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van der Bom JG, Mercier FJ, Bausch-Fluck D, Nordentoft M, Medici M, Abdul-Kadir R. Thromboembolic events in severe postpartum hemorrhage treated with recombinant activated factor VII: a systematic literature review and meta-analysis. Res Pract Thromb Haemost 2024; 8:102533. [PMID: 39262646 PMCID: PMC11387238 DOI: 10.1016/j.rpth.2024.102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 09/13/2024] Open
Abstract
Postpartum hemorrhage (PPH) is an obstetric complication with high associated morbidity. Recombinant activated factor VII (rFVIIa) is used to treat severe PPH when uterotonics fail to stop bleeding. However, data on the safety of rFVIIa treatment of severe PPH from adequately powered trials are lacking. We systematically reviewed published data on the incidence of thromboembolic events (TEs) in women with PPH treated or not treated with rFVIIa (PROSPERO CRD42022360736). Databases (Embase, MEDLINE, BIOSIS, Current Contents, and the Cochrane Library) were searched for peer-reviewed publications published between January 1996 and August 2022 and conference abstracts published between January 2017 and August 2022 using search terms related to thromboembolism or infarction and PPH. Data were extracted from all publications reporting on a general population of women with PPH with information on TEs. Descriptive summary statistics and the estimated proportion of TEs were analyzed using a generalized linear mixed model based on the binomial distribution. Quality assessments were based on the checklist by Downs and Black. From 1637 potentially eligible studies, 55 publications were included reporting on 611 women treated and 32,488 women not treated with rFVIIa. The global estimated proportion of TEs was 1.82% (prediction interval [PI], 0.30-10.23) and 0.72% (PI, 0.03-16.47) in women with severe PPH treated and those not treated with rFVIIa, respectively. The estimated proportions of TEs were similarly small, with wide and largely overlapping PIs. Additional well-designed trials are needed to improve understanding of TE incidence in PPH.
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Affiliation(s)
- Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frédéric J Mercier
- Department of Anaesthesia and Critical Care Medicine, A. Beclere Hospital - APHP, Paris-Saclay University, Clamart, France
| | | | | | | | - Rezan Abdul-Kadir
- Department of Obstetrics and Gynaecology, The Royal Free National Health Service Foundation Hospital, London, United Kingdom
- Institute for Women's Health, University College London, London, United Kingdom
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Lee KE, Lee SU, Kang J, Lim HW, Park IY, Kim MJ. Prognosis of subsequent pregnancy in uterine necrosis after uterine artery embolization. Obstet Gynecol Sci 2024; 67:335-338. [PMID: 38563044 PMCID: PMC11099095 DOI: 10.5468/ogs.23287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/24/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024] Open
Abstract
In an 8-year period at two medical center, 138 patients underwent uterine artery embolization, and 11 of them were diagnosed with uterine necrosis. Among them, three were successfully conceived. However, one of them developed an arteriovenous malformation after an artificial abortion, and another experienced complications, including placenta previa and placenta accreta spectrum, which resulted in early preterm delivery and recurrent postpartum hemorrhage, necessitating subtotal hysterectomy. Therefore, it is crucial to prepare for potential adverse pregnancy outcomes in subsequent pregnancies for patients with a history of uterine necrosis.
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Affiliation(s)
- Kyung Eun Lee
- Department of Obstetrics and Gynecology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
| | - Seon Ui Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jun Kang
- Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyun Wook Lim
- Department of Radiology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Min Jeong Kim
- Department of Obstetrics and Gynecology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
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Park CR, Nam JG, Lee JH, Hwang JC, Lee SH. Safety and efficacy of pelvic arterial embolization for primary postpartum hemorrhage in hemodynamically stable and hemodynamically unstable patients: Is it "time" for a paradigm change? J Gynecol Obstet Hum Reprod 2024; 53:102762. [PMID: 38432627 DOI: 10.1016/j.jogoh.2024.102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/11/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Pelvic artery embolization (PAE) is an effective and safe technique for treating postpartum hemorrhage (PPH) with hemodynamic stability. However, its use in hemodynamically unstable patients remains controversial. PURPOSE To determine the safety and efficacy of pelvic arterial embolization (PAE) according to the hemodynamic state of primary postpartum hemorrhage (PPH) patients. METHODS This cohort study was conducted retrospectively, using data from January 2004 to December 2021, in a resource-rich setting at a tertiary Level 1 trauma academic center. A total of 437 patients were diagnosed with PPH during the study period. Of these 437 patients, 161 with primary PPH who underwent PAE were enrolled in the study. The outcomes assessed included the clinical success rate, mortality, the overall success rate, predictive factors for failed PAE, and time-dependent changes in hemodynamic parameters, such as systolic blood pressure (SBP), heart rate (HR), and shock index (SI). Propensity score (PS) matching analysis was performed to assess the influence of specific variables or conditions on the outcomes. RESULTS Of the 161 patients who underwent PAE for primary PPH (mean age, 32.9 ± 4.3 [SD]), 85 were retrospectively categorized as having hemodynamic stability (mean age, 32.6 ± 4.1 [SD]), while 76 were categorized as having hemodynamic instability (mean age, 33.3 ± 4.4 [SD]). This study showed PAE for primary PPH had a success rate of 91.9 %, with no significant difference in mortality rates between the groups. The clinical success rate was 98.8 % for patients with hemodynamic stability and 84.2 % for those with hemodynamic instability (p < .001). The overall success rate was 98.8 % for hemodynamic stability and 89.5 % for hemodynamic instability (p = .014). After propensity score matching, the clinical success rate was higher in hemodynamically stable patients than in unstable ones (100 % vs. 86.3 %, p = .013). However, there was no significant difference in the overall success rate (100 % vs. 90.2 %, p = .056). Among the PS-matched population, predictive factors for the failed PAE in primary PPH were hemodynamic instability (adjusted odds ratio [aOR] 21.22, 95 % CI 1.27-355.76; p = .034) and emergency Cesarean delivery with accompanying hemorrhag (aOR 54.00, 95 % CI 11.93-244.56; p = .008). In three groups within a PS-matched population - hemodynamically stable, unstable with successful outcomes, and unstable with unsuccessful outcomes, a generalized linear mixed model (GLMM) analysis for time-dependent changes in hemodynamic parameters revealed a statistically significant difference in SBP, HR, and SI at various time points. CONCLUSION Pelvic arterial embolization of primary postpartum bleeding in hemodynamic instability has been identified as an alternative, safe, and effective life-saving procedure for multidisciplinary treatment in resource-rich environments even after the baseline characteristics are balanced by the PS matching, suggesting it is a primary care option.
