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Title: UTERINE ARTERY EMBOLIZATION IN COMPLICATED EARLY PREGNANCIES: A CRITICAL INTERVENTION BEFORE CURETTAGE
e-poster Number: EPOS 40
Category: e Poster
Author Name: Dr. Madhushree B G
Institute:
Co-Author Name:
Abstract :
Objective:
The primary objective of this review is to analyze the efficacy of Uterine artery embolization (UAE) as an interventional radiological procedure in managing obstetric bleeding during the first trimester of pregnancy prior to dilatation and evacuation (D&E).
Methods:
22 patients were analysed with 1st trimester excessive bleed per vagina, who underwent uterine artery embolisation. Diagnostic subtraction angiography was performed in all patients and based on the angiographic findings, embolisation was performed using PVA particles or cyanoacrylate glue till the artery branches showed stasis in flow.
Cessation of bleed was confirmed per vaginally and D&E was performed on the same cath lab table by the consulting obstetrician. The obtained tissue was subjected to histopathological examination.
Results:
Out of 22 patients, 8 were diagnosed with scar ectopic pregnancy (36.3%), 2 with Cervical ectopic Pregnancy (9%), Rest (12) presented with post abortal bleeding (54.5%). Amongst the females presenting with post abortal bleed , 3 of them had AVM(13.6%) (Arteriovenous Malformation) , 3 of them had Gestational Trophoblastic Disease (GTD) (13.6%) proven on HPE. 2 of the patients showed infection(9%) as the concurrent finding on histopathology. Prior history of Lower Segment Cesarean Section (LSCS) was seen in 18 cases (81.8%), 9 (40.9%) had prior D & E in past history, 6 (27.2%) had both LSCS and D & E.
Primary embolizing agent was PVA particles (~500-700 micron size) all patients. Patient requiring only cyanoacrylate glue was one patient with diagnosis of AVM and one patient both PVA and Glue.
The need for post procedure blood transfusion was required only in 7 patients (31.8%) with 3 patients receiving 2 pint and 4 of them receiving 1 pint PRBC.
100% clinical and technical success was achieved in the presented series of patients. 2 successful pregnancies witnessed on follow up with delivery of healthy neonates.
Conclusion:
By addressing knowledge gaps and establishing evidence-based guidelines, Uterine artery embolization (UAE) prior to curettage is a promising intervention for achieving hemostasis enhancing the success of gynaecological interventions while preserving the uterus and its physiological functions of menstruation and fertility, ultimately improving maternal well-being.
