Value of pelvic embolization in the management of severe postpartum hemorrhage due to placenta accreta, increta or percreta.

OBJECTIVES: To evaluate the role, efficacy and safety of pelvic embolization in the management of severe postpartum hemorrhage in women with placenta accreta, increta or percreta. METHODS: The clinical files and angiographic examinations of 12 consecutive women with placenta accreta (n=4), increta (n=2) or percreta (n=6) who were treated with pelvic embolization because of severe primary (n=10) or secondary (n=2) postpartum hemorrhage were reviewed. Before embolization, four women had complete placental conservation, four had partial placental conservation, three had an extirpative approach and one had hysterectomy after failed partial conservative approach. RESULTS: In 10 women, pelvic embolization was successful and stopped the bleeding, after one (n=7) or two sessions (n=3). Emergency hysterectomy was needed in two women with persistent bleeding after embolization, both with placenta percreta and bladder involvement first treated by extirpation. One case of regressive hematoma at the puncture site was the single complication of embolization. CONCLUSIONS: In women with severe postpartum hemorrhage due to placenta accreta, increta or percreta, pelvic embolization is effective for stopping the bleeding in most cases, thus allowing uterine conservation and future fertility. Further studies, however, should be done to evaluate the potential of pelvic embolization in women with placenta percreta with bladder involvement.

Preoperative detection of hepatic metastases: comparison of diffusion-weighted, T2-weighted fast spin echo and gadolinium-enhanced MR imaging using surgical and histopathologic findings as standard of reference.

PURPOSE: The purpose of this study was to retrospectively compare the respective sensitivities of diffusion-weighted (DW), T2-weighted fast spin-echo (T2WFSE) and gadolinium chelate-enhanced MR imaging in the preoperative detection of hepatic metastases using intraoperative ultrasonographic and histopathologic findings as the standard of reference. MATERIALS AND METHODS: Twenty-seven patients with 64 surgically and histopathologically proven hepatic metastases had MR imaging of the liver, including DW, T2WFSE and dynamic gadolinium chelate-enhanced MR imaging. Images from each MR sequence were separately analyzed by two readers with disagreements resolved by consensus readings. The findings on MR images were compared with intraoperative ultrasonographic and histopathologic findings on a lesion-by-lesion basis to determine the sensitivity of each MR sequence. Statistical review of the lesion-by-lesion analysis was performed with the McNemar test. RESULTS: DW, T2WFSE and gadolinium chelate-enhanced MR imaging allowed the depiction of 54/64 (84.4%; 95% CI: 73.1-92.2%), 44/64 (68.8%; 95% CI: 55.9-79.8%), and 51/64 (79.7%; 95% CI: 67.8-88.7%) hepatic metastases respectively. DW MR images allowed depiction of significantly more hepatic metastases than did T2WFSE and was equivalent to gadolinium chelate-enhanced MR imaging (P=.002 and P=.375, respectively). CONCLUSION: DW MR imaging is superior to T2WFSE imaging and equivalent to gadolinium chelate-enhanced MR imaging for the preoperative detection of hepatic metastases. Further studies however are needed to determine at what extent DW MR imaging can be used as an alternative to gadolinium chelate-enhanced MR imaging for the preoperative depiction of hepatic metastases.