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Affiliation(s)
- Chang Ryul Park
- Department of Thoracic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jeong Gu Nam
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jong Hwa Lee
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jae Cheol Hwang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Sang Hun Lee
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, South Korea.
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Amat Pérez R, Gómez Valdés J, Lonjedo Vicent E, Sarrió Llavata M, Quirante Cascales J, Ruiz Guanter A. Eficacia y seguridad de la embolización de arterias uterinas en el manejo de la hemorragia posparto. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Püchel J, Sitter M, Kranke P, Pecks U. Procedural techniques to control postpartum hemorrhage. Best Pract Res Clin Anaesthesiol 2022; 36:371-382. [PMID: 36513432 DOI: 10.1016/j.bpa.2022.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
Postpartum hemorrhage can occur unexpectedly and with high dynamics. The mother's life often depends on quick action and good communication within an interdisciplinary team. Knowledge of each other's therapeutic options plays a major role. Treatment procedures include obstetric, surgical, and radiologic techniques. In addition to availability and experience with the techniques, two important aspects must be considered in the selection process: the type of delivery and the cause of the hemorrhage. In particular, the distinction between pregnancies with or without disturbed placentation from the placenta accreta spectrum is crucial. From these two points of view, we discuss here different uterus-preserving and uterus-removing techniques. We describe in detail the advantages and disadvantages of each procedure. Because most therapeutic options are based on small case series and uncontrolled studies, local circumstances and physician experience are critical in setting internal standards.
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Affiliation(s)
- Jodok Püchel
- Department of Gynaecology and Obstetrics, University Hospital of Cologne, Germany.
| | - Magdalena Sitter
- Department of Anaesthesia, Critical Care Medicine, Emergency Medicine and Pain Medicine, University Hospital of Wuerzburg, Germany.
| | - Peter Kranke
- Department of Anaesthesia, Critical Care Medicine, Emergency Medicine and Pain Medicine, University Hospital of Wuerzburg, Germany.
| | - Ulrich Pecks
- Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
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Obstetrical and Fertility Outcomes Following Transcatheter Pelvic Arterial Embolization for Postpartum Hemorrhage: A Cohort Follow-Up Study. LIFE (BASEL, SWITZERLAND) 2022; 12:life12060892. [PMID: 35743923 PMCID: PMC9228119 DOI: 10.3390/life12060892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022]
Abstract
Objectives: Management of severe postpartum hemorrhage (PPH) includes transcatheter pelvic arterial embolization (TAE). Data regarding subsequent fertility and obstetrical outcomes is limited, as most fertility outcomes derive from TAE in uterine fibroma. The purpose of our study was to evaluate the long-term outcomes of patients undergoing TAE, particularly concerning subsequent fertility and following pregnancies. Material and methods: We included 28 patients who underwent TAE for PPH at our institution between 2009 and 2018 in a retrospective cohort study. Data were assessed by reviewing patients’ charts and by contacting the patients. Results: Ten patients had prophylactic balloon occlusion before cesarean section because of anticipated PPH, with planned hysterectomy by placenta increta/percreta. All these patients were excluded from the analysis regarding fertility. 16 (73%) patients reported having regular menstruation after TAE. In total, 11 women had no desire for subsequent pregnancy. Seven of the remaining 11 patients (63.6%) had a total of 13 spontaneous pregnancies, nine of these resulted in miscarriages. Four patients delivered a live baby (36.4%). Two of these (50%) had recurrent PPH and treatment was conservative. Of the patients with infertility (n = 4, 36.4%), two (18.1%) underwent assisted infertility treatment without success. Conclusion: Our study suggests that the fertility of patients undergoing TAE due to PPH is limited. In women who conceive, the risk for first trimester miscarriage as well as recurrent PPH seems to be increased. If this is a consequence of the underlying cause of PPH or the TAE remains unknown. Larger follow-up cohorts are needed. In the meantime, patients who desire pregnancy after TAE should be counseled accordingly.
