2022 APAGE-ISMIVS HIFU Series Webinars
EP1
Themed “Treatment for Placenta Accreta and Cesarean Scar Pregnancy”, the 2nd episode of AIH 2022 opened on June 16th. Episode 2 invited Prof. Tsutsumi Osamu (Director of Sanno Hospital, Japan) and Prof. Chi-Chang Chang (President of Taiwan Association for Minimally Invasive Gynecology) to be the chairs, with 3 leading experts discussing minimally invasive and noninvasive therapies for patients with placenta accrete and cesarean scar pregnancy.
Prof. Aizura Adlan, Associate Professor of Department Obstetrics and Gynecology, University of Malaya, discussed the pathogenesis, diagnosis and management of placenta accreta and cesarean scar pregnancy (CSP). She believed that conservative management should be considered only for carefully selected cases of placenta accrete spectrum, cases that be considered investigational and after detailed counselling about the risks, uncertain benefits and efficacy. After demonstrating 4 cases of CSP, she provided several treatment modalities including laparoscopic caesarean scar resection, TAS-guided hysteroscopic curettage, and repeated HIFU combined with hysteroscopic S&C.
Dr Lee Jae Seong shared 13 years of clinical experience in the HIFU treatment for gynecological disorders at a single center in South Korea. From February 2010 to October 2017, his center managed 1807 cases (918 cases of uterine fibroids and 889 cases of adenomyosis), among which the uterine fibroid volume (mean ± SD) before HIFU is 176.46 ± 149.87, and 3 months and 12 months after HIFU is 79.87 ± 74.81 (55%) and 46.23 ± 54.7 (74%). He also provided clinical evidence for the safety and efficacy of HIFU therapy with several research papers, then end up summarizing that HIFU clinicians should be careful with patients who want future pregnancies and inform some possibilities of being in trouble of pregnancy and enough experience is needed to make satisfactory treatment outcomes.
Dr Zhang Cai, the Senior HIFU doctor, discussed clinical protocol and outcomes of HIFU followed by dilation and curettage to treat CSP. She first introduced the types of CSP based on the 2016 Chinese Expert Opinion and indicated that the aim of the management of CSP was to preserve fertility, and prevent life-threatening complications such as massive haemorrhage and uterine rupture. She further shared different sonication strategies of HIFU treatment for CSP and compared the adverse events, efficacy and fertility outcomes of HIFU and UAE, and concluded that HIFU therapy featured non-invasive and real-time monitoring qualities which could reduce the risk of vaginal massive bleeding, minimize damage to the uterine, and keep the fertility.
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