Radiofrequency ablation of retained placenta accreta after conservative management: preliminary evaluation in the pregnant ewe and in normal human placenta in vitro

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 116; no. 7; pp. 915 - 922
• Main Authors: Morel, O, Monceau, E, Tran, N, Malartic, C, Morel, F, Barranger, E, Côté, JF, Gayat, E, Chavatte‐Palmer, P, Cabrol, D, Tsatsaris, V
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.06.2009; Blackwell; Wiley Subscription Services, Inc; Wiley
• Subjects: Animals; Biological and medical sciences; Catheter Ablation - methods; Catheter Ablation - standards; Computer Science; Delivery. Postpartum. Lactation; Diseases of mother, fetus and pregnancy; Disorders; Female; Gynecology. Andrology. Obstetrics; Hot Temperature - therapeutic use; Humans; In vitro model; Life Sciences; Medical procedures; Medical sciences; Other treatments; Placenta - surgery; placenta accreta; Placenta Accreta - pathology; Placenta Accreta - surgery; postpartum haemorrhage; Postpartum period; Pregnancy; Pregnancy. Fetus. Placenta; pregnant ewe; radiofrequency; Radiology; Reference Values; Reproducibility of Results; Sheep; Treatment. General aspects; Tumors; Human; Pregnancy disorders; Gynecology; Ultrasonic treatment; Instrumentation therapy; Thermal ablation; Placenta diseases; In vitro; Obstetrics; Pregnancy; Placenta accreta; Vertebrata; Ewe; Mammalia; Retention of placental fragments; Sheep; Delivery disorders; Artiodactyla; Ungulata; Conservative treatment; RADIOFREQUENCY; POSTPARTUM HAEMORRHAGE; PREGNANT EWE; IN VITRO MODEL; POSTPARTUM; PLACENTA ACCRETA
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2009.02166.x

Objective  To evaluate radiofrequency (RF) efficiency and safety for the ablation of retained placenta in humans, using a pregnant sheep model. Design  Experimental study. Setting  Laboratory of Surgery School, Nancy, France. Population/sample  Three pregnant ewes/ten human placentas. Methods  Various RF procedures were tested in pregnant ewes on 50 placentomes (individual placental units). Reproducibility of the best procedure was then evaluated in a further 20 placentomes and on ten human term placentas in vitro after delivery. Main outcome measures  Placental tissues destruction, lesions’ size, myometrial lesions. Results  Low power (100 W) and low target temperatures (60°C) lead to homogenous tissue destruction, without myometrial lesion. No significant difference was observed in terms of lesion size and procedure duration for in the placentomes of pregnant ewe in vivo and in human placentas in vitro. The diameter of the ablation could be correlated with the tines deployment. Conclusion  The placental tissue structure is very permissive to RF energy, which suggests that RF could be used for the ablation of retained placenta, providing optimal control of tissue destruction. These results call for further experimental evaluations.