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Transcatheter Arterial Embolization (TAE) Using N-Butyl-2-cyanoacrylate (NBCA) as the First Choice for Postpartum Vulvovaginal Hematoma; Case Series and Reviews of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12061429. [PMID: 35741239 PMCID: PMC9221906 DOI: 10.3390/diagnostics12061429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Transcatheter arterial embolization (TAE) has long been reported to be safe, effective, and to have a high clinical and technical success rate for vulvovaginal hematoma. We used a permanent embolic material, diluted N-butyl-2-cyanoacrylate (NBCA), for the first choice intervention for six cases of vulvovaginal hematoma, in order to confirm the effectiveness of NBCA. Regarding post-embolization adverse events, we did not observe any fever nor necrosis or pain in the vaginal wall or vulva, in all cases. The use of NBCA as a first-line treatment for TAE of vulvovaginal hematoma is considered to be effective, in the following two ways: First, hemostasis can be achieved by adjusting the mixing ratio of NBCA and lipiodol, according to the distance between the tip of the catheter and the site of injury. Second, NBCA does not cause complications such as pain, necrosis, or infection, and it can be used safely. There are no reports clearly recommending NBCA as the first choice in the treatment of TAE for vulvovaginal hematoma. This is the first report to examine the efficacy and safety of NBCA as the first-line intervention for such cases.
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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: 17] [Impact Index Per Article: 4.3] [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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Tateishi H, Kuroki K, Machida H, Iwamoto T, Kariyasu T, Kinoshita Y, Watanabe M, Shiga H, Yuda S, Yokoyama K. Clinical applications of digital angiography with the harmonization function in body interventional radiology. Jpn J Radiol 2020; 38:922-933. [PMID: 32430663 PMCID: PMC7529630 DOI: 10.1007/s11604-020-00990-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/09/2020] [Indexed: 12/02/2022]
Abstract
Digital subtraction angiography (DSA) is frequently applied in interventional radiology (IR). When DSA is not useful due to misregistration, digital angiography (DA) as an alternative option is used. In DA, the harmonization function (HF) works in real time by harmonizing the distribution of gray steps or reducing the dynamic range; thus, it can compress image gradations, decrease image contrast, and suppress halation artifacts. DA with HF as a good alternative to DSA is clinically advantageous in body IR for generating DSA-like images and simultaneously reducing various motion artifacts and misregistrations caused by patient body motion, poor breath-holding, bowel and ureter peristalsis, and cardiac pulsation as well as halation artifacts often stemming from the lung field. Free-breath DA with HF can improve body IR workflow and decrease the procedure time by reducing the risk of catheter dislocation and using background structures as anatomical landmarks, demonstrating reduced radiation exposure relative to DSA. Thus, HF should be more widely and effectively utilized for appropriate purposes in body IR. This article illustrates the basic facts and principles of HF in DA, and demonstrates clinical advantages and limitations of this function in body IR.
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Affiliation(s)
- Hidekatsu Tateishi
- Department of Radiology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Kazunori Kuroki
- Department of Radiology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Haruhiko Machida
- Department of Radiology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Toshihiko Iwamoto
- Section of Radiology, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Toshiya Kariyasu
- Department of Radiology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yuusuke Kinoshita
- Department of Radiology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Masanaka Watanabe
- Department of Radiology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hisae Shiga
- Department of Radiology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Saori Yuda
- Section of Radiology, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Kenichi Yokoyama
- Department of Radiology, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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Ruiz Sánchez E, Peinado Rodenas J, Gil Martínez-Acacio L, Arones Collantes M, Villar García M, García de la Torre JP, Amezcua Recover AN. Uterine necrosis. A rare complication of embolisation due to post-partum haemorrhage. J Gynecol Obstet Hum Reprod 2020; 50:101773. [PMID: 32325270 DOI: 10.1016/j.jogoh.2020.101773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/20/2022]
Abstract
Post-partum haemorrhage (PPH) is a major cause of maternal mortality, according to the WHO. Early PPH occurs in 5% to 15% of births. In 80% of cases, uterine atonia is the cause. We describe a case of uterine necrosis following uterine artery embolization (UAE). due to PPH. The patient was a 37-year-old woman who had a normal delivery after her second pregnancy, but experienced haemorrhage due to uterine atonia that failed to respond to drugs. She underwent UAE with Spongostan® with no complications. The peri-partum period was normal. At 16 days, she consulted due to recurrence of fever. Magnetic resonance imaging confirm the diagnosis of uterine necrosis. Abdominal hysterectomy was performed.
