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Emergency and prophylactic uterine artery embolization in gynecology and obstetrics - a retrospective analysis Cover

Emergency and prophylactic uterine artery embolization in gynecology and obstetrics - a retrospective analysis

Radiology and Oncology
Volume 58 (2024): Issue 3 (September 2024)
By: Polona Vihtelic,  Eva Skuk,  Natasa Kenda Suster,  Marina Jakimovska Stefanovska and  Peter Popovic  
Open Access
|Sep 2024

Figures & Tables

Figure 1.

Patient distribution for prophylactic and emergency uterine artery embolization (UAE).
Patient distribution for prophylactic and emergency uterine artery embolization (UAE).

Figure 2.

(A) Transvaginal ultrasonography in a 34-year-old female with vaginal bleeding after spontaneous termination of pregnancy at 12 weeks of gestation. Color Doppler ultrasound showed a 45 x 30 mm mass in the uterus with increased vascularity suggestive of retained products of conception. (B) Pelvic arteriogram demonstrating numerous spiral arteries in the uterus fed by both right and left uterine arteries, confirming the diagnosis of RPOC. (C) Left uterine arteriogram in the same patient before prophylactic embolization with absorbable gelatin sponge particles showing numerous spiral arteries. Postembolization left (D) and right (E) uterine arteriogram demonstrating successful embolization. Subsequently, surgical resection of retained products of conception was successfully performed.
(A) Transvaginal ultrasonography in a 34-year-old female with vaginal bleeding after spontaneous termination of pregnancy at 12 weeks of gestation. Color Doppler ultrasound showed a 45 x 30 mm mass in the uterus with increased vascularity suggestive of retained products of conception. (B) Pelvic arteriogram demonstrating numerous spiral arteries in the uterus fed by both right and left uterine arteries, confirming the diagnosis of RPOC. (C) Left uterine arteriogram in the same patient before prophylactic embolization with absorbable gelatin sponge particles showing numerous spiral arteries. Postembolization left (D) and right (E) uterine arteriogram demonstrating successful embolization. Subsequently, surgical resection of retained products of conception was successfully performed.

Figure 3.

(A) Abdominal magnetic resonance imaging in a 35-year-old woman with singleton pregnancy at the 33rd week of gestation with suspected placenta accrete. The placenta covers the whole anterior part of the uterine wall. On T2-weighted MR images, there is marked thinning of the myometrium at the placental-myometrial interface, with MRI signs of placenta accrete and placenta increta. On the left cranial part of the junction, there is suspected placental invasion through the entire uterine wall, suspicious for placenta percreta. (B-E) Selective uterine angiography and embolization following delivery in the same 35-year-old woman with placenta accrete. Left (B) and right (D) uterine angiogram confirming the diagnosis of RPOC with numerous voluminous spiral arteries before prophylactic embolization. Left (C) and right (E) post-embolization angiogram after successful selective uterine artery embolization with absorbable gelatin sponge particles to reduce vascularity prior to surgical removal. After embolization, the placental tissue was successfully resected, and hysterectomy was prevented.
(A) Abdominal magnetic resonance imaging in a 35-year-old woman with singleton pregnancy at the 33rd week of gestation with suspected placenta accrete. The placenta covers the whole anterior part of the uterine wall. On T2-weighted MR images, there is marked thinning of the myometrium at the placental-myometrial interface, with MRI signs of placenta accrete and placenta increta. On the left cranial part of the junction, there is suspected placental invasion through the entire uterine wall, suspicious for placenta percreta. (B-E) Selective uterine angiography and embolization following delivery in the same 35-year-old woman with placenta accrete. Left (B) and right (D) uterine angiogram confirming the diagnosis of RPOC with numerous voluminous spiral arteries before prophylactic embolization. Left (C) and right (E) post-embolization angiogram after successful selective uterine artery embolization with absorbable gelatin sponge particles to reduce vascularity prior to surgical removal. After embolization, the placental tissue was successfully resected, and hysterectomy was prevented.

Clinical overview of the emergency uterine artery embolization (UAE) group

EMERGENCY UAENumber of casesInterventionBlood loss during gynecological procedureHysterectomy
DURING PREGNANCY TERMINATION
Hemorrhage3Pregnancy termination → hemorrhage → embolization2x 300 mL 1x 1,000 mL0
DURING DELIVERY
Uterine atony10Hemorrhage after vaginal/Cesarean delivery → intrauterine balloon tamponade → embolization8x < 1,000 mL 1x > 2,000 mL 1x > 3,000 mL2
Placental abnormalities5Hemorrhage after vaginal/Cesarean delivery → intrauterine balloon tamponade → embolization< 800 mL0

Clinical overview of the prophylactic uterine artery embolization (UAE) group

PROPHYLACTIC UAENumber of casesInterventionBlood loss during gynecological procedureHysterectomy
BEFORE PREGNANCY TERMINATION
Fetal anomalies accompanied by placental abnormalities5Embolization → pregnancy termination300 –400 mL(median 300 mL)0
Cervical pregnancy4Embolization → pregnancy termination100 –400 mL (median 250 mL)0
BEFORE DELIVERY
Placental abnormalities with or without fetal anomalies8Embolization → vaginal/cesarean delivery200 –1,800 mL (median 400 mL)0
AFTER PREGNANCY TERMINATION
Retained products of conception (RPOC)21Embolization → surgical removal of RPOC100 – 400 mL0
AFTER DELIVERY
Retained products of conception RPOC8Embolization → surgical removal of RPOC100 – 500 mL0
DOI: https://doi.org/10.2478/raon-2024-0037 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 397 - 405
Submitted on: Feb 21, 2024
Accepted on: Jun 21, 2024
Published on: Sep 15, 2024
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
postpartum hemorrhage,
retained products of conception,
endovascular treatment,
uterine artery embolization,
hysterectomy,
fertility
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2024 Polona Vihtelic, Eva Skuk, Natasa Kenda Suster, Marina Jakimovska Stefanovska, Peter Popovic, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

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