Maternal and perinatal outcomes in placenta accreta spectrum disorders with prophylactic internal iliac artery balloon catheterization and embolization.

OBJECTIVES: To summarize our five-year experience with managing patients diagnosed with wide range of PAS disorder and treated with prophylactic internal iliac balloon implantation prior to cesarean section and to assess maternal and fetal outcomes. MATERIAL AND METHODS: Retrospective cohort study. RESULTS: A total of 30 patients were included in the study. Hysterectomy was performed in 10 cases - partial hysterectomy in six and total hysterectomy in four. Median estimated blood loss was 1.18 L. In two cases technical complications were noted. In one case bilateral internal iliac artery thrombosis requiring urgent surgical intervention occurred. A total of 30 live infants were delivered. Mean birth weight was 2435 g and mean Apgar score at 1', 5' and 10' minutes was 6.8, 8 and 8.7 respectively. After average 30 days of hospitalization all infants and their mothers were discharged in good clinical condition. CONCLUSIONS: Placenta accreta spectrum remains a challenge for obstetricians and gynecologists and despite interdisciplinary approach is associated with numerous complications with life-threatening postpartum hemorrhage being the most serious one. Prophylactic placement of iliac balloons is a minimally invasive and safe endovascular technique which allows rapid and effective control of postpartum bleeding in patients with PAS, with low complication rate for both mother and the child.

Estrogen receptor alpha and beta expression in uterine leiomyomas from premenopausal women.

OBJECTIVE: To measure messenger RNA levels of estrogen receptor (ER) alpha and beta in uterine leiomyomas, normal myometrium, and endometrium. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Seventeen premenopausal women who underwent surgery due to symptomatic uterine leiomyomas. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Quantitative RT-PCR was used for evaluation of ERalpha and ERbeta expression. Results were normalized to total cellular DNA. RESULT(S): Expression of ERalpha and ERbeta did not differ between leiomyomas and myometrium; however, in both tissues, expression of ERalpha was significantly higher than that of ERbeta. Estrogen receptor-alpha expression in endometrium was lower than in leiomyomas and myometrium. In leiomyomas and endometrium, correlations between expression of ERalpha and ERbeta were found. CONCLUSION(S): Uterine leiomyomas, myometrium, and endometrium display distinct patterns of ER expression.