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Affiliation(s)
- Esther Ruiz Sánchez
- Department of Obstetrics and Gynaecology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain.
| | - Javier Peinado Rodenas
- Department of Radiology, Hospital of Alcázar de San Juan (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Leyre Gil Martínez-Acacio
- Department of Obstetrics and Gynaecology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Marco Arones Collantes
- Department of Obstetrics and Gynaecology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Miguel Villar García
- Department of Radiology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Juan Pablo García de la Torre
- Department of Anatomical Pathology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Antonio N Amezcua Recover
- Department of Obstetrics and Gynaecology, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
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Saiga A, Yokota H, Higashide T, Takishima H, Omoto A, Kubota Y, Horikoshi T, Uno T. The Relationship Between Gelatin Sponge Preparation Methods and the Incidence of Intrauterine Synechia Following Uterine Artery Embolization for Postpartum Hemorrhage. Cardiovasc Intervent Radiol 2018; 42:195-204. [PMID: 30238332 DOI: 10.1007/s00270-018-2078-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/13/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the relationship between gelatin sponge preparation methods and the incidence of intrauterine synechia following uterine artery embolization (UAE) for postpartum hemorrhage (PPH). MATERIALS AND METHODS In a retrospective monocentric study, we used data from 20 consecutive UAE procedures (19 patients) for PPH, performed in 2007-2016, in which gelatin sponge had been used. The gelatin sponge was processed either into a slurry by pumping it back and forth about 10 times through two syringes connected to a three-way stopcock or into pledgets using a scalpel and small scissors to obtain pieces approximately 2 × 2 × 2 mm in size. Patient information was obtained from medical records, and the data were compared between patients treated with the slurry (n = 7) or pledgets (n = 13) forms. Due to the lack of follow-up data and hysterectomy after UAE, the sample size was 6 and 12 because 1 patient with 2 procedures was excluded. RESULTS The rate of intrauterine synechia was significantly higher in the slurry group (5/6, 83.3%) than that in the pledgets group (0/12, 0%; P < 0.001). In contrast, there were no significant differences in population characteristics, such as the incidence of placenta accreta, non-placental diseases, and severity of shock (DIC score, shock index, or blood loss) between the groups. CONCLUSIONS Although non-randomization and small sample size were the two main limitations, our observations suggest that UAE using gelatin sponge slurry may be associated with a high incidence of intrauterine synechia compared to UAE using pledgets.
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Affiliation(s)
- Atsushi Saiga
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan. .,Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Hajime Yokota
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Takashi Higashide
- Department of Radiology, Japanese Red Cross Narita Hospital, 90-1, Iida-cho, Narita City, Chiba, 286-8523, Japan
| | - Hazuki Takishima
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Akiko Omoto
- Department of Maternal-Fetal Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Yoshihiro Kubota
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Takuro Horikoshi
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Takashi Uno
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
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Spreu A, Abgottspon F, Baumann MU, Kettenbach J, Surbek D. Efficacy of pelvic artery embolisation for severe postpartum hemorrhage. Arch Gynecol Obstet 2017; 296:1117-1124. [PMID: 28993867 DOI: 10.1007/s00404-017-4554-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of our study was to evaluate the outcome of selective pelvic arterial embolisation (PAE) in women with severe postpartum hemorrhage (PPH). METHODS We performed a retrospective, controlled, single-center cohort study. A total of 16 consecutive women with PPH who underwent therapeutic PAE were included. As historical control group, we included 22 women with similar severity of PPH who were managed without PAE. Outcome measures included necessity of surgical interventions such as postpartum hysterectomy and laparotomy after vaginal delivery, the amount of red blood cell transfusions, and hematologic findings after the procedure. RESULTS PAE was successful in stopping PPH and preserving the uterus in all 16 women in the study group. No woman in the PAE group required a postpartum hysterectomy, whereas postpartum hysterectomy was unavoidable in two women in the control group. Laparotomy after vaginal delivery was necessary in two women of the group without embolisation. Hematologic parameters after the treatment were better in the PAE group than in the control group, although these differences were only in part statistically significant. There were no unwarranted effects of PAE identifiable in the study group. CONCLUSION This is the first controlled study assessing the efficacy of PAE for the treatment of PPH. Our data suggest that PAE is effective for the treatment of severe PPH. In view of the lack of complications and unwarranted effects, clinical use of PAE in severe PPH seems justified, particularly in view of the life-threatening condition and the potential to preserve fertility in affected patients. Further evidence from well-designed prospective randomized-controlled trials would be nevertheless desirable in the future.
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Affiliation(s)
- Annette Spreu
- Department of Obstetrics and Gynecology, Inselspital University Hospital, University of Bern, Effingerstrasse 102, 3010, Bern, Switzerland.
