular interventional techniques need to be further explored.…”

Section: Discussionmentioning

confidence: 99%

Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester

Chen²

2020

Medicine

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Introduction: The clinical treatment is complicated for patients with placenta previa who must terminate pregnancy due to fetal malformation, death, or inevitable abortion in the second trimester. It is difficult to manage excessive bleeding during pregnancy termination; and those patients face risks of removing the uterus, infection and other complications. Patient concerns: Two patients had placenta previa in the second trimester. Both cases had to terminate pregnancy. Case 1 patient had intrauterine fetal death. Case 2 patient had life-threatening vaginal bleeding. Both patients had bleeding and their cervix was not mature during vaginal delivery. Diagnosis: After hospitalization, placenta previa was confirmed by magnetic resonance imaging for case 1 patient. Placenta previa was confirmed by ultrasound examination for case 2 patient. Both patients had to terminate pregnancy. Interventions: We designed a new procedure using a cervical ripening balloon to reduce the risks during pregnancy termination for patients with placenta previa. A cervical ripening balloon was inserted through the placenta and placed between the fetus and placenta; external force was applied to keep the cervical ripening balloon pressing against the placenta that covers the cervical os. The cervical ripening balloon dilated the cervix, quickly reduced bleeding, and induced vaginal delivery during pregnancy termination for patients with placenta previa. This method was applied to 2 patients with placenta previa who must terminate pregnancy. Outcomes: Using the new method, both patients had a successful pregnancy termination and vaginal delivery with minimal bleeding. Total time from the balloon placement to the end of the delivery was about 3 hours. The procedure only used a cervical ripening balloon without uterine artery embolization needed. The fetus was delivered through the vagina; and the uterus was fully retained. There was no postpartum infection. Conclusion: This new method using a cervical ripening balloon could be a quick and effective way to reduce the risks during pregnancy termination for patients with placenta previa. It is especially helpful in emergency situations with minimal requirements of personnel and equipment. Our study showed great potential of this new utilization of a cervical ripening balloon, and is worthy of further research.

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Section: Discussionmentioning

confidence: 99%

Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester

Chen²

2020

Medicine

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“…How to prevent and deal with prenatal hemorrhage is the key. In recent years, the combination of UAE and conventional medical or instrument labor induction methods has become a new treatment scheme widely studied in clinical practice [7,9,28] . Prophylactic UAE before curettage in patients with cesarean scar pregnancy is safe and effective [7] .…”

Section: Discussionmentioning

confidence: 99%

“…Prophylactic UAE before curettage in patients with cesarean scar pregnancy is safe and effective [7] . However, whether to use emergency or prophylactic UAE for termination of mid-pregnancy with placental previa still remains debated [9,28] . He et al [9] analyzed 85 cases with complete placenta previa for termination of second-trimester pregnancy, in which 20 cases were treated with cesarean delivery, 30 cases were treated with Mifepristone+Rivanl+UAE, and 35 patients were induced by Mifepristone+Rivanol.…”

Section: Discussionmentioning

confidence: 99%

“…The results showed that the total amount of blood loss during induction and labor was lowest, the incidence of fever was highest in cases using Mifepristone+Rivanol+UAE, but 13 patients underwent emergency UAE and 2 patients underwent emergency cesarean section in the cases using Mifepristone+Rivanol. Wang et al [28] found the patients with complete placenta previa who underwent mid-trimester pregnancy termination by labor induction with prophylactic UAE(n=15) and without prophylactic UAE(n=10), the rate of success abortion, the bleeding volume, induction-to-abortion time had no signi cant difference, but the hospital stay was longer and pyrexia was more common in the cases with prophylactic UAE. So prophylactic UAE was not recommended for secondtrimester abortion with complete placenta previa.…”

Section: Discussionmentioning

confidence: 99%

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Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa 

