Taiwanese Journal of Obstetrics and Gynecology
Volume 45, Issue 2 , Pages 150-154, June 2006

Experience with Conservative Strategy of Uterine Artery Embolization in the Treatment of Placenta Percreta in the first Trimester of Pregnancy

  • Shih-Hui Tseng

      Affiliations

    • Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Chung Shan Medical University, Huang Kung University, and National Yang Ming University, Taiwan
    • ,
  • Chia-Hui Lin

      Affiliations

    • Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Chung Shan Medical University, Huang Kung University, and National Yang Ming University, Taiwan
    • ,
  • Jen I. Hwang

      Affiliations

    • Department of Radiology, Taichung Veterans General Hospital, Chung Shan Medical University, Huang Kung University, and National Yang Ming University, Taiwan
    • ,
  • Wei-Che Chen

      Affiliations

    • Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Chung Shan Medical University, Huang Kung University, and National Yang Ming University, Taiwan
    • ,
  • Esther Shih-Chu Ho

      Affiliations

    • Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Chung Shan Medical University, Huang Kung University, and National Yang Ming University, Taiwan
    • ,
  • Min-Min Chou

      Affiliations

    • Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Chung Shan Medical University, Huang Kung University, and National Yang Ming University, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Min-Min Chou, Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 160, Taichungkang Road, Section 3, Taichung 407, Taiwan

Accepted 13 December 2005.

Article Outline

Summary 

Objective

There is little prospective experience in the conservative treatment of placenta percreta during the first trimester in order to preserve uterine fertility. We describe herein our experience with uterine artery embolization (UAE) in the management of placenta percreta at 9 weeks of gestation.

Case Report

A 36-year-old woman, gravida 3, para 1, was referred for ultrasonographic evaluation because of suspected molar pregnancy due to persistent vaginal spotting at 9 weeks of gestation. A Grade 3+ lacunar flow pattern with multiple bizarre and large irregular sonolucent spaces were observed. Color Doppler imaging revealed extensive turbulent lacunar blood flow perfusing throughout the whole surrounding uteroplacental tissues and fetus. The patient was informed of the situation and she had a strong desire to avoid surgery. Conservative management with bilateral UAE was performed using polyvinyl alcohol particles to promote involution and shedding of the abnormally adherent placenta. However, an unsatisfactory vessel-occluding effect caused by extensive collateral supply was still detected after repeated UAE. We, therefore, performed hysterectomy, and the patient had an uneventful postoperative course.

Conclusion

The efficacy and complications of UAE as a therapeutic modality for the conservative management of invasive placentation in the first trimester of pregnancy are not clear, as this is the first report of its kind. However, although UAE had failed in this case, it may still be a useful procedure as a prophylactic measure before surgical intervention, and hysterectomy can also be performed for better control of operative hemorrhage.

Key Words:  hysterectomy , placenta percreta , uterine artery embolization

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PII: S1028-4559(09)60214-X

doi:10.1016/S1028-4559(09)60214-X

Taiwanese Journal of Obstetrics and Gynecology
Volume 45, Issue 2 , Pages 150-154, June 2006

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