| | - F Abgottspon
- Department of Obstetrics and Gynecology, Inselspital University Hospital, University of Bern, Effingerstrasse 102, 3010, Bern, Switzerland
| | - M U Baumann
- Department of Obstetrics and Gynecology, Inselspital University Hospital, University of Bern, Effingerstrasse 102, 3010, Bern, Switzerland
| | - J Kettenbach
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - D Surbek
- Department of Obstetrics and Gynecology, Inselspital University Hospital, University of Bern, Effingerstrasse 102, 3010, Bern, Switzerland
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Outcomes of pelvic arterial embolization in the management of postpartum haemorrhage: a case series study and systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 206:12-21. [PMID: 27612214 DOI: 10.1016/j.ejogrb.2016.07.510] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/04/2016] [Accepted: 07/26/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Pelvic arterial embolization (PAE) is considered as a second-line treatment, although the published results have not been reviewed systematically since 2007. OBJECTIVES To evaluate success and complication rates of PAE to treat PPH in the study hospital between 2009 and 2015, and to perform a systematic review of the literature on the reported efficacy and safety of PAE for the management of PPH. SEARCH STRATEGY A systematic review of articles on PAE in English or Spanish was conducted using Medline and the Cochrane Library. SELECTION CRITERIA All published articles assessing success and complication rates of PAE in cases of PPH. The search was restricted to articles published in English or Spanish between 2000 and 2015, with at least 25 cases. DATA COLLECTION AND ANALYSIS Obstetric variables, maternal haemodynamic state, pre-/postembolization management, technique-related variables, post-PAE evolution and complications were recorded in the case series study. Study characteristics, success rates and PAE-related complication rates were recorded in the systematic review. MAIN RESULTS The case series included 29 patients. The majority of these patients were primiparous, with singleton term pregnancies and spontaneous labour. Caesarean section was performed in 62.1% of patients undergoing PAE for PPH. PAE was successful in 89.6% [95% confidence interval (CI) 78.3-100] of cases. Twenty studies were included in the systematic review, providing data from 1739 patients. PAE was successful in 89.4% (95% CI 87.9-90.9) of cases. The mortality rate was 0.9%, and other major complications were uncommon (1.8%). CONCLUSIONS PAE was found to be a minimally invasive, highly successful and safe technique for the management of PPH. It should be considered in PPH refractory to initial treatment.
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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: 23] [Impact Index Per Article: 2.9] [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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Nogueira García J, Moreno Selva R, Ruiz Sánchez E, Peinado Rodenas J, Pedrosa Jiménez M, Gómez García T, González de Merlo G. Embolización de arterias uterinas como tratamiento de la hemorragia obstétrica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2014.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Poggi SH, Yaeger A, Wahdan Y, Ghidini A. Outcome of pregnancies after pelvic artery embolization for postpartum hemorrhage: retrospective cohort study. Am J Obstet Gynecol 2015; 213:576.e1-5. [PMID: 26164697 DOI: 10.1016/j.ajog.2015.06.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/21/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The effects of pelvic artery embolization (PAE) for postpartum hemorrhage (PPH) on subsequent pregnancies have been explored in small case series and one case-control study by mailed questionnaire with uncomplicated pregnancies as controls. We conducted a single-center retrospective cohort study using women with PPH without PAE for comparison. STUDY DESIGN From a cohort of 103 women undergoing PAE for primary PPH between January 1999 and December 2012 (exposed) and 189 pregnancies with PPH not requiring PAE between January 2008 and December 2012 (unexposed), we queried the electronic medical records for readmissions to labor and delivery in subsequent years. Outcomes of subsequent pregnancies continuing past 20 weeks were obtained by chart review. RESULTS Repeat pregnancies were documented in 17 of 103 exposed women (16.5%) and 18 of 189 unexposed women (9.5%). At delivery complicated by PPH, the groups did not differ in demographics, gestational age, units of blood transfused, or PPH cause. At the time of subsequent deliveries, there was a greater interdelivery interval in women exposed to PAE than those unexposed (1710 ± 938 days vs 904 ± 358 days; P = .002), and the 2 groups were similar in terms of gestational age and birthweight. However, there was a significantly higher rate of placenta accreta in exposed than unexposed women (23.5 % vs 0%; P = .04), with 3 of 17 sustaining total abdominal hysterectomy and 1 requiring repeat PAE for severe PPH. CONCLUSION Pregnancies following PAE for PPH were more likely than those not receiving PAE for treatment to be complicated by placenta accreta. Pregnancies following PAE should be followed up for imaging evidence of placenta accreta.
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Izumi Y, Ikeda S, Kitagawa A, Katsuda E, Hagihara M, Kamei S, Ota T, Ishiguchi T. Uterine artery embolization by use of porous gelatin particles for symptomatic uterine leiomyomas: comparison with hand-cut gelatin sponge particles. Jpn J Radiol 2015; 33:461-70. [DOI: 10.1007/s11604-015-0445-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/07/2015] [Indexed: 12/21/2022]
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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: 0.9] [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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Pelage JP, Fohlen A, Le Pennec V. Place de l’embolisation artérielle en cas d’hémorragie du post-partum. ACTA ACUST UNITED AC 2014; 43:1063-82. [DOI: 10.1016/j.jgyn.2014.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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Selective embolization to treat obstetric hemorrhage. RADIOLOGIA 2014. [DOI: 10.1016/j.rxeng.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Ferrer Puchol M, Lanciego C, Esteban E, Ciampi J, Edo M, Ferragud S. Embolización selectiva como tratamiento de la hemorragia obstétrica. RADIOLOGIA 2014; 56:148-53. [DOI: 10.1016/j.rx.2012.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 01/15/2012] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
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Hongsakul K, Songjamrat A, Rookkapan S. Transarterial embolization for the treatment of massive bleeding in gynecologic and obstetric emergencies: a single center experience. Emerg Radiol 2014; 21:333-9. [PMID: 24522752 DOI: 10.1007/s10140-014-1198-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 01/21/2014] [Indexed: 11/30/2022]
Abstract
Delayed treatment of the massive bleeding in gynecologic and obstetric conditions can cause high morbidity and mortality. The aim of this study is to assess the angiographic findings and outcomes of transarterial embolization in cases of massive hemorrhage from underlying gynecological and obstetrical conditions. This is a retrospective study of 18 consecutive patients who underwent transarterial embolization of uterine and/or hypogastric arteries due to massive bleeding from gynecological and obstetrical causes from January 2006 to December 2011. The underlying causes of bleeding, angiographic findings, technical success rates, clinical success rates, and complications were evaluated. Massive gynecological and obstetrical bleeding occurred in 12 cases and 6 cases, respectively. Gestational trophoblastic disease was the most common cause of gynecological bleeding. The most common cause of obstetrical hemorrhage was primary post-partum hemorrhage. Tumor stain was the most frequent angiographic finding (11 cases) in the gynecological bleeding group. The most common angiographic findings in obstetrical patients were extravasation (2 cases) and pseudoaneurysm (2 cases). Technical and final clinical success rates were found in all 18 cases and 16 cases. Collateral arterial supply, severe metritis, and unidentified cervical laceration were causes of uncontrolled bleeding. Only minor complications occurred, which included pelvic pain and groin hematoma. Percutaneous transarterial embolization is a highly effective and safe treatment to control massive bleeding in gynecologic and obstetric emergencies.
