Sepsis after uterine artery embolization-assisted termination of pregnancy with complete placenta previa: A case report

Wang, Yinfeng; Huang, Xiufeng

doi:10.1177/0300060517723257

Cited by 14 publications

(10 citation statements)

References 10 publications

(13 reference statements)

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“…In severe cases, hysterotomy abortion or even hysterectomy is still needed due to sepsis or labor induction failure. [ 12 ] In the case of severe bleeding, emergency uterine artery embolization requires a radiology surgical team, additional equipment, extra time for patient transfer and operation. Bleeding may be aggravated during the process; uterine contraction medicine may lead to vasoconstriction and then increase the operational difficulties.…”

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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“…After branching from the internal iliac artery, the tortuous UtA traversed inferiorly and medially, formed a hairpin loop in the pelvis, and subsequently carried blood superiorly and laterally to radial and spiral arteries. This anatomy has been partly described in embolization procedures for peripartum hemorrhage, 16,17 however, there is limited knowledge of its normal and pathophysiologic anatomical variation. We observed substantial bilateral UtA anatomical and hemodynamic heterogeneity, which may reflect variations in placental location, molecular signals that promote UtA remodeling and growth, body habitus, and variations in patient position during imaging.…”

Section: Discussionmentioning

confidence: 99%

“…GA, maternal age, placental position, and TOF angiogram of the pelvic arteries in three representative subjects(16,25,30) and three abnormal subjects (A, B, C).…”

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confidence: 99%

Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4d flow mri and its correlation with doppler ultrasound

Hwuang

Vidorreta

Schwartz

et al. 2018

Magnetic Resonance Imaging

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Background: Uterine artery (UtA) hemodynamics might be used to predict risk of hypertensive pregnancy disorders, including preeclampsia and intrauterine growth restriction. Purpose or Hypothesis: To determine the feasibility of 4D flow MRI in pregnant subjects by characterizing UtA anatomy, computing UtA flow, and comparing UtA velocity, and pulsatility and resistivity indices (PI, RI) with transabdominal Doppler ultrasound (US). Study Type: Prospective cross-sectional study from June 6, 2016, to May 2, 2018. Population or Subjects or Phantom or Specimen or Animal Model: Forty-one singleton pregnant subjects (age [range] = 27.0 ± 5.9 [18–41] years) in their second or third trimester. We additionally scanned three subjects who had prepregnancy diabetes or chronic hypertension. Field Strength/Sequence: The subjects underwent UtA and placenta MRI using noncontrast angiography and 4D flow at 1.5T. Assessment: UtA anatomy was described based on 4D flow-derived noncontrast angiography, while UtA flow properties were characterized by net flow, systolic/mean/diastolic velocity, PI and RI through examination of 4D flow data. PI and RI are standard hemodynamic parameters routinely reported on Doppler US. Statistical Tests: Spearman’s rank correlation, Wilcoxon signed rank tests, and Bland-Altman plots were used to preliminarily investigate the relationships between flow parameters, gestational age, and Doppler US. Results: 4D flow MRI and UtA flow quantification was feasible in all subjects. There was considerable heterogeneity in UtA geometry in each subject between left and right UtAs and between subjects. Mean 4D flow-based parameters were: mean bilateral flow rate = 605.6 ± 220.5 mL/min, PI = 0.72 ± 0.2, and RI = 0.47 ± 0.1. Bilateral flow did not change with gestational age. We found that MRI differed from US in terms of lower PI (mean difference −0.1) and RI (mean difference < −0.1) with Wilcoxon signed rank test P = 0.05 and P = 0.13, respectively. Data Conclusion: 4D flow MRI is a feasible approach for describing UtA anatomy and flow in pregnant subjects. Level of Evidence: Technical Efficacy: Stage 1

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“…Although there is no consensus on treatment, currently available treatments reported in the literature include medical therapy, uterine artery embolization (UAE) in combination with dilatation and curettage, hysteroscopic resection, laparotomic resection, laparoscopic resection, and transvaginal resection. Medical therapy involves long recovery times, whereas UAE has complications such as postthrombotic syndrome, injury to ovarian function and the urinary system, and even pulmonary embolism, [ 1 ] sepsis, [ 2 ] and rectal perforation. [ 3 ] Neither medical therapy nor UAE in combination with dilatation and curettage can repair scar dehiscence, and these treatments do not reduce the risk of recurrence, particularly for patients who wish to preserve fertility.…”

Section: Introductionmentioning

confidence: 99%

Combined laparoscopic and hysteroscopic management of cesarean scar pregnancy with temporary occlusion of bilateral internal iliac arteries

Xia

et al. 2018

Medicine

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Rationale:Cesarean scar pregnancy is a rare event that carries a risk of heavy hemorrhage and emergency hysterectomy. Many treatment modalities have been reported, but with no consensus. Here we report a case of combined laparoscopic and hysteroscopic treatment with temporary occlusion of the bilateral internal iliac arteries.Patient concerns:A 28-year-old woman presented with amenorrhea diagnosed as an 11-week cesarean scar pregnancy after an unsuccessful abortion. The patient's serum human chorionic gonadotropin level was 40,542 mIU/mL. Magnetic resonance imaging revealed a mass measuring 5 × 4.5 cm over the anterior uterine isthmus.Diagnose:Type III cesarean pregnancy.Interventions:Diagnostic and operative laparoscopy were performed to remove the pregnancy tissue and repair the scar dehiscence after temporary occlusion of the bilateral internal iliac arteries, followed by hysteroscopy to confirm no pregnancy remnants and to free intrauterine adhesions.Outcomes:Intraoperative and postoperative bleeding were minimal. The postoperative recovery was uneventful. Human chorionic gonadotropin normalized after 3 weeks.Lessons:Temporary occlusion of the bilateral internal iliac arteries seems to be a good strategy to reduce hemorrhage in cesarean scar pregnancy. Hysteroscopy is necessary to deal with intrauterine lesions.

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Sepsis after uterine artery embolization-assisted termination of pregnancy with complete placenta previa: A case report

Cited by 14 publications

References 10 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

Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4d flow mri and its correlation with doppler ultrasound

Combined laparoscopic and hysteroscopic management of cesarean scar pregnancy with temporary occlusion of bilateral internal iliac arteries

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