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Palacios-Jaraquemada JM, Nieto-Calvache AJ, Basanta AN. Extrauterine Causes of Severe and Concealed Postpartum Bleeding: Clinical Aspects and Challenges. MATERNAL-FETAL MEDICINE 2024; 6:232-235. [PMID: 40406173 PMCID: PMC12094407 DOI: 10.1097/fm9.0000000000000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 08/29/2024] [Indexed: 05/24/2025] Open
Abstract
Objective To describe the challenges in diagnosing concealed postpartum bleeding, a rare but potentially life-threatening condition, and to highlight key factors in identifying and managing this condition. Methods We reviewed clinical cases and diagnostic approaches where concealed postpartum bleeding was suspected, focusing on the role of imaging, serologic markers, and angiography. We examined instances of hemodynamic instability, the utility of pelvic space analysis via computed tomography, and the limitations of digital angiography, particularly in identifying bleeding sources in the posterior iliac internal artery division. Results Concealed postpartum bleeding often originates from venous damage or, less commonly, arterial injury. Hemodynamic instability was noted to occur periodically, despite negative findings on vaginal examination and ultrasound, leading to diagnostic delays. Digital angiography often yields negative results when the focus is limited to the anterior division of the internal iliac artery. Bleeding typically arises from damage to the vaginal muscular layer or levator ani muscle, both supplied by branches of the internal pudendal artery (posterior iliac division). In some cases, laparotomy also failed to locate the source due to the bleeding being in the subperitoneal spaces. Conclusion Concealed postpartum bleeding presents a diagnostic challenge due to intermittent hemodynamic instability and often negative imaging results. A detailed pelvic space analysis and awareness of posterior iliac internal artery involvement are crucial. Advanced expertise, along with serologic markers of hidden bleeding, is essential for timely diagnosis and management.
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Affiliation(s)
- JM Palacios-Jaraquemada
- Department of Obstetrics and Gynecology, CEMIC University Hospital, Buenos Aires C1431, Argentina
- Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires C1427, Argentina
| | - AJ Nieto-Calvache
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali 760032, Colombia
| | - AN Basanta
- Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires C1427, Argentina
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali 760032, Colombia
- Department of Obstetrics and Gynecology, Fernández Hospital, Buenos Aires C1427, Argentina
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Psilopatis I, Fleckenstein FN, Gebauer B, David M. Medical historical notes on myoma treatment by uterine artery embolization on the occasion of its introduction 30 years ago. ROFO-FORTSCHR RONTG 2023; 195:890-895. [PMID: 37467778 DOI: 10.1055/a-2077-1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Since its development, uterine artery embolization (UAE) for the treatment of symptomatic fibroids has become an established minimally invasive alternative to surgical myoma treatment. Currently, more than 25,000 myoma patients worldwide are likely to be treated with UAE annually. METHOD Thirty years ago, Jacques-Henri Ravina (b. 1930) and his Paris team first performed this therapy as a "substitute" for gynecologic surgery. We contacted him as part of the preparation of the present review. In addition, we performed a literature search with the aim of summarizing the current literature and data in addition to a historical account of the development of UAE. RESULTS AND CONCLUSION On the occasion of this anniversary, we would like to recall the interdisciplinary roots and some facets of the history of the development of this relatively young myoma treatment method. KEY POINTS · UAE is an established minimally invasive alternative to surgical myoma treatment.. · UAE was first developed 30 years ago.. · UAE has continuously increased in importance in recent years.. CITATION FORMAT · Psilopatis I, Fleckenstein FN, Gebauer B et al. Medical historical notes on myoma treatment by uterine artery embolization on the occasion of its introduction 30 years ago. Fortschr Röntgenstr 2023; 195: 890 - 895.
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Affiliation(s)
| | - Florian Nima Fleckenstein
- Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Germany
- BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charite, Berlin, Germany
| | - Bernhard Gebauer
- Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Germany
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Palacios-Jaraquemada JM, Nieto-Calvache Á, Basanta NA. Anatomical basis for the uterine vascular control: implications in training, knowledge, and outcomes. Am J Obstet Gynecol MFM 2023; 5:100953. [PMID: 37031866 DOI: 10.1016/j.ajogmf.2023.100953] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
The efficiency of uterine vascular control depends on the precise management of its arterial pedicles and anastomotic network. Although all specialists know the uterine and ovarian arteries, only a few are familiar with the anatomy of the inferior supply system and the connections of the pelvic vessels. For this reason, specific proven inefficient hemostatic procedures are still used worldwide. The pelvic arterial system is extensively interconnected with the aortic, internal iliac, external iliac, and femoral anastomotic components. Most uterine vascular control methods act on the blood supply to the uterus and ovary but rarely on the anastomotic network of the internal pudendal artery. Therefore, the effectiveness of vascular control procedures depends on the topographic area in which they are performed. In addition, the procedure's effectiveness depends on the skill and experience of the operator, among other factors. From a practical point of view, the uterine arterial supply is divided into 2 sectors, sector S1, which involves the uterine body, supplied by the uterine and ovarian arteries, and sector S2, which includes the uterine segment, the cervix, and the upper part of the vagina, provided by pelvis subperitoneal pedicles arising from the internal pudendal artery. As both sectors receive different arterial pedicles, the hemostatic procedures for one or the other are also different. The urgent nature of obstetrical hemorrhage, correct application of a specific technique, surgeon experience, time to provide accurate informed consent in a person under a life-threatening condition, lack of precise or possible harmful consequences of the proposed method, lack of randomized controlled trials or multiple phase II trials, epidemiologic data, qualitative data, and reports from the field from clinicians using an intervention multiple other aspects could be impossible to randomize all patients to obtain more precise information. Apart from actual effectiveness, there are no reliable morbidity data, as most complications are rarely published for various reasons. However, a simple and current presentation of pelvic and uterine blood supply and its anastomotic system allows readers to understand the value of different hemostatic procedures.