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Affiliation(s)
- Keerati Hongsakul
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanit Road, Hat Yai, Songkhla, 90110, Thailand,
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Miyayama S, Yamakado K, Anai H, Abo D, Minami T, Takaki H, Kodama T, Yamanaka T, Nishiofuku H, Morimoto K, Soyama T, Hasegawa Y, Nakamura K, Yamanishi T, Sato M, Nakajima Y. Guidelines on the use of gelatin sponge particles in embolotherapy. Jpn J Radiol 2014; 32:242-50. [PMID: 24510242 DOI: 10.1007/s11604-014-0292-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/17/2014] [Indexed: 12/20/2022]
Abstract
Gelatin sponge (GS) is one of the most widely used embolic agents in interventional procedures. There are four commercially available GS products in Japan; however, the endovascular use of Gelfoam and Spongel is off-label, and Gelpart can only be used for hepatic artery embolization and Serescue can only be used for hemostasis of arterial bleeding. GS has been used for a variety of clinical indications, mainly tumor embolization and stopping massive arterial bleeding. The optimal size and preparation procedure of GS particles differs slightly for each clinical indication. In addition, there is a risk of ischemic and/or infectious complications associated with GS embolization in various situations. Therefore, radiologists should be familiar with not only the preparation and handling of GS particles, but also the disadvantages and potential risks, in order to perform GS embolization safely and effectively.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1 Wadanaka-cho, Funabashi, Fukui, 918-8503, Japan,
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Outcome of pelvic arterial embolization for postpartum hemorrhage: A retrospective review of 117 cases. Obstet Gynecol Sci 2014; 57:17-27. [PMID: 24596814 PMCID: PMC3924745 DOI: 10.5468/ogs.2014.57.1.17] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/10/2013] [Accepted: 07/23/2013] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to evaluate indications, efficacy, and complications associated with pelvic arterial embolization (PAE) for postpartum hemorrhage (PPH). Methods We retrospectively reviewed the medical records of 117 consecutive patients who underwent PAE for PPH between January 2006 and June 2013. Results In our single-center study, 117 women underwent PAE to control PPH refractory to conservative management including uterine massage, use of uterotonic agents, surgical repair of genital tract lacerations, and removal of retained placental tissues. Among 117 patients, 69 had a vaginal delivery and 48 had a Cesarean section. The major indication for embolization was uterine atony (54.7%). Other causes were low genital tract lacerations (21.4%) and abnormal placentation (14.5%). The procedure showed a clinical success rate of 88.0% with 14 cases of PAE failure; there were 4 hemostatic hysterectomies and 10 re-embolizations. On univariate analysis, PAE failure was associated with overt disseminated intravascular coagulation (P=0.009), transfusion of more than 10 red blood cell units (RBCUs, P=0.002) and embolization of both uterine and ovarian arteries (P=0.003). Multivariate analysis showed that PAE failure was only associated with transfusions of more than 10 RBCUs (odds ratio, 8.011; 95% confidence interval, 1.531-41.912; P=0.014) and embolization of both uterine and ovarian arteries (odds ratio, 20.472; 95% confidence interval, 2.715-154.365; P=0.003), which were not predictive factors, but rather, were the results of longer time for PAE. Three patients showed uterine necrosis and underwent hysterectomy. Conclusion PAE showed high success rates, mostly without procedure-related complications. Thus, it is a safe and effective adjunct or alternative to hemostatic hysterectomy, when primary management fails to control PPH.
