Uterine Artery Embolization for Management of Primary Postpartum Hemorrhage Associated with Placenta Accreta

Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women(mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients(94%) during follow-up period(median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion Uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.

Placement of a Long Intestinal Tube in Patients with Early Postoperative Small Bowel Obstruction under Fluoroscopic Guidance

Objective To investigate the placement of a long tube into the small intestine under fluoroscopic guidance and to evaluate its decompression effect on early postoperative small bowel obstruction(EPSBO).Methods Fifty-four patients with EPSBO requiring decompression between April 2010 and July 2014 were enrolled in the study.Insertion of a long tube was guided by fluoroscopy.We first used the guide wire to pass the pylorus and then used the 10 Fr feeding tube as an exchangeable tube to put the superstiff wire into the duodenum.Finally the long tube could be passed over the guide wire through the pylorus into the intestine.The total procedure time,the radiation exposure time,and the incidence of complications were evaluated.Results The long tubes passed into the jejunum on initial insertion for all patients,so the success rate of this technique was 100%.The long tube was inserted into ileum in 18 patients.The mean total procedure time was 34.4±8.6 minutes,and the mean radiation exposure time 18.9±6.8 minutes.A total of 47 patients(87%) experienced full recovery following long-tube decompression and without the need for surgical intervention.Conclusions Using the wire-exchange technique,it is easy to place a long tube into the small bowel under fluoroscopic guidance.This decompression method is safe and effective for management of EPSBO.

Lead dislodgement complicated with paroxysmal atrial fibrillation as a rare cause of inappropriate implantable cardioverter defibrillator shock:a case report

Inappropriate shock of implantable cardioverter defibrillator(ICD)is a rare but catastrophic phenomenon.Inappropriate shock is usually caused by oversensing of noise or supraventricular tachycardias(SVTs).However,inappropriate shock can also be triggered by other uncommon mechanisms.Lead dislodgement is also rare in patients with cardiac implantable electronic devices,which can manifest as pacing failure and mis-sensing of other signals.