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Keywords:
Interventional vascular, Obstetrics (Pregnancy / birth / postnatal period), Fluoroscopy, MR, Ultrasound, Embolisation, Intraoperative, Surgery, Obstetrics
Authors:
A. Rebonato, S. Mosca, M. J. Fischer, D. Maiettini, L. Bellantonio, C. Fusco, C. D'Elia, G. A. Crinò, M. Scialpi; Perugia/IT
DOI:
10.1594/ecr2015/B-1268
Results
Seven patients had placenta previa,
three placenta accreta,
one placenta increta and one placenta percreta were included in the study.
In 8 of 12 patients contrast extravasation was confirmed by detecting active pooling during the angiography ( Fig. 1 ).
We used gelatin sponges in all cases ( Fig. 2 ),
injecting piecemeal with cutting sponges; coils were also used in 8 cases ( Fig. 3 ).
PAE was able to control the haemorrhage in 4 cases,
avoiding hysterectomy (all previa patients).
In four cases the PAE wasn’t able to control haemorrhage and to prevent the hysterectomy (one previa,
3 accreta),
and in one of these not even hysterectomy controlled the bleeding and a second embolization session was necessary to control the hemorrhage (previa).
In four patients (all accreta) the initial decision was to undergo the hysterectomy group,
however bleeding was not controlled therefore PAE was retained as the last resort for haemostasis ( Table 1 ).
Technical success was achieved in all patients; clinical success in the 67%.
Maternal and fetal mortality and morbility was 0%.
Embolization procedures lasted an average of 38 minutes.
A significant difference (p-value 0,0183) was found between the mean estimated intra-operative blood loss (2389ml overall) between previa (1710±513ml) and accreta (3340±1264ml).
No complications (according SIR classification) due to embolization were encountered after the procedure.
The mean intraoperative blood loss was 2389ml.
The mean blood Haemoglobin (Hb) before the delivery was 10.77mg/dL and dropped to 6.27mg/dL during the delivery ( Table 2 ).