This book provides a state-of-the-art review of the technical and clinical aspects of the vascular interventional radiological (IR) procedures currently employed in obstetrics and gynaecology. A particular focus is on uterine artery embolisation for fibroid disease, which is contrasted with the main alternative uterus-conserving surgical approach of myomectomy, and with ablation therapy. Detailed consideration is also given to the role of embolisation in a variety of other less common conditions, including arteriovenous malformations, post-partum haemorrhage, abnormal placentation and pelvic congestion syndrome. IR procedures are examined from a critical gynaecological perspective and with regard to surgical alternatives. The authors include leading interventional radiologists and gynaecologists from the United Kingdom, Europe and North America.

Inhalt

The History and Epidemiology of Fibroids.- Medical Treatment of Fibroids.- Clinical presentations of fibroids.- Gynaecological assessment prior to UAE.- Imaging of fibroids pre and post-UAE.- Indications and contraindications.- Embolisation Techniques.- Choice of Embolisation materials.- Clinical results of fibroid embolisation, trials and registries.- Complications of fibroid embolisation.- When to consider Ovarian embolization.- Early Post UAE management.- Post UAE problems and management.- The role of a repeat UAE procedure.- Myomectomy techniques.- Myomectomy results and complications.- Myomectomy after UAE Gynae.- There is a role for UAE in women with symptomatic fibroids and fertility goals.- UAE is not recommended for women with future fertility goals.- Costing issues and UAE in the developing world.- Who can and should do UAE.- Is there a place for UAE in Adenomyosis.- The role for Focussed Ultrasound ablation in the treatment of Fibroids.- Bleeding in Obstetrics: Obstetric Management of Post-Partum Haemorrhage.- Embolisation in Post-Partum Haemorrhage.- The problem of abnormal Placentation and is there a role for Interventional Radiology.- Pelvic Congestion Syndrome: Clinical Significance of Pelvic Congestion Syndrome.- Embolisation in Pelvic Congestion Syndrome.