Female Genital Tract and Obstetric Interventions

Recent advances in interventional radiology in women’s health, and its minimally invasive nature, have led to a rapid increase in the conditions that can be treated by interventional radiology. Infertility is seen in nearly 15% of couples of reproductive age group, and tubal obstruction is the most common cause of female infertility. Fallopian tube recanalization is a minimally invasive procedure for the treatment of proximal tubal occlusion, with a technical success rate reaching up to 90%. Interventional radiology is also useful in the diagnosis and treatment of certain obstetric conditions. Amniocentesis and chorionic villous sampling are two common procedures for prenatal genetic work and diagnosis of chromosomal abnormality. In addition, amniocentesis is useful in the diagnosis of fetal infection, and amniotic fluid infection, and also assesses the severity of fetal Rh isoimmunization and alloimmunization. It can also be used in the treatment of polyhydramnios (decompression amniocentesis) and oligohydramnios (amnioinfusion). Cordocentesis can be used for the diagnosis and treatment of severe fetal anemia by intrauterine fetal transfusion, diagnosis and response assessment of neonatal alloimmune thrombocytopenia, and evaluation of non-immune fetal hydrops. In monochorionic twin pregnancies at risk of impending fetal death of an abnormal twin, an elective fetal terminal of an abnormal twin can be considered to improve the survival of a normal twin. Umbilical cord ablation of the abnormal twin cuts off blood supply to the abnormal twin causing selective fetal terminal and also prevents exsanguination of normal fetus, through placental vascular communications, if any. Twin transfusion syndrome is a unique uncommon complication seen in monochorionic twin pregnancy due to the existence of unidirectional placental vascular communication. Fetoscopic laser ablation of causative placental anastomosis is the treatment of choice in twin-twin transfusion syndrome. Large fetal hydrothorax, or intrathoracic cystic lesion, can lead to fetal lung hypoplasia, and sometimes, fetal hydrops, and can be treated by thoracocentesis and thoracoamniotic shunt. Untreated lower urinary tract obstruction in the fetus can lead to irreversible renal damage, severe oligohydramnios, and subsequently lung hypoplasia. Vesicocentesis and vesicoamniotic shunt can be considered in these patients to decompress the high-pressure urinary system.