Cervical insufficiency and placenta accreta after prior pelvic radiation

Bowman, Zachary S.; Simons, Margaret A.; Sok, Christina; Draper, Michael L.

doi:10.3109/01443615.2014.920799

Cited by 6 publications

(3 citation statements)

References 6 publications

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“… G1: Cervical insufficiency leading to preterm delivery G2: Abdominal cerclage leading to planned cesarean section at 37 weeks with very thin lower uterine segment. G3: Placenta accreta requiring cesarean hysterectomy ( Bowman et al, 2014 ). G1 Pregnancy: 13 weeks ( Pridjian et al, 1990 ) 7000 rad external beam radiation ( Pridjian et al, 1990 ).…”

Section: Discussionmentioning

confidence: 99%

A case of placenta previa with increta with a history of pelvic radiation

Baucom

Herzog

Jackson

et al. 2021

Gynecologic Oncology Reports

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Section: Discussionmentioning

confidence: 99%

A case of placenta previa with increta with a history of pelvic radiation

Baucom

Herzog

Jackson

et al. 2021

Gynecologic Oncology Reports

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“…According to our Pubmed search using “placenta accreta” and “total body irradiation” or “radiotherapy” as key words, only five cases of placenta accreta, including the present case, have been reported in women with a history of radiotherapy involving the uterus [6–9] (Table 2). The degree of uterine damage depends not only on the total irradiation dose, but also on a patient's age at the time of radiotherapy [4].…”

Section: Discussionmentioning

confidence: 99%

Placenta Accreta in a Woman with Childhood Uterine Irradiation: A Case Report and Literature Review

Sasagasako

Tani

Chigusa

et al. 2019

Case Reports in Obstetrics and Gynecology

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The pregnancies of childhood cancer survivors who have received uterine irradiation are associated with a high risk of several obstetrical complications, including placenta accreta. The present case was a 26-year-old pregnant woman with a history of myelodysplastic syndrome treated with umbilical cord blood transplantation following chemotherapy and total body irradiation at the age of 10. Despite every possible measure to prevent preterm labor, uterine contractions became uncontrollable and a female infant weighing 892 g was vaginally delivered at 27+4 weeks of gestation. Under the postpartum ultrasonographic diagnosis of placenta accreta, we selected to leave the placenta in situ. Although emergency bilateral uterine artery embolization was required, complete resorption of the residual placenta was accomplished on the 115th day postpartum. Our experience highlighted the following points. (1) The expectant management of placenta accreta arising in an irradiated uterus may not only fulfill fertility preservation, but may also reduce possible risks associated with cesarean hysterectomy. (2) Due to extreme thinning of and a poor blood supply to the myometrium, reaching an antepartum diagnosis of placenta accreta in an irradiated uterus is difficult. (3) The recurrence of placenta accreta in subsequent pregnancies needs to be considered after successful preservation of the uterus.

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“…As adults, reduced clinical pregnancy rates (22,23) and increased rates of pregnancy complications (24)(25)(26)(27)(28)(29)(30) and adverse pregnancy outcomes (11,17,19,(31)(32)(33)(34)(35)(36)(37)(38)(39) are reported in survivors. Critically, these complications are evident in survivors treated both pre-and postpubertally with a treatment regimen consisting of radiotherapy alone or in combination with chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy exposure directly damages the uterus and causes pregnancy loss

Griffiths¹,

Marshall²,

Cousins³

et al. 2023

JCI Insight

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Female cancer survivors are significantly more likely to experience infertility than the general population. It is well established that chemotherapy and radiotherapy can damage the ovary and compromise fertility, yet the ability of cancer treatments to induce uterine damage, and the underlying mechanisms, have been understudied. Here, we show that in mice total-body γ-irradiation (TBI) induced extensive DNA damage and apoptosis in uterine cells. We then transferred healthy donor embryos into ovariectomized adolescent female mice that were previously exposed to TBI to study the impacts of radiotherapy on the uterus independent from effects to ovarian endocrine function. Following TBI, embryo attachment and implantation were unaffected, but fetal resorption was evident at midgestation in 100% of dams, suggesting failed placental development. Consistent with this hypothesis, TBI impaired the decidual response in mice and primary human endometrial stromal cells. TBI also caused uterine artery endothelial dysfunction, likely preventing adequate blood vessel remodeling in early pregnancy. Notably, when pro-apoptotic protein Puma-deficient ( Puma –/– ) mice were exposed to TBI, apoptosis within the uterus was prevented, and decidualization, vascular function, and pregnancy were restored, identifying PUMA-mediated apoptosis as a key mechanism. Collectively, these data show that TBI damages the uterus and compromises pregnancy success, suggesting that optimal fertility preservation during radiotherapy may require protection of both the ovaries and uterus. In this regard, inhibition of PUMA may represent a potential fertility preservation strategy.

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Cervical insufficiency and placenta accreta after prior pelvic radiation

Cited by 6 publications

References 6 publications

A case of placenta previa with increta with a history of pelvic radiation

A case of placenta previa with increta with a history of pelvic radiation

Placenta Accreta in a Woman with Childhood Uterine Irradiation: A Case Report and Literature Review

Radiotherapy exposure directly damages the uterus and causes pregnancy loss

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