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Affiliation(s)
- José M Palacios-Jaraquemada
- Department of Anatomy, Centro de Educación Médica e Investigaciones Clínicas University Hospital, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina (Dr Palacios-Jaraquemada); Universitas Airlangga, Surabaya, Indonesia (Dr Palacios-Jaraquemada).
| | - Álbaro Nieto-Calvache
- Placental Accreta Spectrum Clinic, Fundación Valle del Lili, Cali, Colombia (Dr Nieto-Calvache)
| | - Nicolás A Basanta
- Department of Anatomy, Fernández Hospital, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina (Dr Basanta)
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Kim BM, Jeon GS, Choi MJ, Hong NS. Usefulness of transcatheter arterial embolization for eighty-three patients with secondary postpartum hemorrhage: Focusing on difference in angiographic findings. World J Clin Cases 2023; 11:3471-3480. [PMID: 37383902 PMCID: PMC10294178 DOI: 10.12998/wjcc.v11.i15.3471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/13/2023] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Transcatheter arterial embolization (TAE) has been widely used as an effective and a safe treatment method and was often used as an alternative to the surgical management, but there are limited studies on the efficacy and the safety for patients undergoing their secondary postpartum hemorrhage (PPH).
AIM To evaluate the usefulness of TAE for secondary PPH focusing on the angiographic findings.
METHODS We conducted a research from January 2008 to July 2022 on all 83 patients (mean: 32 years, range: 24-43 years) presented with secondary PPH and they were treated with TAE in two university hospitals. The medical records and angiography were retrospective reviewed in order to evaluate the patients’ characteristics, delivery details, clinical status and peri-embolization management, angiography and embolization details, technical/clinical success and complications. The group with active bleeding sign and the group without it were also compared and analyzed.
RESULTS On angiography, 46 (55.4%) patients showed active bleeding signs such as contrast extravasation (n = 37) or pseudoaneurysm (n = 8) or both (n = 1), and 37 (44.6%) patients showed non-active bleeding signs such as only spastic uterine artery (n = 2) or hyperemia (n = 35). In the active bleeding sign group there were more multiparous patients, low platelet count, prothrombin time prolongation, and high transfusion requirements. The technical success rates were 97.8% (45/46) in active bleeding sign group and 91.9% (34/37) in non-active bleeding sign group, and the overall clinical success rates were 95.7% (44/46) and 97.3% (36/37). An uterine rupture with peritonitis and abscess formation occurred to one patient after the embolization, therefore hysterostomy and retained placenta removal were performed which was a major complication.
CONCLUSION TAE is an effective and a safe treatment method for controlling secondary PPH regardless of angiographic findings.
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Affiliation(s)
- Bong Man Kim
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan-si 31116, Chungcheongnam-do, South Korea
| | - Gyeong Sik Jeon
- Department of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si 13496, Gyeonggi-do, South Korea
| | - Min Jeong Choi
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan-si 31116, Chungcheongnam-do, South Korea
| | - Nam-Soo Hong
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
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Kosai S, Higashihara H, Yano H, Kashiwagi E, Nagai K, Tanaka K, Ono Y, Miyake T, Tomiyama N. Risk Factors Associated with Clinical Failure of Uterine Artery Embolization for Postpartum Hemorrhage. J Vasc Interv Radiol 2023; 34:95-101. [PMID: 36167298 DOI: 10.1016/j.jvir.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 09/05/2022] [Accepted: 09/18/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To identify risk factors for clinical failure of uterine artery embolization (UAE) for postpartum hemorrhage (PPH), with particular attention to the uterine artery diameter. MATERIALS AND METHODS This retrospective study included 47 patients who underwent UAE for PPH between January 1, 2010, and January 31, 2021. Technical success was defined as the completion of embolization of the arteries thought to be the cause of the bleeding. Clinical success was defined as no recurrent bleeding or need for additional therapeutic interventions. Univariate and multivariate analyses were performed to examine the risk factors associated with clinical failure of UAE. RESULTS Of the 47 patients, 6 had recurrent bleeding. Of the 6 patients, 4 underwent hysterectomy, and 2 underwent repeat embolization. The clinical success rate was 87.2% (41/47), with no major adverse events such as uterine infarction or death. In univariate analysis, there were slight differences in multiparity (P = .115) and placental abruption (P = .128) and a significant difference in the findings of a narrow uterine artery on digital subtraction angiography (DSA) (P = .005). In multivariate analysis, only a narrow uterine artery on DSA was a significant factor (odds ratio, 18.5; 95% confidence interval, 2.5-134.8; P = .004). CONCLUSIONS A narrow uterine artery on DSA was a risk factor for clinically unsuccessful UAE for PPH. It may be prudent to conclude the procedure only after it is ensured that vasospasm has been relieved.
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Affiliation(s)
- Shinya Kosai
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of High Precision Image-guided Percutaneous Intervention, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Hiroki Yano
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Eiji Kashiwagi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keisuke Nagai
- Department of Diagnostic Radiology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Kaishu Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsuya Miyake
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Li WJ, Chen KH, Huang LW, Tsai YL, Seow KM. Low Maternal Serum 25-Hydroxyvitamin D Concentration Is Associated With Postpartum Hemorrhage: A Retrospective Observational Study. Front Endocrinol (Lausanne) 2022; 13:816480. [PMID: 35370939 PMCID: PMC8968120 DOI: 10.3389/fendo.2022.816480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/22/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The primary aim of this study is to investigate the relationship between vitamin D serum level and the incidence of postpartum hemorrhage (PPH). The secondary objective is to determine the relative risk of low vitamin D associated with PPH. METHODS This was a retrospective observational study. A total of 600 women who had delivered their babies in a single tertiary teaching hospital were enrolled. Serum blood test for 25(OH)D was performed at 35 + 0 to 36 + 6 weeks of pregnancy to measure vitamin D. A 25(OH)D level < 20 ng/mL was defined as vitamin D deficient, and a level 21-29 ng/mL as insufficient. RESULTS Vitamin D levels were deficient in 145 (24.1%) and insufficient in 254 (42.3%) of the women tested. Women with deficient and insufficient vitamin D levels were significantly younger than those with sufficient vitamin D levels (p < 0.001). The overall rates of PPH in the deficient and insufficient groups were 6.9% (10/145) and 6.7% (17/254), respectively, and were significantly higher than the rate of the normal vitamin D group (1.5%, p = 0.009). Women with sufficient vitamin D levels had significantly higher hemoglobin levels than those with low vitamin D levels. Higher vitamin D levels were associated with a significantly low risk of PPH (AOR: 0.93, CI: 0.89-0.98, p = 0.006). CONCLUSION Our results suggest that a low vitamin D level is a risk factor for PPH. Low vitamin D also related to high risk of low hemoglobin before delivery. Thus, antepartum care should include vitamin D supplements for all women if possible.
