High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta

High-Intensity Focused Ultrasound Ablation Combined With Hysteroscopy for the Treatment of Uterine Arteriovenous Fistula Associated With Retained Products of Conception: A Prospective Cohort Study

STUDY OBJECTIVE

To evaluate the efficacy of combining high-intensity focused ultrasound (HIFU) ablation with hysteroscopic removal of retained products of conception in the presence of a uterine arteriovenous fistula (UAVF).

DESIGN

Prospective cohort study SETTING: Tertiary hospital.

PATIENTS

Seventeen patients with UAVF and retained products of conception.

INTERVENTIONS

HIFU ablation combined with hysteroscopic removal of retained products of conception.

MEASUREMENTS AND MAIN RESULTS

All patients presented with irregular vaginal bleeding following pregnancy termination and were not responsive to medical treatment. Patients were confirmed to have a UAVF along with concurrent intrauterine residue using three-dimensional color Doppler ultrasonography, uterine angiography, or pelvic-enhanced magnetic resonance imaging; and demonstrated a poor response to medical treatment. Under real-time ultrasound guidance, HIFU was used to ablate the arteriovenous malformation region. Patients underwent hysteroscopic removal of retained products of conception; the removed tissue was subjected to pathological examination. All patients underwent monthly uterine color Doppler ultrasound examinations and menstrual status follow-up within 3 months postoperatively and showed normal menstrual recovery without signs of arteriovenous malformations on ultrasonography. Pathological examination of the tissues removed during hysteroscopic clearance revealed characteristics consistent with pregnancy, with abnormal blood vessels in some tissues. All patients experienced normal menstrual recovery postoperatively, without intrauterine adhesions.

CONCLUSION

Combining HIFU ablation with postoperative hysteroscopic surgery effectively treats pregnancy-related UAVF with minimal complications and preserves fertility, it offers an additional treatment option for patients wanting future fertility.

The effectiveness of single ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in managing placenta accreta spectrum (PAS) disorder

OBJECTIVE

To evaluate the feasibility and effectiveness of single ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in managing placenta accreta spectrum (PAS) disorder.

MATERIALS AND METHODS

We retrospectively analyzed 40 PAS patients between April 2017 and October 2021. All the patients received one session of HIFU treatment. Regular follow-up was done after HIFU treatment until normal menstruation returned and placental tissue disappeared. The patient's reproductive-related outcomes were obtained through telephone interviews.

RESULTS

The median follow-up time for the 40 patients was 30.50 (15.75-44.00) months and the mean placental tissue elimination time was 45.29 ± 33.32 days. The mean duration of bloody lochia was 13.43 ± 10.01 days, with no incidences of severe bleeding. Notably, Linear regression analysis showed that the residual placenta volume before HIFU was a factor affecting the duration of bloody lochia after HIFU (R2 = 0.284, B = 0.062, P = 0.000). The normal menstrual return time was 58.71 ± 31.14 days. One (2.50%) patient developed an infection. Two (5.00%) patients were subjected to ultrasound-guided suction curettage for persistent vaginal discharge for more than one month without infection. Notably, 7 of the 18 patients who expressed reproductive plans became pregnant during the 4 to 53 months of follow-up without placental abnormalities. The remaining 11 patients were on contraceptives.

CONCLUSIONS

Single HIFU is an effective treatment option for managing PAS. However, future studies on further treatment strategies to reduce complications and promote patient recovery after HIFU ablation are desirable.

A comparison of results following the treatment of placenta accreta and placenta increta using high-intensity focused ultrasound followed by hysteroscopic resection

OBJECTIVE

To compare the safety and efficacy of high-intensity focused ultrasound (HIFU) followed by hysteroscopic resection for different placenta accreta spectrum disorders.

MATERIALS AND METHODS

Thirty-four patients with placenta accreta, placenta increta, or placenta percreta were treated with USgHIFU from January 2016 to December 2019 and were retrospectively reviewed. The patients were classified into three categories according to the relationship between the trophoblastic villi and the myometrium, based on magnetic resonance imaging (MRI). Fifteen patients were classified as placenta accreta, 17 patients were classified as placenta increta, and 2 were classified as placenta percreta. All patients completed follow-up. Treatment efficacy and safety were evaluated.

RESULTS

No significant differences in baseline characteristics and results of HIFU ablation were observed between the patients with placenta accreta and those with placenta increta. The return of HCG levels to normal was longer in patients with placenta accreta compared with patients with placenta increta, while no significant difference was observed in the amount of intraoperative blood loss, the return of normal menstruation and the length of hospital stay.

CONCLUSIONS

HIFU treatment followed by hysteroscopic resection is safe and effective in the treatment of patients with placenta accreta and placenta increta.

