Application of 3-d angiography in the management of placenta percreta treated with repeat uterine artery embolization.
BACKGROUND
Rising Caesarean section rates have increased rates of abnormally invasive placentation. In the management of such invasive placentation, hysterectomy may result in greater morbidity than more conservative measures. Non-surgical interventions such as uterine artery embolization (UAE) attempt to decrease placental perfusion and augment placental resorption. Repeat UAE may decrease the risk of unpredictable hemorrhage requiring emergency intervention. Three-dimensional angiography is a novel technology for assessing volume with objective measures of internal flow.


METHODS
We report a case of placenta previa percreta that was treated conservatively by repeat UAE for persistent densely perfused placenta. Three-dimensional angiography was used to objectively assess placental characterization and vascularization.


CONCLUSIONS
Repeat UAE may be beneficial in reducing the risk of delayed hemorrhage in women with placenta previa accreta or percreta managed conservatively. Objective assessment of placental volume and vascularity by 3-D angiography can provide data on patients at risk and allow case selection for repeat UAE.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal QC, Canada.
Amira
A
El-Messidi
Cathie
C
Morissette
Wylam
W
Faught
Lawrence
L
Oppenheimer
D000328:Adult; D000792:Angiography / Q000379:methods*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D010921:Placenta Accreta / Q000000981:diagnostic imaging*; D011247:Pregnancy; D014463:Ultrasonography; D055988:Uterine Artery