Interventional radiology and the morbidly adherent placenta

International Conference on Medical Physics

August 03-05, 2015 Birmingham, UK

Bernhard Heidemann

Posters-Accepted Abstracts: J Nucl Med Radiat Ther

Abstract :

Morbidly adherent placenta comprises placenta accreta, placenta increta and placenta percreta, conditions where there is failure of the placenta to separate normally after birth. This leads to a failure of the uterus to contract and is associated with major haemorrhage. In Western society the incidence has risen 10-fold in the last four decades and in the UK is responsible for 39% of peripartum hysterectomies. The risk factors for the development of a morbidly adherent placenta include previous caesarean section, maternal age > 35 and parity > 3. From 2007, the UK Confidential Enquiries into Maternal and Child Health have recommended that Interventional Radiology (IR) should be considered in the management of morbidly adherent placenta. The arguments for using IR in this setting are reduced blood loss, improved surgical field, preservation of future fertility and decreased morbidity from massive transfusion. Opponents of IR point out that the technique is associated with significant morbidity: popliteal artery thrombosis, vaginal necrosis, leg paraesthesia, fever, abdominal pain, iliac artery thrombosis with lower limb ischaemia, pseudo-aneurysms, arterial rupture, rectal or bladder ischaemia and secondary haemorrhage. More recently fetal compromise has been described as a consequence of IR. Whilst exposure to ionizing radiation for the mother has been discussed and is usually recorded little attention has been paid to the radiation exposure of the fetus and it is unclear as to what could be regarded as a safe dose and how to predict the likely dose of the fetus.