R Pit Sp Cialis Diclofenacnatrium Ratiopharm 50 Mg Cialis Generico Capsule Gelatinoase Soft Tabs Y Buy Clomid For Men Online Pfizer Viagra Pharmacy

///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-05:00

A Two-Day Interventional Radiologic Approach to Invasive Placenta Percreta

Abstract Number: SUN-64
Abstract Type: Case Report/Case Series

Brandon M Lopez MD1

Introduction:

Placenta percreta is a disorder involving abnormal invasion of the placenta through the myometrium and into surrounding structures. This case presents a multi-specialty two-day staged cesarean hysterectomy.

Case:

40 yoF G7P2042 presents for tertiary care due to expected placenta percreta with MRI findings of invasion into the bladder and peri-rectal space. Significant past surgical history of 2 prior CDs, 1 ectopic pregnancy, 3 SABs and 2 D&Cs. Multidisciplinary meeting held with radiology, gyn oncology, urology, anesthesia, MFM, and neonatology. Operative day 1 patient underwent occlusion balloon placement in bilateral internal iliac arteries under sedation, followed by CD under GA uneventfully. She was immediately brought back to IR for bilateral hypogastric gel-foam embolization, including other small feeding vessels. Operative day 2 started in IR with re-embolization of anterior divisions of internal iliac and bilateral occlusion balloons. She was then brought to OR for hysterectomy and cystotomy with repair leading to 4 L EBL and massive transfusion despite embolization and occlusion balloons. She was extubated POD 1 with stable course.

Discussion:

Despite multiple IR embolizations and balloon catheters, we still experienced a large hemorrhage intraoperatively. Without the help of embolization and staging, the likelihood of mortality is presumed high. This case highlights the importance of a multi-disciplinary team approach to reduce morbidity and mortality in these patients.

References:

Leung TK, Au HK, Lin YH, Lee CM, Shen LK, Lee WH, Wang HJ, Hsiao WT, Chen YY.

Prophylactic trans-uterine embolization to reduce intraoperative blood loss for placenta percreta invading the urinary bladder. J Obstet Gynaecol Res. 2007 Oct;33:722-5.

Dubois J, Garel L, Grignon A, Lemay M, Leduc L. Placenta percreta: balloon occlusion and embolization of the internal iliac arteries to reduce intraoperative blood losses. Am J Obstet Gynecol. 1997 Mar; 176:723-6.

Ballas J, Hull AD, Saenz C, Warshak CR, Roberts AC, Resnik RR, Moore TR, Ramos GA. Preoperative intravascular balloon catheters and surgical outcomes in pregnancies complicated by placenta accreta: a management paradox. Am J Obstet Gynecol. 2012 Sep; 207:216.e1-5.



SOAP 2017