Serial Uterine Artery Embolization for the Treatment of Placenta Percreta in the First Trimester: A Case Report.

Two patients with placenta percreta underwent uterine artery embolization (UAE) for abnormally invasive placenta (AIP) in the first trimester. Patient 1 had a 9-week cervical ectopic, while Patient 2 had a 9-week cesarean scar pregnancy. Elective termination of pregnancy was performed in both patients. UAE was performed with tris-acryl gelatin microspheres as well as gelfoam until stasis and was repeated in cases of revascularization. Both patients were followed with US/MRI/MRA scans and ß-hCG levels. Revascularization occurred in both patients following UAE, requiring multiple embolizations to achieve complete placental involution. Serial bland UAE may be an effective technique in the treatment of first-trimester AIP, with the distinct advantage of maintaining a patient's fertility. LEVEL OF EVIDENCE: Level IV.

Complications due to adhesion formation following cesarean sections: a review of deliveries in three cases.

OBJECTIVE: To describe complications due to adhesion formation following cesarean sections and methods to prevent adhesion formation. DESIGN: Case reports. SETTING: Labor and delivery suites in three hospitals. PATIENT(S): [1] A 32-year-old G2P1 undergoing a repeat cesarean section with severe adhesions and subsequent bladder injury and repair. [2] A 36-year-old G3P1 undergoing a vaginal birth after cesarean (VBAC) with partial uterine dehiscence, fetal distress, and dense pelvic adhesions. [3] A 38-year-old G4P2 undergoing repeat cesarean section with dense adhesions from the uterus to the anterior abdominal wall. INTERVENTION(S): Cesarean sections, lysis of adhesions, and cystotomy repair. RESULT(S): All three patients had significant complications and sequelae secondary to dense uterine adhesions from previous cesarean sections. CONCLUSION(S): Adhesion prevention measures should be routinely implemented to reduce adhesion formation after cesarean deliveries and thus decrease corresponding sequelae. Critical steps to decrease adhesion formation include practicing meticulous surgical techniques, gentle tissue handling, minimizing ischemia and desiccation, controlling hemostasis, avoiding powdered gloves, and achieving peritoneal closure. Based on available data, adhesion barriers are effective in preventing or reducing adhesions after gynecologic surgery and have also been effective following cesarean sections.