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Affiliation(s)
- Wei-Jiun Li
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan
- School of Medicine, Buddhist Tzu-Chi University, Hualien, Taiwan
| | - Lee-Wen Huang
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Yieh-Loong Tsai
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Rand T, Patel R, Magerle W, Uberoi R. CIRSE standards of practice on gynaecological and obstetric haemorrhage. CVIR Endovasc 2020; 3:85. [PMID: 33245432 PMCID: PMC7695782 DOI: 10.1186/s42155-020-00174-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
This CIRSE Standards of Practice document provides best practices for obstetric haemorrhage embolisation (OHE) in the management of postpartum haemorrhage (PPH). The document is aimed at interventional radiologists involved in treating postpartum haemorrhage, and has been developed by a writing group established by the CIRSE Standards of Practice Committee. CIRSE Standards of Practice documents are not clinical practice guidelines and do not intend to impose a standard of care, rather provide reasonable approaches to and best practices for specific interventional radiology treatments and techniques.
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Affiliation(s)
- Thomas Rand
- Institute for Interventional and Diagnostic Radiology, Klinik Floridsdorf, Brünnerstr.68, 1210, Vienna, Austria. .,Scientific research in diagnostics and interventional radiology, Karl Landsteiner Society, St. Pölten, Austria.
| | - Rafiuddin Patel
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Raman Uberoi
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Park HS, Cho HS. Management of massive hemorrhage in pregnant women with placenta previa. Anesth Pain Med (Seoul) 2020; 15:409-416. [PMID: 33329843 PMCID: PMC7724116 DOI: 10.17085/apm.20076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022] Open
Abstract
Patients with placenta previa are at risk for intra- and postpartum massive blood loss as well as increased risk of placenta accreta, a type of abnormal placental implantation. This condition can lead to serious obstetric complications, including maternal mortality and morbidity. The risk factors for previa include prior cesarean section, multiparity, advanced maternal age, prior placenta previa history, prior uterine surgery, and smoking. The prevalence of previa parturients has increased due to the rising rates of cesarean section and advanced maternal age. For these reasons, we need to identify the risk factors for previa and identify adequate management strategies to respond to blood loss during surgery. This review evaluated the diagnosis of placenta previa and placenta accreta and assessed the risk factors for previa-associated bleeding prior to cesarean section. We then presented intraoperative anesthetic management and other interventions to control bleeding in patients with previa expected to experience massive hemorrhage and require transfusion.
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Affiliation(s)
- Hee-Sun Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Seok Cho
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Radaelli T, Ferrari MM, Duiella SF, Gazzola FG, Campoleoni M, Merlini C, Martinetti L, Ambrosini MT, Ossola MW, Nicolini A. Prophylactic intraoperative uterine artery embolization for the management of major placenta previa. J Matern Fetal Neonatal Med 2020; 35:3359-3364. [PMID: 32928020 DOI: 10.1080/14767058.2020.1818218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Placenta previa is a major cause of maternal morbidity and mortality, associated to a high risk of peripartum hemorrhage and hysterectomy. We aimed to verify if prophylactic intraoperative uterine artery embolization in patients with placenta previa and at least one additional risk of bleeding (major placenta previa), can reduce hemorrhage, need for blood transfusions, peripartum hysterectomy and maternal morbidity. MATERIALS AND METHODS We enrolled 76 patients with major placenta previa; a specific multidisciplinary protocol was designed for management, including ultrasound evaluation, hospitalization at 34 weeks, antenatal corticosteroids and scheduled cesarean section at 35-36 weeks. 44 patients (control group or CTR) were treated with elective cesarean section, 32 patients (embolized group or EMB) underwent selective catheterization of bilateral uterine arteries before cesarean section and subsequent uterine embolization. In both cases cesarean section was performed by a senior surgeon. RESULTS Significant differences were found in term of intraoperative blood loss (CTR: 1431 ml; EMB: 693 ml); despite an high percentage of CTR patients had a bleeding greater than 1000 ml (56%), the need for blood transfusion was not significantly different between the two groups. Time of surgery was higher in the EMB group, considering that embolization procedure required approximatively 30 min. Three patients from the CTR group needed hysterectomy and ICU admission, compared to none in the EMB group. Duration of hospitalization and neonatal outcome were similar. Uterine embolization was not related to any short or long-term complications; return to normal menses and preservation of fertility were confirmed at follow up. CONCLUSIONS Our results are promising, although we believe that a major contribution is referable to the multidisciplinary approach rather than the procedure itself. Nevertheless, we demonstrated the feasibility and safety of preventive uterine embolization in patients with placenta previa; in order to establish its prophylactic role in the prevention of peripartum hemorrhage, randomized trial should be carried out, on a larger population.
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Affiliation(s)
- Tatjana Radaelli
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Maria M Ferrari
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Silvia F Duiella
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Federica G Gazzola
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Mauro Campoleoni
- Department of Medical Physics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Claudia Merlini
- Department of Anesthesiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Laura Martinetti
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Maria T Ambrosini
- Department of Anesthesiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Manuela W Ossola
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Antonio Nicolini
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
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Experience of a Colombian center in the endovascular management of lifethreatening postpartum hemorrhage. BIOMEDICA 2019; 39:314-322. [PMID: 31529818 DOI: 10.7705/biomedica.v39i3.3837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Indexed: 11/21/2022]
Abstract
Introduction: Postpartum hemorrhage is a world-leading cause of morbidity and mortality. Lacerations are the second most frequent cause. Early management with appropriate treatment is essential to obtain adequate outcomes; the endovascular occlusion of pelvic vessels is among the management options.
Objective: To describe the management experience with the arterial embolization of pelvic vessels.
Materials and methods: We conducted a retrospective case series study based on the institutional registry of Fundación Valle del Lili (Cali, Colombia), which included patients with postpartum hemorrhage admitted between January 1st, 2011 and October 31st, 2016.
Results: Out of 430 patients diagnosed with PPH, 11 were subject to embolization of pelvic vessels. Within our group, 10 patients had a vaginal delivery with severe vaginal lacerations; most of them (9 cases, 82%) were referred from other lower-complexity institutions after 20.5 hours. Occlusion was more frequent in the superior vaginal and the internal pudendal arteries. No patients showed complications associated with the procedure and only 2 showed recurrent bleeding while 3 required a hysterectomy, but no deaths occurred.
