Obstet Gynecol Sci.  2016 Sep;59(5):421-425. 10.5468/ogs.2016.59.5.421.

High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta

• Lee JS
• Hong GY
• Park BJ
• Hwang H
• Kim R
• Kim TE

• KMID: 2391696
• DOI: http://doi.org/10.5468/ogs.2016.59.5.421

Abstract

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

Keyword

High-intensity focused ultrasound ablation; Hysteroscopic resection; Retained placenta accrete

MeSH Terms

Chorionic Villi
Fertility
High-Intensity Focused Ultrasound Ablation
Humans
Methods
Myoma
Placenta, Retained*
Ultrasonography*
Uterine Hemorrhage

Figure

• 

  Fig. 1 Pre and post 1st hysteroscopic resection sono finding. (A) Transabdominal sonographic finding before 1st hysteroscopic resection (coronal and sagittal view): 3.2×2.0×1.5-cm hyperechogenic shadow in the endometrial cavity was shown (arrow). (B) Transabdominal sonographic finding after 1st hysteroscopic resection (coronal and sagittal view): remained hyperechogenic shadow was shown (arrow).

• 

  Fig. 2 Pre and post high-intensity focused ultrasound (HIFU) combined with 2nd hysteroscopic resection magnetic resonance imaging finding (MRI). (A) T2W1 and (B) contrast enhanced image was MRI finding before HIFU ablation. The retained placenta accreta was shown as low signal intensity on (A) and low enhanced image on (B). (C) T2W1 and (D) contrast enhanced image was MRI finding 3 months later after HIFU combined with 2nd hysteroscopic resection. The lesion was not seen.

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