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Doumouchtsis SK, Nikolopoulos K, Talaulikar VS, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG 2013; 121:382-8. [DOI: 10.1111/1471-0528.12546] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 11/29/2022]
Affiliation(s)
- SK Doumouchtsis
- Department of Obstetrics and Gynaecology; St George's Healthcare NHS Trust; Tooting London UK
| | - K Nikolopoulos
- Department of Obstetrics and Gynaecology; St George's Healthcare NHS Trust; Tooting London UK
| | - VS Talaulikar
- Department of Obstetrics and Gynaecology; St George's Healthcare NHS Trust; Tooting London UK
| | - A Krishna
- Department of Obstetrics and Gynaecology; St George's Healthcare NHS Trust; Tooting London UK
| | - S Arulkumaran
- Department of Obstetrics and Gynaecology; St George's Healthcare NHS Trust; Tooting London UK
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Chaudhary V, Sachdeva P, Arora R, Kumar D, Karanth P. Pelvic arterial embolization in obstetric hemorrhage. World J Obstet Gynecol 2013; 2:185-191. [DOI: 10.5317/wjog.v2.i4.185] [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: 04/29/2013] [Revised: 05/20/2013] [Accepted: 07/18/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To analyze safety and efficacy of pelvic arterial embolization (PAE) in preventing and treating obstetrical hemorrhage.
METHODS: A consecutive study of eight cases undergoing pelvic artery embolization from January 2010 to October 2012 in Department of Obstetric and Gynecology of Maulana Azad Medical College for intractable obstetric hemorrhage was done. All embolization were carried out in cath lab of cardiology Department at associated GB Pant Hospital.
RESULTS: Clinical success was defined as arrest of bleeding after PAE without need for repeat PAE or additional surgery which was 75% in our series. PAE was successful in controlling obstetrical hemorrhage in all except one who had mortality. Other had hysterectomy due to secondary hemorrhage. Five resumed menstruation. None of the women intended to conceive, hence are practicing contraception.
CONCLUSION: PAE is minimally invasive procedure which should be offered early for hemostasis in intractable obstetrical haemorrhage unresponsive to uterotonic. It is a fertility sparing option with minor complications.
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Uterine necrosis following pelvic arterial embolization for post-partum hemorrhage: review of the literature. Eur J Obstet Gynecol Reprod Biol 2013; 170:309-14. [DOI: 10.1016/j.ejogrb.2013.07.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/12/2013] [Accepted: 07/08/2013] [Indexed: 11/20/2022]
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Mohan PP, Hamblin MH, Vogelzang RL. Uterine Artery Embolization and Its Effect on Fertility. J Vasc Interv Radiol 2013; 24:925-30. [DOI: 10.1016/j.jvir.2013.03.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 03/10/2013] [Accepted: 03/12/2013] [Indexed: 12/20/2022] Open
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Gizzo S, Saccardi C, Patrelli TS, Di Gangi S, Breda E, Fagherazzi S, Noventa M, D'Antona D, Nardelli GB. Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature. Fertil Steril 2013; 99:2097-107. [PMID: 23498891 DOI: 10.1016/j.fertnstert.2013.02.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the most appropriate surgical technique for optimizing hemostasis and preservation of subsequent fertility after postpartum hemorrhage (PPH). DESIGN Systematic review of the literature. SETTING Not applicable. PATIENT(S) None. INTERVENTION(S) Review of MEDLINE, EMBASE, ScienceDirect, and the Cochrane Library. MAIN OUTCOME MEASURE(S) Comparison of the effectiveness of conservative surgical techniques, separately or together, with respect to success rate (ability to stop bleeding and preserve the uterus), fertility rate (subsequent pregnancies or the return of regular menstrual cycles), complication rate of the procedure, and the outcomes of subsequent pregnancies in terms of type of delivery and eventual delivery complications. RESULT(S) Compressive sutures and vessel embolization may be considered life-saving procedures by achieving the best hemostatic efficacy. Data on restoration of menses and pregnancy rates after these procedures are limited by short-term follow-up and by the paucity of studies, especially for vascular ligation. CONCLUSION(S) Pelvic vessel embolization and compressive sutures are associated with high rates of restoration of regular menses and successive pregnancies, even if the former is burdened by an increased rate of placental disorders and fetal growth restriction and the latter by an increased risk of cesarean deliveries and PPH recurrence. Randomized trials would be desirable to define the best management of PPH.
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Affiliation(s)
- Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy.
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Malartic C, Cagnat J, Morel O, Ricbourg A, Gayat É, Mebazaa A, Ledref O, Barranger E. Prise en charge invasive conservatrice pour hémorragie du post-partum : fertilité et devenir obstétrical. ACTA ACUST UNITED AC 2012; 40:582-90. [DOI: 10.1016/j.gyobfe.2012.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 03/28/2012] [Indexed: 11/29/2022]
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Lee HY, Shin JH, Kim J, Yoon HK, Ko GY, Won HS, Gwon DI, Kim JH, Cho KS, Sung KB. Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution. Radiology 2012; 264:903-9. [PMID: 22829685 DOI: 10.1148/radiol.12111383] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of pelvic arterial embolization (PAE) for the treatment of primary postpartum hemorrhage (PPH) and to determine the factors associated with clinical outcomes. MATERIALS AND METHODS This retrospective single-center study was institutional review board approved, and informed consent was waived. Outcomes were analyzed in 251 patients who underwent PAE for primary PPH between January 2000 and February 2011. Mode of delivery, causes of bleeding, detailed laboratory and treatment records, and clinical outcomes were recorded. Clinical success was defined as cessation of bleeding after initial session of PAE without the need for additional PAE or surgery. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes. RESULTS The clinical success rate was 86.5% (217 of 251). Among the 34 failed cases, 12 underwent repeat PAE, 16 underwent additional surgery, and three recovered with conservative management. Overall bleeding control was achieved in 98.0% (246 of 251) of the patients. Overall mortality was 2% (five of 251) after the first (n = 3) or second (n = 1) session of PAE or additional surgery (n = 1). Among the 113 patients with long-term follow-up, 110 (97.3%) maintained a regular menstrual cycle and 11 had successful pregnancies. Univariate analysis showed that cesarean section delivery, disseminated intravascular coagulation (DIC), and massive transfusion of more than 10 red blood cell units were related to failed PAE. Multivariate analysis showed that DIC (odds ratio, 0.36; P = .04) and massive transfusion (odds ratio, 0.10; P < .001) were significantly related to clinical failure. CONCLUSION PAE is safe and effective for managing primary PPH. Patients with DIC and massive transfusion were likely to have poor results after PAE.