Conclusion: Percutaneous management is a safe and effective third-line method for difficult-management bleedings control in patients with postpartum hemorrhage after a severe perineal tear. These results are similar to case reports published in the worldwide literature available to date.
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Chen C, Chu HH, Shin JH, Li HL, Ko HK, Kim JW, Yoon HK. Inferior mesenteric artery embolization for persistent postpartum hemorrhage after sufficient bilateral iliac arteries embolization: safety and efficacy in eight patients. Br J Radiol 2019; 92:20180896. [PMID: 31045432 DOI: 10.1259/bjr.20180896] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the safety and efficacy of transcatheter arterial embolization (TAE) of the inferior mesenteric artery (IMA) for the management of post-partum hemorrhage (PPH). METHODS A retrospective analysis was performed regarding eight patients (mean age, 34.4 y; age range, 31 - 40 y) who underwent TAE of the IMA for PPH between March 2001 and September 2018. Obstetric records, including maternal characteristics, clinical manifestations, complications, and clinical outcomes, as well as TAE details were obtained. RESULTS All eight patients had primary PPH and the vaginal delivery mode. CT scans of two patients showed active bleeding from the lower uterus or hematoma and with the origin of contrast extravasation abutting the adjacent rectum. In seven patients, an aortogram or IMA arteriogram following persistent vaginal bleeding after sufficient embolization of the bleeding focus from the bilateral iliac arteries, found the bleeding focus of the IMA, while in one patient, the IMA bleeding focus was found at the second session 4 h after the first session. TAE of the IMA was technically successful in all eight patients and cessation of bleeding without repeated TAE or additional hemostatic surgery was achieved in all patients after TAE of the IMA. There were neither procedure-related complications nor bowel ischemia during follow-up. CONCLUSION TAE of the IMA for PPH was safe and effective with successful hemostasis. Bleeding from the IMA should be suspected when there is persistent vaginal bleeding after sufficient embolization of bleeders from the bilateral iliac arteries. ADVANCES IN KNOWLEDGE Bleeding from the IMA should be suspected when there is persistent vaginal bleeding after sufficient embolization of bleeders from the bilateral iliac arteries.
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Affiliation(s)
- Chengshi Chen
- 1 Department of Radiology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University , Zhengzhou , China
| | - Hee Ho Chu
- 2 Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu , Seoul , Korea
| | - Ji Hoon Shin
- 2 Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu , Seoul , Korea
| | - Hai-Liang Li
- 1 Department of Radiology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University , Zhengzhou , China
| | - Heung-Kyu Ko
- 2 Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu , Seoul , Korea
| | - Jong-Woo Kim
- 2 Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu , Seoul , Korea
| | - Hyun-Ki Yoon
- 2 Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu , Seoul , Korea
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Fox BR, Robinson JK, Venbrux AC. The Use of Interventional Endovascular Techniques Immediately Before Hysterectomy for a Large Uterine Arteriovenous Malformation. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bradley R. Fox
- George Washington University School of Medicine, Washington, DC
| | - James K. Robinson
- Department of Minimally Invasive Gynecologic Surgery, MedStar Health, Washington, DC
| | - Anthony C. Venbrux
- Department of Radiology, George Washington University School of Medicine, Washington, DC
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Chen C, Lee SM, Kim JW, Shin JH. Recent Update of Embolization of Postpartum Hemorrhage. Korean J Radiol 2018; 19:585-596. [PMID: 29962865 PMCID: PMC6005941 DOI: 10.3348/kjr.2018.19.4.585] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/06/2017] [Indexed: 12/14/2022] Open
Abstract
Postpartum hemorrhage (PPH) is a life-threatening condition and remains a leading cause of maternal mortality. Transcatheter arterial embolization (TAE) is an effective therapeutic strategy for PPH with the advantages of fast speed, repeatability, and the possibility of fertility preservation. We reviewed the vascular anatomy relevant to PPH, the practical details of TAE emphasizing the timing of embolization, and various clinical conditions of PPH according to a recent literature review.
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Affiliation(s)
- Chengshi Chen
- Department of Radiology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, China.,Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
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Newsome J, Martin JG, Bercu Z, Shah J, Shekhani H, Peters G. Postpartum Hemorrhage. Tech Vasc Interv Radiol 2017; 20:266-273. [DOI: 10.1053/j.tvir.2017.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Pei R, Wang G, Wang H, Huang X, Yan X, Yang X. Efficacy and Safety of Prophylactic Uterine Artery Embolization in Pregnancy Termination with Placenta Previa. Cardiovasc Intervent Radiol 2016; 40:375-380. [PMID: 27853824 DOI: 10.1007/s00270-016-1507-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To appraise the efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa. METHODS A cohort of 54 consecutive patients with placenta previa underwent prophylactic uterine artery embolization before vaginal delivery from February 2012 to March 2015. Vaginal delivery was attempted in all patients. Cesarean section or hysterectomy was introduced when vaginal delivery failed. RESULTS Vaginal delivery succeeded in 50 patients (93.6%) and failed in 4 patients (6.4%), thereupon converted to cesarean delivery. No patients resorted to hysterectomy. Six patients (11.1%) underwent blood transfusion. None of clinical characteristics, including maternal age, gestational age, history of abortion, history of cesarean delivery, and volume of vaginal bleeding, was significantly associated with complete placenta previa (P > 0.05). However, patients with complete placenta previa had a significantly lower successful rate of vaginal delivery than did patients without complete placenta previa (81 vs 100%, P = 0.038). The rate of complications was 3.7%. No major complications were observed. CONCLUSION Uterine artery embolization is an effective and safe technique to assist pregnancy termination with placenta previa, which may lower the risk of cesarean section, hysterectomy, and blood transfusion.
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Affiliation(s)
- Renguang Pei
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China.
| | - Guoxiang Wang
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Heping Wang
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Xinyu Huang
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Xiaoxing Yan
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Xiaohua Yang
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
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16
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Soro MAP, Denys A, de Rham M, Baud D. Short & long term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review. Eur Radiol 2016; 27:749-762. [PMID: 27229338 DOI: 10.1007/s00330-016-4395-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Arterial embolisation (AE) plays a major role in current practice in the management of postpartum haemorrhage (PPH) that fails to respond to conservative treatment. While its benefit is well known, long-term outcomes of AE have been poorly investigated. The objective of this review is to assess its potential complications and long-term effects on the patients' quality of life. METHODS Using the terms "embolisation" and "postpartum haemorrhage", we searched the Cochrane Central Register of Controlled Trials, Medline and PubMed for published studies. We limited the search to articles in English and French reporting "complications", "fertility", "menstruation" or "menstrual cycle" in humans. To ensure completeness, the references of extracted articles and review articles were also searched. RESULTS The fertility rate in patients attempting another pregnancy reaches 70-80 %. Pregnancies following AE for PPH are not associated with a higher rate of intrauterine growth restriction. Pathological placentation (placenta accreta/increta/percreta) occurs more frequently after AE than in the general population. Psychological wellbeing, post-traumatic stress and sexual dysfunction after a life-threatening PPH requiring AE will require further investigation. CONCLUSION AE does not appear to adversely affect menstrual cycle, fertility and subsequent pregnancies, but may affect placentation. The experience of a life-threatening PPH, however, might prevent couples from pursuing another pregnancy. KEY POINTS • Embolisation for PPH does not adversely affect menstrual cycle and fertility • Experience of life-threatening PPH might prevent couples from pursuing another pregnancy • Pathological placentation seems to occur more frequently after embolisation for PPH.
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Affiliation(s)
- Marie-Aimée Päivi Soro
- Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland.,Department of Radiology, University Hospital, 1011, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology, University Hospital, 1011, Lausanne, Switzerland
| | - Maud de Rham
- Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland
| | - David Baud
- Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland.
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17
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Woodhams R. The role of interventional radiology in primary postpartum hemorrhage. HYPERTENSION RESEARCH IN PREGNANCY 2016. [DOI: 10.14390/jsshp.hrp2015-016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Reiko Woodhams
- Department of Diagnostic Radiology, Kitasato University School of Medicine
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18
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Singhal M, Gupta P, Sikka P, Khandelwal N. Uterine Artery Embolization Following Internal Iliac Arteries Ligation in a Case of Post-Partum Hemorrhage: A Technical Challenge. J Obstet Gynaecol India 2015; 65:202-5. [PMID: 26085745 DOI: 10.1007/s13224-014-0595-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- Manphool Singhal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Sikka
- Department of Gynaecology and Obstetrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Foetal Radiation Dose During Prophylactic Occlusion Balloon Placement for Morbidly Adherent Placenta. Cardiovasc Intervent Radiol 2015; 38:1487-93. [DOI: 10.1007/s00270-015-1102-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/26/2015] [Indexed: 01/10/2023]
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20
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Interventional radiology for critical hemorrhage in obstetrics: Japanese Society of Interventional Radiology (JSIR) procedural guidelines. Jpn J Radiol 2015; 33:233-40. [DOI: 10.1007/s11604-015-0399-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
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21
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Karaman B, Oren NC, Andic C, Ustunsoz B. Transcatheter embolization for the treatment of both vaginal and lower intestinal bleeding due to advanced pelvic malignancy. Eurasian J Med 2015; 42:153-6. [PMID: 25610148 DOI: 10.5152/eajm.2010.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 08/30/2010] [Indexed: 11/22/2022] Open
Abstract
We report a 31-year-old woman with end-stage cervical carcinoma who suffers both lower intestinal and vaginal bleeding. A selective internal iliac arteriogram demonstrated pseudoaneurysm formation in the vaginal branch of the left internal iliac artery. There was also a fistula between the pseudoaneurysm and the lower intestinal segments. Selective transcatheter coil embolization was performed, and the bleeding was treated successfully. We conclude that the internal iliac artery should be evaluated first in patients with advanced pelvic malignancy when searching for the source of lower gastrointestinal (GI) bleeding. Additionally, transcatheter arterial embolization is a safe and effective treatment technique.
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Affiliation(s)
- Bulent Karaman
- Department of Radiology, Gulhane Military Medical School, Ankara, Turkey
| | - Nisa Cem Oren
- Department of Radiology, Gulhane Military Medical School, Ankara, Turkey
| | - Cagatay Andic
- Department of Radiology, Gulhane Military Medical School, Ankara, Turkey
| | - Bahri Ustunsoz
- Department of Radiology, Gulhane Military Medical School, Ankara, Turkey
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22
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Park KJ, Shin JH, Yoon HK, Gwon DI, Ko GY, Sung KB. Postpartum hemorrhage from extravasation or pseudoaneurysm: efficacy of transcatheter arterial embolization using N-butyl cyanoacrylate and comparison with gelatin sponge particle. J Vasc Interv Radiol 2014; 26:154-61. [PMID: 25454736 DOI: 10.1016/j.jvir.2014.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 08/16/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) using N-butyl cyanoacrylate (NBCA) for the treatment of active postpartum hemorrhage (PPH) and compare the efficacy of NBCA with gelatin sponge particles. MATERIALS AND METHODS From January 2004 to September 2013, 26 patients with PPH underwent TAE using NBCA as the primary embolic material. All patients were actively bleeding, and 12 (46.2%) had coagulopathy. TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil with or without use of a coil or gelatin sponge. To compare the efficacy of NBCA with conventional embolic material, 50 patients with active bleeding who underwent TAE using gelatin sponge were also analyzed. RESULTS Angiograms demonstrated pseudoaneurysm or extravasation or both. The technical and clinical success rates were 100% and 92.3% (24 of 26 patients), respectively, for NBCA and 98% and 86.0% (43 of 50 patients), respectively, for gelatin sponge. In the NBCA group, one patient recovered with conservative management, and the other patient died because of multiorgan dysfunction. There were no major or minor procedure-related complications. CONCLUSIONS TAE using NBCA as the primary embolic agent is an effective method for treating PPH with extravasation or pseudoaneurysm; NBCA is comparable to gelatin sponge particles. TAE using NBCA seems to fill pseudoaneurysms and make devascularization more effective than using gelatin sponge.
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Affiliation(s)
- Kye Jin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea..
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
| | - Dong-Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
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Lee JW, Song IA, Ryu J, Park HP, Jeon YT, Hwang JW. Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report. Korean J Anesthesiol 2014; 67:279-82. [PMID: 25368788 PMCID: PMC4216792 DOI: 10.4097/kjae.2014.67.4.279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/12/2013] [Accepted: 08/25/2013] [Indexed: 11/10/2022] Open
Abstract
Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.
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Affiliation(s)
- Jae Woo Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - In Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Junghee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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24
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Gipson MG, Smith MT. Endovascular therapies for primary postpartum hemorrhage: techniques and outcomes. Semin Intervent Radiol 2014; 30:333-9. [PMID: 24436559 DOI: 10.1055/s-0033-1359726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Interventional radiologists are often consulted for acute management of hemorrhagic complications in obstetric and gynecologic patients. The aim of this article is to review the common indications for vascular embolization in obstetric and gynecologic emergencies, specifically in the setting of primary postpartum hemorrhage, and to discuss the technique and outcomes of endovascular treatment.
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Affiliation(s)
- Matthew G Gipson
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado
| | - Mitchell T Smith
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado
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25
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Julve R, Meler E, Murillo E, Serra B. Buttock necrosis after hypogastric artery embolization for postpartum hemorrhage. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2013-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background: Uterine or hypogastric artery embolization is a useful alternative to hysterectomy in the treatment of postpartum hemorrhage.
Case: Puerpera requiring a bilateral hypogastric artery embolization for postpartum hemorrhage after cesarean section in a term twin pregnancy. Unexpected unilateral buttock necrosis appeared 5 days later. Treatment consisted of debridement, the use of vacuum-assisted closure therapy and skin grafting.
Conclusion: Buttock necrosis is a rare complication after hypogastric artery embolization in the treatment of postpartum hemorrhage.
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Affiliation(s)
- Robin Julve
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Dexeus Salut de la Dona, Hospital Universitari Quirón Dexeus, Barcelona, Spain
| | - Eva Meler
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Dexeus Salut de la Dona, Hospital Universitari Quirón Dexeus, Barcelona, Spain
| | - Elena Murillo
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Dexeus Salut de la Dona, Hospital Universitari Quirón Dexeus, Barcelona, Spain
| | - Bernat Serra
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Institut Dexeus Salut de la Dona, Hospital Universitari Quirón Dexeus, Barcelona, Spain
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Antony KM, Dildy GA. Postpartum hemorrhage: the role of the Maternal-Fetal Medicine specialist in enhancing quality and patient safety. Semin Perinatol 2013; 37:246-56. [PMID: 23916023 DOI: 10.1053/j.semperi.2013.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Postpartum hemorrhage in excess of 1000 mL affects 2.9-4.3% of deliveries in North America and the prevalence is increasing (Calvert et al., 2012(1); Callaghan et al., 2010(2)). Given the unpredictable nature of most postpartum hemorrhages, all obstetric providers must understand the initial steps in the assessment and management of this emergency. In this monograph we will review the potential role of the Maternal-Fetal Medicine (MFM) specialist in managing this acute obstetric emergency. MFMs are uniquely positioned to develop hospital protocols, advocate for investment in resources to optimize outcomes, and utilize novel educational models, such as simulation, to educate other providers on the recognition and management of this condition. MFMs can also aid in the antepartum diagnosis of abnormal placentation, which is an increasingly common risk factor for severe hemorrhage.
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Affiliation(s)
- Kathleen M Antony
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, 6651 Main St, 10th Floor, Houston, TX 77030, USA.
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Kim GM, Yoon CJ, Seong NJ, Kang SG, Kim YJ. Postpartum haemorrhage from ruptured pseudoaneurysm: efficacy of transcatheter arterial embolisation using N-butyl-2-cyanoacrylate. Eur Radiol 2013; 23:2344-9. [DOI: 10.1007/s00330-013-2830-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/06/2013] [Accepted: 02/27/2013] [Indexed: 11/30/2022]
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28
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Uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta. Clin Radiol 2012; 67:e71-6. [DOI: 10.1016/j.crad.2012.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 07/18/2012] [Accepted: 07/30/2012] [Indexed: 11/22/2022]
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29
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Kaicker J, Wu K, Athreya S. Assessing the reliability and quality of online uterine fibroid embolization resources. Cardiovasc Intervent Radiol 2012; 36:385-94. [PMID: 22648699 DOI: 10.1007/s00270-012-0418-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 04/29/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was designed to examine the best internet resources about uterine fibroid embolization (UFE) pertinent to medical trainees, radiologists, gynecologists, family physicians, and patients. METHODS The terms "uterine fibroid embolization," "uterine fibroid embolization," and "uterine artery embolization" were entered into Google, Yahoo, and Bing search engines; the top 20 hits were assessed. The hits were categorized as organizational or nonorganizational. Additionally, 23 radiological and obstetrical organizations were assessed. The DISCERN instrument and Journal of the American Medical Association (JAMA) benchmarks (authorship, attribution, currency, disclosure) were used to assess the information critically. The scope, strength, weaknesses, and unique features were highlighted for the top five organizational and nonorganizational websites. RESULTS A total of 203 websites were reviewed; 23 were removed in accordance with the exclusion criteria and 146 were duplicate websites, for a total of 34 unique sites. It was found that 35 % (12/34 websites) were organizational (family medicine, radiology, obstetrics/gynecology) and 65 % (22/34 websites) were nonorganizational (teaching or patient resources). The overall mean DISCERN score was 49.6 (10.7). Two-tailed, unpaired t test demonstrated no statistically significant difference between organizational and nonorganizational websites (p = 0.101). JAMA benchmarks revealed 44 % (15/34 websites) with authorship, 71 % (24/34 websites) with attribution, 68 % (23/34 websites) with disclosure, and 47 % (16/34 websites) with currency. CONCLUSIONS The overall quality of websites for UFE is moderate, with important but not serious shortcomings. The best websites provided relevant information about the procedure, benefits/risks, and were interactive. DISCERN scores were compromised by sites failing to provide resources for shared decision-making, additional support, and discussing consequence of no treatment. JAMA benchmarks revealed lack of authorship and currency.
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Affiliation(s)
- Jatin Kaicker
- Department of Medical Imaging, Michael G. Degroote School of Medicine, 1200 Main St West, MDCL 3111, Hamilton, ON, L8N 3Z5, Canada
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Nakash A, Tuck S, Davies N. Uterine sepsis with uterine artery embolisation in the management of obstetric bleeding. J OBSTET GYNAECOL 2012; 32:26-9. [PMID: 22185529 DOI: 10.3109/01443615.2011.615420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper reports three complicated clinical cases of uterine artery embolisation (UAE) in the management of massive obstetric haemorrhage (MPPH), and the consequences of impaired uterine perfusion.
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Affiliation(s)
- A Nakash
- Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK.
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Postpartum hemorrhage treated with gelfoam slurry embolization using the superselective technique: immediate results and 1-month MRI follow-up. Cardiovasc Intervent Radiol 2012; 36:98-104. [PMID: 22327604 DOI: 10.1007/s00270-012-0355-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of superselective embolization of the uterine arteries in a postpartum hemorrhage. MATERIALS AND METHODS Between November 2004 and January 2011, a total of 44 consecutive women (median ± standard deviation age 34 ± 3 years, range 23-41 years) were referred to our institution for postpartum intractable hemorrhage management. All patients were embolized with a microcatheter that was placed deep into the uterine arteries upstream of the cervical arteries. The embolic agent was a mixture of contrast medium and 5 × 5 × 5 cm pieces of gelfoam (Gelita-Spon) modified into a gelatin emulsion as follows: rapid mixing through a three-way stopcock with two 2.5-ml syringes. A 1-ml syringe was used for injection. One month after embolization, all patients underwent magnetic resonance imaging and clinical examination. RESULTS Technical and clinical success was obtained in all cases. Thirty-five patients experienced bleeding related to poor retraction of the uterus, 7 patients because of a tear of the cervix and 2 because of a vaginal hematoma. Pre- and postembolization red blood cell transfusions were (mean ± standard deviation [SD]) 6 ± 1.2 (range 3-8) U and 2 ± 0.7 (range 2-4) U, respectively. One-month magnetic resonance imaging follow-up revealed no sign of ischemic myometrium or necrosis, and no instances of uterine rupture and no pelvic vein thrombosis. Incidental findings included two small intramyometrial hematic collections. All uterine arteries were patent via magnetic resonance angiography. Seventeen patients had concomitant fibroids, all of which appeared hypovascular. CONCLUSION This technique permits good, safe clinical results with no marked damage to the uterine arteries or the uterus itself.
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Carnevale FC, Kondo MM, de Oliveira Sousa W, Santos AB, da Motta Leal Filho JM, Moreira AM, Baroni RH, Francisco RPV, Zugaib M. Perioperative Temporary Occlusion of the Internal Iliac Arteries as Prophylaxis in Cesarean Section at Risk of Hemorrhage in Placenta Accreta. Cardiovasc Intervent Radiol 2011; 34:758-64. [DOI: 10.1007/s00270-011-0166-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
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Ganguli S, Stecker MS, Pyne D, Baum RA, Fan CM. Uterine Artery Embolization in the Treatment of Postpartum Uterine Hemorrhage. J Vasc Interv Radiol 2011; 22:169-76. [DOI: 10.1016/j.jvir.2010.09.031] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 09/17/2010] [Accepted: 09/20/2010] [Indexed: 11/15/2022] Open
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Messina MDL, Deutsch F, Zlotnik E, Nasser F, Affonso BB, Melo NRD, Baracat EC. Endovascular surgery in gynecology. EINSTEIN-SAO PAULO 2010; 8:488-94. [PMID: 26760336 DOI: 10.1590/s1679-45082010rw1372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Endovascular surgery has presented a high evolution since 1960 with Charles Dotter, who changed the concept of catheter utilization as a mean to diagnose and introduce therapeutic in interventionist vascular environment. The first reports of bleeding control of gastrointestinal and transluminal angioplasty input the development of new techniques for endovascular access, and new materials use, such as microcatheters and embolic agents, become this procedure effective and viable for treatment of several pathologies. The embolization of several organs of human body is a procedure carried out for more than 30 years all over the world showing safety, efficacy and of simple execution. In obstetrics and gynecology, particularly, the first reports refer to pelvic hemorrhage control of varied etiology, including pelvic trauma, bladder and gynecology neoplasia, anteriovenous fistulas and puerperal hemorrhages. The embolization of uterine myoma appears in the 1990's as an alternative for treat of uterine leiomyoma, and a number of studies try to clarify the risks and benefits of this procedure. It is a multidisciplinary technique, with diagnostic and indication performed by gynecologist and the procedure done by interventional vascular radiologist. This review is a critical analysis of interventionist vascular radiologic methods and its main therapeutic indications in gynecology.
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Affiliation(s)
| | - Fernanda Deutsch
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, BR
| | - Eduardo Zlotnik
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, BR
| | - Felipe Nasser
- Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | | | - Nilson Roberto de Melo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, BR
| | - Edmund Chada Baracat
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, BR
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Webster V, Stewart R, Stewart P. A survey of interventional radiology for the management of obstetric haemorrhage in the United Kingdom. Int J Obstet Anesth 2010; 19:278-81. [DOI: 10.1016/j.ijoa.2009.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 06/15/2009] [Accepted: 10/13/2009] [Indexed: 12/29/2022]
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The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol 2010; 33:887-95. [PMID: 20464555 DOI: 10.1007/s00270-010-9864-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 01/20/2010] [Indexed: 12/12/2022]
Abstract
Obstetric hemorrhage remains a major cause of maternal morbidity and mortality worldwide. Traditionally, in cases of obstetric hemorrhage refractory to conservative treatment, obstetricians have resorted to major surgery with the associated risks of general anesthesia, laparotomy, and, in the case of hysterectomy, loss of fertility. Over the past two decades, the role of pelvic arterial embolization has evolved from a novel treatment option to playing a key role in the management of obstetric hemorrhage. To date, interventional radiology offers a minimally invasive, fertility-preserving alternative to conventional surgical treatment. We review current literature regarding the role of interventional radiology in postpartum hemorrhage, abnormal placentation, abortion, and cervical ectopic pregnancy. We discuss techniques, success rates, and complications.
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Al-Wahbi AM. Management of limb threatening ischaemia following bilateral Gelfoam embolisation of the internal iliac artery. J OBSTET GYNAECOL 2010; 30:413-4. [PMID: 20455733 DOI: 10.3109/01443611003753300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A M Al-Wahbi
- Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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Naguib NN, Mbalisike E, Nour-Eldin NEA, Jost A, Lehnert T, Ackermann H, Vogl TJ. Leiomyoma Volume Changes at Follow-up after Uterine Artery Embolization: Correlation with the Initial Leiomyoma Volume and Location. J Vasc Interv Radiol 2010; 21:490-5. [DOI: 10.1016/j.jvir.2009.12.388] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 11/08/2009] [Accepted: 12/01/2009] [Indexed: 10/19/2022] Open
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Persistent postpartum haemorrhage after failed arterial ligation: value of pelvic embolisation. Eur Radiol 2010; 20:1777-85. [DOI: 10.1007/s00330-010-1713-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
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Opinion: Integration of diagnostic and management perspectives for placenta accreta. Aust N Z J Obstet Gynaecol 2009; 49:578-87. [DOI: 10.1111/j.1479-828x.2009.01088.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kirby JM, Kachura JR, Rajan DK, Sniderman KW, Simons ME, Windrim RC, Kingdom JC. Arterial Embolization for Primary Postpartum Hemorrhage. J Vasc Interv Radiol 2009; 20:1036-45. [DOI: 10.1016/j.jvir.2009.04.070] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 04/22/2009] [Accepted: 04/30/2009] [Indexed: 11/25/2022] Open
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Ratnam LA, Gibson M, Sandhu C, Torrie P, Chandraharan E, Belli AM. Transcatheter pelvic arterial embolisation for control of obstetric and gynaecological haemorrhage. J OBSTET GYNAECOL 2009; 28:573-9. [DOI: 10.1080/01443610802273374] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Josephs SC. Obstetric and gynecologic emergencies: a review of indications and interventional techniques. Semin Intervent Radiol 2008; 25:337-46. [PMID: 21326575 DOI: 10.1055/s-0028-1102992] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There are many interventional techniques that can be used to aid the obstetrician or gynecologist in caring for their patients in the acute setting. Embolization can be life saving in the case of postpartum hemorrhage. Bleeding related to cervical cancer or the threat of bleeding from cervical ectopic pregnancy is amenable to embolization as is hemorrhage related to uterine arteriovenous malformations. Postpartum women are also at a uniquely high risk for deep vein thrombosis and pulmonary emboli and may benefit from consultation and treatment by an interventional radiologist. The goal of this article is to discuss the valuable role that the interventional radiologist plays in the treatment of these obstetric and gynecologic conditions.
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Affiliation(s)
- Shellie C Josephs
- Department of Radiology, Vascular and Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
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Gaia G, Chabrot P, Cassagnes L, Calcagno A, Gallot D, Botchorishvili R, Canis M, Mage G, Boyer L. Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study. Eur Radiol 2008; 19:481-7. [PMID: 18766350 DOI: 10.1007/s00330-008-1140-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 07/07/2008] [Accepted: 07/15/2008] [Indexed: 01/19/2023]
Abstract
To evaluate long-term effects of arterial embolization (AE) for postpartum hemorrhage (PPH) on menses recovery and subsequent pregnancies. One hundred thirteen consecutive patients, recruited from 1999 to 2006, who had undergone AE for severe PPH were evaluated in a retrospective monocentric study. As embolization agents, pledgets of absorbable gelatine sponge (Curaspon) were used in 106 cases, Curaspon powder in 3 cases, and inert microparticles in 4 cases. In 111/113 cases (98.1%), AE was successful in controlling PPH. In two cases (1.7%), the AE was unsuccessful and required a total abdominal postembolization hysterectomy. Concerning fertility, 6 patients were lost to follow-up and 107 were available. The average time to follow-up was 46.4+/-21.8 months. Of the 107 patients, 99 had recovery of menses (92.5%). Of the 107 (61%) patients, 66 reported regular menstruation with normal delay after the delivery. Thirty-three patients (31%) reported subjective changes in the frequency and amount of menses. Six patients (5.6%) had documented amenorrhea after AE and developed diffuse uterine synechiae at the hysteroscopic investigation. Out of 29 patients who desired and attempted conception, 18 patients (62%) reported a total of 19 pregnancies at the end of the follow-up. One miscarriage at 12 weeks of gestation was reported. The 18 pregnancies at term were uneventful until delivery, but 3 cases of further PPH (15%) occurred due to abnormal placentation requiring a further AE. All full-term newborns were healthy. AE is a feasible, safe, and reproducible technique to control PPH, allowing a very high resumption of menses and subsequent pregnancies; in these cases, considering the elevated incidence of further PPH due to abnormal placentation, an accurate ultrasonographic monitoring during pregnancy seems appropriate.
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Affiliation(s)
- G Gaia
- C.H.U. Clermont-Ferrand, Department of Gynaecology and Obstetrics, Polyclinique de l'Hôtel-Dieu, Boulevard Leon Malfreyt, 63058 Clermont-Ferrand cedex 1, France.
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Abstract
Postpartum hemorrhage is an obstetric emergency that represents a major cause of maternal morbidity and mortality. With the recent rise in the cesarean delivery rate, prompt recognition and proper management at the time of cesarean delivery are becoming increasingly important for providers of obstetrics. Preparedness for hemorrhage can be achieved by recognition of prior risk factors and implementation of specific hemorrhage protocols. Medical and surgical therapies are available to treat obstetric hemorrhage after cesarean delivery.
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Affiliation(s)
- Clarissa Bonanno
- Division of Maternal Fetal Medicine, Columbia Presbyterian Medical Center, 622 West 168th Street, PH-16, New York, NY 10032, USA.
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Mok M, Heidemann B, Dundas K, Gillespie I, Clark V. Interventional radiology in women with suspected placenta accreta undergoing caesarean section. Int J Obstet Anesth 2008; 17:255-61. [DOI: 10.1016/j.ijoa.2007.11.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Accepted: 11/01/2007] [Indexed: 11/25/2022]
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Naydich M, Friedman A, Aaron G, Silberzweig J. Arterial embolization of vaginal arterial branches for severe postpartum hemorrhage despite hysterectomy. J Vasc Interv Radiol 2008; 18:1047-50. [PMID: 17675626 DOI: 10.1016/j.jvir.2007.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Postpartum hemorrhage remains a substantial cause of maternal morbidity and mortality. Arterial embolization has been described as a successful primary modality and an important adjunct in the treatment of postpartum hemorrhage. Herein, the authors report a case of intractable postpartum hemorrhage refractory to hysterectomy. The bleeding was controlled with embolotherapy. The findings emphasize the role of angiographic embolization in postpartum hemorrhage.
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Affiliation(s)
- Marsha Naydich
- Department of Radiology, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1000 10th Ave, New York, NY 10019, USA.
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