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

Abstract

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.