Abnormal placental implantation (API) occurs in one of 1/7000  and these numbers are increasing because of the rise of risk factors for placental abnormalities.
APIs are burdened by a massive PPH,
more than other deliveries,
with a blood loss that might exceed 5000 ml .
The role of Interventional Radiology is not yet well established in the management of PPH,
even though many guidelines and authors highlighted IR efficacy [1,3,4,5]. The purpose of this study is to report the experience...
Methods and materials
We collected data for this retrospective study from the clinical records of our institution.
Between 2009 and 2013,
seventy-six patients with imaging confirmed diagnosis (MRI or US) of API were managed with our protocol for API deliveries.
A 5F introducer sheath was positioned in the common femoral artery in the angiographic suite in all patients prior to the delivery .
Twelve of these 76 patients,
experienced an intractable intra-operative PPH after caesarean delivery and underwent pelvic...
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).
PAE is a suitable alternative to hysterectomy to control PPH in API pregnancies.
placenta previa is the more susceptible of hysterectomy sparing procedures,
both for the different approach of the physician that for the minor blood loss during the delivery.
Is reasonable to attempt PAE before hysterectomy more on placenta previa,
while surgeons and IR team should carefully consider the timing of hysterectomy/PAE on placenta percreta.
If there is no active pooling at the angiograms,...
The role of emergency and elective interventional radiology in postpartum haemorrhage June 2007.
Available via http://www.rcog.org.uk/goodpractice Sofiah S,
Fung C et al (2009) Placenta accreta: clinical risk factors,
accuracy of antenatal diagnosis and effect on pregnancy outcome.
Med J Malaysia 64:298–302. Postpartum Haemorrhage,
Prevention and Management (Green-top Guideline No.
52). May 2009 (Minor revisions November 2009 and April 2011) No 52.