Long¹,

Wu²,

Du³

et al. 2021

Preprint

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Objective: Investigate the different methods for termination at mid-trimester in pregnant women with placenta previa. Methods: A retrospective study was conducted on 264 cases for termination at mid-pregnancy in our hospital, and 34 cases with placenta previa were set as the observation group, and 230 cases with normal placenta were set as control group. Among them, the preferred methods of termination at first were Mifepristone combined with Misoprostol/Rivanol in the observation group, and Mifepristone combined with Misoprostol/Rivanol/cervical double balloon (CDB) in the control group. If the volume of prenatal bleeding was up to 100 mL in the observation group, emergency artery embolization (UAE) was implemented to stop bleeding, then CDB plus with curettage were used in order. If it failed to induce in the control group, CDB was used subsequently followed with Misoprostol/Rivanol. Then, all those cases were set as the comprehensive-induce group, and the others were set as the simple-induce group.Results: the average maternal age, the number of gravidity/parities, the rate of cesarean section, the hospitalization days and cost, the induction time, the rate of postpartum hemorrhage, puerperal infection were higher in the observation group than those in the control group(p<0.05). There were 4 cases used UAE+CDB+curettage in the observation group and 6 cases used CDB after Misoprostol/Rivanol in the control group. The duration time of termination, the rate of postpartum hemorrhage and transferring to ICU, hospitalization days and cost in the comprehensive-induce group were significantly higher than those in the simple-induce group (p<0.05). All cases were delivered through vaginal successfully.Conclusion: We should pay more attention to the complications of prenatal bleeding, postpartum hemorrhage, puerperal infection during the induction at mid-trimester in pregnant women with placenta previa. Emergency UAE + CDB +curettage is a good combination method in prenatal hemorrhage of placenta previa during termination, and CDB was a good tool for cervical ripen with immature cervical condition in mid-trimester for induction of labor.

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“…UAE with minimal invasion has been widely used in the field of gynecology and obstetrics to control hemorrhages, including caesarean scar pregnancy [10] , postpartum hemorrhage [11] by caesarean delivery or vaginal delivery. Whether or not to use prophylactic UAE for termination in the second trimester for pregnant women with CPP remains debated [7,10] .…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study on the Clinical Effect of Uterine Artery Embolization Combined with Cervical Double Balloon for Patients with Complete Placenta Previa Undergoing Pregnancy Termination in the Second Trimester

Peng

et al. 2021

Preprint

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Background Pregnancy termination in the second trimester is a complex and delicate situation for patients with complete placenta previa (CPP), which has less been reported. The objective of this research was to investigate and evaluate the clinical effect of uterine artery embolization(UAE) combined with cervical double balloon(CDB) for patients with CPP. Methods We conducted a retrospective study based on a large medical center. The medical records of patients who were diagnosed with CPP and treated UAE combined with CDB for termination in the second trimester in our hospital from January 2017 and March 2021 were retrospectively reviewed. The clinical outcomes were analyzed.Results A total of 11 patients with CPP were included in this study. Prenatal diagnosis of CPP was realized by trans-vaginal ultrasound. The average age was 34.2 years old, and the gestational week was 21.6 weeks. Of the selected patients, 3 cases (3/11) had previous caesarean delivery, 5 cases were at older maternal age (≥35 years old), 10 cases underwent emergency UAE for prenatal bleeding equal or up to 400 mL and 1 case underwent prophylactic UAE for placenta percreta, and all cases underwent CDB to promote cervical ripening. It was worth noting that 5 cases (5/11) of selected patients underwent curettage to take out fetus and placenta. The uterus preservation was achieved in all 11 patients. The complications associated with conservative management included prenatal hemorrhaging (10/11), blood transfusion (5/11), fever (2/11), and septicemia (1/11). The mean dilation of cervix was from 0cm to 1.9cm, the length of cervix was from 3.5cm to 0.6cm and the Bishop scores were from 1.5 to 7.3 after using CDB, the changes of cervical conditions were statistically significant (p＜0.05). The levels of WBC and CRP were higher after termination with medicine+UAE+CDB and/or curettage. Conclusion The adjuvant therapy of UAE, CDB, and/curettage step by step is a preferred choice for patients with CPP who underwent pregnancy termination in the second trimester.

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Prophylactic uterine artery embolization in second-trimester pregnancy termination with complete placenta previa

Cited by 12 publications

References 27 publications

Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester

Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester

Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa

A Retrospective Study on the Clinical Effect of Uterine Artery Embolization Combined with Cervical Double Balloon for Patients with Complete Placenta Previa Undergoing Pregnancy Termination in the Second Trimester

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Prophylactic uterine artery embolization in second-trimester pregnancy termination with complete placenta previa

Cited by 12 publications

References 27 publications

Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester

Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester

Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa&nbsp;

A Retrospective Study on the Clinical Effect of Uterine Artery Embolization Combined with Cervical Double Balloon for Patients with Complete Placenta Previa Undergoing Pregnancy Termination in the Second Trimester

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Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa