RESUMO
PURPOSE: To evaluate the feasibility and safety of early and proactive involvement of interventional radiology (IR) in the management of placenta accreta spectrum (PAS) by performing the cesarean operation and prophylactic uterine artery embolization in the IR angiography suite as a combined procedure. MATERIALS AND METHODS: This study evaluated the effectiveness and safety of prophylactic uterine artery embolization prior to placental separation in cases of antenatally proven or suspected abnormal placentation. Over a 5-year period, 16 consecutive patients with PAS underwent combined IR and obstetric intervention. In all cases, cesarean delivery was performed in the IR angiography suite. Vascular access was obtained prior to surgery with balloon placement into both internal iliac arteries. These balloons were inflated after delivery, followed by uterine artery embolization (14 of 16) if there was evidence of active postpartum bleeding or inability to deliver the placenta. RESULTS: There was no fetal or maternal mortality and no significant IR or surgical adverse events. Mean blood loss was 1900 mL. Seven patients (44%) underwent hysterectomy. CONCLUSIONS: In patients with PAS, cesarean section in the angiography suite preceded by prophylactic balloon placement and followed by uterine artery embolization was feasible, safe, and effective in preventing massive blood loss, with a 56% uterine sparing rate.
Assuntos
Oclusão com Balão , Placenta Acreta , Hemorragia Pós-Parto , Embolização da Artéria Uterina , Gravidez , Humanos , Feminino , Placenta Acreta/terapia , Placenta Acreta/cirurgia , Embolização da Artéria Uterina/efeitos adversos , Cesárea/efeitos adversos , Placenta , Oclusão com Balão/efeitos adversos , Oclusão com Balão/métodos , Histerectomia , Artéria Ilíaca , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Morbidade , Estudos Retrospectivos , Perda Sanguínea Cirúrgica/prevenção & controleRESUMO
Despite efforts by medical and social activists, transgender parturients encounter barriers to adequate and gender-inclusive health care, resources, and support. We present a case of a 38-year-old transgender man presenting for induction of labor at term. Our case highlights the importance of multidisciplinary planning, appropriate gender-related language, and interventions that may ameliorate gender dysphoria during childbirth. Because some transgender men may desire childbirth, we recommend that health care providers become familiar with and respectful of the unique considerations for this patient population in the peripartum setting.
Assuntos
Disforia de Gênero , Pessoas Transgênero , Adulto , Atenção à Saúde , Identidade de Gênero , Humanos , Masculino , Período PeripartoRESUMO
Carotid stump syndrome is one of the recognised causes of recurrent ipsilateral cerebrovascular events after occlusion of the internal carotid artery. It is believed that microemboli arising from the stump of the occluded internal carotid artery or the ipsilateral external carotid artery can pass into the middle cerebral artery circulation as a result of patent external carotid-internal carotid anastomotic channels. Different pathophysiologic causes of this syndrome and endovascular options for treatment are discussed.