Focused Ultrasound Ablation Surgery combined with ultrasound-guided suction curettage in the treatment and management of Cesarean Scar Pregnancy

OBJECTIVE

To evaluate the feasibility, safety, and effectiveness of Focused Ultrasound Ablation Surgery (FUAS) combined with ultrasound-guided suction curettage in the management of Cesarean Scar Pregnancy (CSP).

STUDY DESIGN

We retrospectively analyzed 52 patients with CSP from April, 2017, to December, 2019. All the patients received one session of FUAS, and suction curettage under ultrasound guidance was performed 1-3 days after FUAS. The intraoperative blood loss in suction curettage, duration of vaginal bleeding after curettage, reproductive outcomes, and adverse effects were recorded and analyzed.

RESULTS

All the 52 patients completed one session of FUAS combined with suction curettage without serious adverse effects. The mean intraoperative blood loss was 32.81 ± 53.83 mL. 47 (90.38 %) patients had a successful suction curettage with a blood loss of less than 80 mL. 5 (9.62 %) patients had an active bleeding of ≥80 mL; however, the bleeding was stopped effectively by Foley's urinary catheter and no evident bleeding presented when the catheter was removed 24 h later. The mean duration of vaginal bleeding was 7.88 ± 4.24 days. 48 (92.30 %) patients recovered with little vaginal bleeding after curettage. 4 (7.69 %) type III CSP patients experienced late-onset severe bleeding and required UAE or surgery. During 6-36 months of the follow-up period, 12 patients expressed reproductive plan, in which 4 patients delivered by cesarean section, 3 patients had an ongoing pregnancy and 1 patient had an abortion in the early pregnancy.

CONCLUSIONS

FUAS combined with ultrasound-guided suction curettage is a safe and effective treatment strategy in the management of CSP type I and CSP type II and is particularly advantageous for CSP patients with reproductive requirements. However, further studies are warranted to determine the meticulous inclusion criteria for patients with type III CSP.

High-intensity focused ultrasound versus uterine artery embolization for patients with retained placenta accreta

OBJECTIVE

To compare the safety and clinical effectiveness of high-intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) for retained placenta accreta.

STUDY DESIGN

A retrospective analysis was performed on women who underwent HIFU or UAE followed by hysteroscopic resection for retained placenta accreta from January 2015 to December 2019 at the Third Xiangya Hospital of Central South University.

RESULTS

A total of 63 and 31 patients who underwent HIFU and UAE followed by hysteroscopic resection, respectively, were analyzed. The baseline characteristics, including age, gravidity, parity, previous cesarean section rate, previous curettage rate, previous intrauterine adhesions rate, and delivery mode, were similar between the two groups. Vaginal bleeding was the major complaint in patients with retained placenta accreta. The number of hysteroscopy sessions, amount of intraoperative blood loss, and the length of hospital stays were also similar between the groups. No further hysterectomy was needed in either group.

CONCLUSION

Both HIFU and UAE combined with hysteroscopic resection seem to be safe and effective procedures in cases of retained placenta accreta.

High-intensity focused ultrasound combined procedures treatment of retained placenta accreta with marked vascularity after abortion or delivery

OBJECTIVE

To evaluate the safety and feasibility of combined procedures: HIFU combined with systemic MTX followed by ultrasound-guided curettage or hysteroscopic resection while treating placenta accreta (PA).

METHOD

This study included 21 patients diagnosed with retained PA with marked vascularity after abortion or delivery from July 2015 to December 2017. Patients with high serum β-hCG level (≥100 mIU/mL) received systemic MTX + HIFU treatment for 3 days and the ones with low β-hCG level (<100 mIU/mL) only received USgHIFU treatment for 3 days before ultrasound-guided curettage or hysteroscopic resection. All patients had completed follow-up data. The safety and feasibility of the treatment were evaluated retrospectively.

RESULT

Sixteen patients received systemic 100 mg MTX without myelosuppression. All patients received three days of HIFU ablation therapy; the median of HIFU treatment time was 60 minutes. Ultrasound-guided curettage and ovum forceps were used to extract planted placental tissue in 5 patients with one week after birth or after abortion. Sixteen patients received a hysteroscopic operation after the HIFU treatment. The median of intraoperative blood loss was 30 ml. Twenty patients had recovered normal menstruation on average 32 days (range 14-60) after the operation.

CONCLUSION

Based on the results of this study, with a relatively small number of patients, it seems that three-days' therapy of HIFU ± systemic MTX followed by ultrasound-guided curettage or hysteroscopic resection, is a safe and feasible treatment for retained PA with marked vascularity after abortion or delivery.