Uterine artery embolization in obstetrics

Abstract

Introduction. We did not find any publications or mentions in the Ukrainian medical segment of the Internet and special medical literature about previously performed similar operations (simultaneous caesarean section and embolization of the uterine arteries directly at the moment of birth), which allows us to consider the two operations performed «Prophylactic selective transcatheter embolization of uterine arteries» in pa­­tients with placenta previa percreta the first in Ukraine. Background. The prevalence of placenta previa and placenta percretaincreases from year to year as a result of an increase in the number of cesarean sections. Because of this, the percentage of women at high risk of massive life-threatening bleeding is also increasing. Predictions around the world show that the incidence of cesarean section will increase, which will lead to an increase in the number of placenta previa and placenta increta and thereafter maternal mortality, since the main cause of maternal mortality is bleeding (about 35 % of cases). The aim study was to asses of the effect of preventi­­ve selective embolization of uterine arteries with placenta previa percreta on the volume of blood loss during delivery, and the possibility of preserving the uterus and the reproductive function of women. Material and methods. In 2018—2019, we per­­formed two prophylactic selective transcatheter em­­bolizations of the uterine arteries in patients with placenta previa percreta. The delivery of these patients took place in the form of simultaneous endovascular embolization of the uterine arteries during cesarean section. The delivery algorithm was as follows: the first stage was the contralateral catheterization of the uterine arteries by transfemoral access. Next, corporal cae­sarean section was performed. After extraction of the fetus and clamping of the umbilical cord, uterine arteries were selectively embolized until the blood flow through them was completely stopped. Then, sepa­­ration/dissection of the placenta, metroplasty and suturing of the wound were performed. At the end of the operation, catheters from the uterine arteries were removed. Results and discussion. The entire embolization procedure (in total: from puncture of the femoral arteries to control angiography after embolization) took 27 minutes in the first case and 38 minutes in the second. The longer embolization time in the second case is partially associated with unilateral access and alternate catheterization of the uterine arteries. This was done to minimize post-procedural complications of the site of puncture of the femoral artery. Unfortunately, the technical conditions for these embolizations did not allow transradial access, which is possible from a practical point of view. The postpartum period was without complications. As the experience of these two operations showed, it was not possible to achieve the fullness of the «dry uterus» by embolization of the uterine arteries, but the volume of blood loss taking into account reinfusion in the form of washed red blood cells turned out to be lower than the median values of most cases and published studies described in foreign literature. Conclusions. Preventive selective transcatheter em­­bo­­lization of the uterine arteries before birth/removal of the placenta can be considered as a good preventi­­on of primary postpartum hemorrhage and thus to provide organ rescue. In pregnant women of high-risk groups, it is better to carry out catheterization of the uterine arteries in a planned manner before delivery, simultaneously with cesarean section, which is technically simpler.