REGULAR CONTENT
Final ID
402
Type
Original Scientific Research-Oral or Pos
Authors
J DeMeritt1, A Al Khan1, A Wattamwar1, B Litkouhi1, A Vaidya1, M Sbarra1, S Zamudio1, R Acera Pozzi2, A Canning3, J Woytanowski3
Institutions
1Hackensack University Medical Center, Hackensack, NJ, 2Rutgers, NJ Medical School, Newark, NJ, 3St George's University School of Medicine, True Blue, Grenada
Purpose
Abnormally invasive placenta (AIP) is associated with morbidity and mortality, most often in the 3rd trimester. Uterine artery embolization (UAE) for the conservative management of AIP has had varying success. Experimentally, placental tissue is resistant to ischemic hypoxia.
Materials & Methods
Two patients underwent UAE for AIP in the 1st trimester. Patient 1: 9 week cervical ectopic and placenta percreta. Patient 2: 9 week cesarean scar pregnancy and placenta percreta. Baseline MRI scans were obtained. Termination of pregnancy (TOP) was performed in both with fetal KCL plus 8 days of methotrexate in patient one. Both were followed with U/S and/or MR/MRA scans and ßHCG levels until resolution. UAE was performed with 500-900 micron Embospheres and gelfoam until stasis, plus coils in patient one. Repeat UAE was performed for revascularization. Patients were followed for bleeding.
Results
1st patient: MRA performed 1.5 weeks (wks) after the 1st UAE showed persistent early enhancing placental tissue. A 2nd UAE performed 1 week later showed revascularization (ßHCG 978). Another MRA 5 wks after the 2nd UAE showed persistent albeit decreased early enhancing placental tissue (ßHCG 75). A 3rd UAE 4 wks later (ßHCG 19) showed revascularization. A 4th MRA 7 wks later showed no residual placental tissue (ßHCG 0). Resolution time from TOP: 4.5 months. 2nd patient: An U/S (ßHCG 322) 3 wks after the 1st UAE showed recurrent vascularity which worsened on a 2nd U/S 3 wks thereafter (BHCG 49). A 2nd UAE 2 wks later showed marked revascularization. A 3rd U/S 3 wks after the 2nd UAE showed recurrent vascularity. A 4th U/S 4 wks later (ßHCG 0) and a 5th U/S 6 wks thereafter both showed resolving vascularity. Resolution time from TOP: 3.5 months. No bleeding occurred.
Conclusions
Recurrent vascular recanalization and recruitment was observed following UAE for AIP despite falling ßHCG levels which may reflect known resistance of placental tissue to ischemic hypoxia. Revascularization of residual placental tissue following UAE could account for treatment failures. Serial bland UAE may mitigate the risk of revascularization. Future studies should define the role of chemoembolization which may accelerate placental involution.
Final ID
402
Type
Original Scientific Research-Oral or Pos
Authors
J DeMeritt1, A Al Khan1, A Wattamwar1, B Litkouhi1, A Vaidya1, M Sbarra1, S Zamudio1, R Acera Pozzi2, A Canning3, J Woytanowski3
Institutions
1Hackensack University Medical Center, Hackensack, NJ, 2Rutgers, NJ Medical School, Newark, NJ, 3St George's University School of Medicine, True Blue, Grenada
Purpose
Abnormally invasive placenta (AIP) is associated with morbidity and mortality, most often in the 3rd trimester. Uterine artery embolization (UAE) for the conservative management of AIP has had varying success. Experimentally, placental tissue is resistant to ischemic hypoxia.
Materials & Methods
Two patients underwent UAE for AIP in the 1st trimester. Patient 1: 9 week cervical ectopic and placenta percreta. Patient 2: 9 week cesarean scar pregnancy and placenta percreta. Baseline MRI scans were obtained. Termination of pregnancy (TOP) was performed in both with fetal KCL plus 8 days of methotrexate in patient one. Both were followed with U/S and/or MR/MRA scans and ßHCG levels until resolution. UAE was performed with 500-900 micron Embospheres and gelfoam until stasis, plus coils in patient one. Repeat UAE was performed for revascularization. Patients were followed for bleeding.
Results
1st patient: MRA performed 1.5 weeks (wks) after the 1st UAE showed persistent early enhancing placental tissue. A 2nd UAE performed 1 week later showed revascularization (ßHCG 978). Another MRA 5 wks after the 2nd UAE showed persistent albeit decreased early enhancing placental tissue (ßHCG 75). A 3rd UAE 4 wks later (ßHCG 19) showed revascularization. A 4th MRA 7 wks later showed no residual placental tissue (ßHCG 0). Resolution time from TOP: 4.5 months. 2nd patient: An U/S (ßHCG 322) 3 wks after the 1st UAE showed recurrent vascularity which worsened on a 2nd U/S 3 wks thereafter (BHCG 49). A 2nd UAE 2 wks later showed marked revascularization. A 3rd U/S 3 wks after the 2nd UAE showed recurrent vascularity. A 4th U/S 4 wks later (ßHCG 0) and a 5th U/S 6 wks thereafter both showed resolving vascularity. Resolution time from TOP: 3.5 months. No bleeding occurred.
Conclusions
Recurrent vascular recanalization and recruitment was observed following UAE for AIP despite falling ßHCG levels which may reflect known resistance of placental tissue to ischemic hypoxia. Revascularization of residual placental tissue following UAE could account for treatment failures. Serial bland UAE may mitigate the risk of revascularization. Future studies should define the role of chemoembolization which may accelerate placental involution.