In:
Ultraschall in der Medizin - European Journal of Ultrasound, Georg Thieme Verlag KG, Vol. 39, No. 01 ( 2018-02), p. 48-55
Abstract:
Purpose AVMs are rare tumorous vascular lesions derived from placental tissue that may present with massive post-partum hemorrhage (PPH) causing potentially life-threatening anemic shock. Current treatment options include the embolization of uterine arteries and emergency postpartum hysterectomy. We present a new form of minimally invasive, highly specific sonographically guided treatment in the form of the application of a human fibrin sealant leading to the instant cease of blood loss. Materials and Methods A management protocol was established and a case series of 14 patients is presented. Diagnosis by endovaginal color Doppler sonography is followed by the sonographically guided application of biological glue (TISSEEL®), thus allowing for super-selective occlusion of the feeding vessels. Results The procedure was technically successful in all 14 patients, 3 of whom (21 %) had a repeated procedure after 4 – 7 days. The mean age (yrs.) of the patients was 31 (25 – 40), the gravity was median 2 (1 – 5) and the parity was median 1 (0 – 4), the lowest Hb value was on average 9.35 ± 2.25 (5.2 – 14.2) g/dl, the lowest Ht was on average 30.82 ± 6.02 (18 – 41 %). Spectral Doppler analysis revealed an average of 80.71 ± 11.2 (66 – 115) cm/sec for the maximal detectable PSV. In the period of 4 – 55 months after treatment, 7 patients (50 %) had 8 successful pregnancies and 2 miscarriages. Conclusion In PPH there is vital interest in timely diagnosis of the underlying cause, thus allowing fertility-sparing, minimally invasive and super-selective emergency treatment. In AVMs causing PPH, a positive impact on perinatal morbidity and mortality may be achieved by sonographically guided application of this biological glue.
Type of Medium:
Online Resource
ISSN:
0172-4614
,
1438-8782
DOI:
10.1055/s-0041-107764
Language:
English
Publisher:
Georg Thieme Verlag KG
Publication Date:
2018
detail.hit.zdb_id:
2028670-3
SSG:
12
Bookmarklink