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Affiliation(s)
- Ha Young Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Korea
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Pinto A, Niola R, Brunese L, Pinto F, Losco M, Romano L. Postpartum hemorrhage: what every radiologist needs to know. Curr Probl Diagn Radiol 2012; 41:102-10. [PMID: 22459890 DOI: 10.1067/j.cpradiol.2011.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Postpartum hemorrhage is among the most common causes of maternal morbidity and mortality. Postpartum hemorrhage is defined as a blood loss of greater than 500 mL or any amount that, if not replaced, could cause shock or death in the mother. The most common cause of postpartum hemorrhage is uterine atony. This occurs when the normal myometrium fails to contract after delivery of the placenta. The initial treatment involves the administration of intravenous oxytocin and uterine massage. If the initial maneuvers fail to stop the postpartum hemorrhage, other techniques, such as uterine packing, suture techniques, uterine or hypogastric artery ligation, can be considered. In the last 30 years, a new angiographic approach for treatment of postpartum hemorrhage has emerged. Pelvic arterial embolization, after emerging as a treatment option to control and prevent pregnancy-related hemorrhage, has been established to be safe and effective. The goal of treatment for all causes of postpartum hemorrhage is cessation of bleeding in a timely fashion, before the onset of consumptive coagulopathy and end organ damage.
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Affiliation(s)
- Antonio Pinto
- Department of Diagnostic Imaging, Section of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy.
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Bros S, Chabrot P, Kastler A, Ouchchane L, Cassagnes L, Gallot D, Boyer L. Recurrent bleeding within 24 hours after uterine artery embolization for severe postpartum hemorrhage: are there predictive factors? Cardiovasc Intervent Radiol 2011; 35:508-14. [PMID: 21614439 DOI: 10.1007/s00270-011-0181-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/18/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE To retrospectively identify predictive factors of recurrent bleeding within 24 h after uterine artery embolization (UAE) for postpartum hemorrhage (PPH). MATERIALS AND METHODS A total of 194 patients underwent UAE for PPH between August 1999 and April 2009 at our institution. Twelve patients experienced recurrent bleeding within the next 24 h; a second attempt at UAE was thus necessary, which was successful in 10 cases. In two cases, hemostatic hysterectomy was performed. Epidemiological, gynecological-obstetrical, anatomic, and biological data were analyzed. RESULTS Complete data were available for 148 of the 194 (76%) included patients. Sixty-four (43%) were primiparous, 18 (12.2%) had a placenta accreta, 21 (14%) had a coagulopathy, and 28 (18.9%) had an anatomic variant of the uterine arterial vasculature. Mean age and pregnancy term were similar in both recurring and nonrecurrent bleeding groups. After multivariate analysis, three criteria emerged as risk factors of recurrent bleeding: primiparity (10 patients, 83%; odds ratio [OR]=18.84; P=0.014), coagulation disorders (6 patients, 50%; OR=12.08; P=0.006), and anatomic variant of the uterine arterial vasculature (28 patients; OR=9.83; P=0.003). CONCLUSION Search for uterine collaterals must be performed before UAE for PPH. Primiparity and coagulation disorders increase the risk of recurrent bleeding after UAE for PPH.
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Affiliation(s)
- Sébastien Bros
- Department of Radiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France.
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Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan. BMC Pregnancy Childbirth 2011; 11:28. [PMID: 21489279 PMCID: PMC3087691 DOI: 10.1186/1471-2393-11-28] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 04/13/2011] [Indexed: 11/10/2022] Open
Abstract
Background Massive postpartum hemorrhage is a life threatening obstetric emergency. In order to prevent the complications associated with this condition, an organized and step-wise management protocol should be immediately initiated. Methods An evidence based management protocol for massive postpartum hemorrhage was implemented at Aga Khan University Hospital, Karachi, Pakistan after an audit in 2005. We sought to evaluate the compliance and outcomes associated with this management protocol 3 years after its implementation. A review of all deliveries with massive primary postpartum hemorrhage (blood loss ≥ 1500 ml) between January, 2008 to December, 2008 was carried out. Information regarding mortality, mode of delivery, possible cause of postpartum hemorrhage and medical or surgical intervention was collected. The estimation of blood loss was made via subjective and objective assessment. Results During 2008, massive postpartum hemorrhage occurred in 0.64% cases (26/4,052). No deaths were reported. The mean blood loss was 2431 ± 1817 ml (range: 1500 - 9000 ml). Emergency cesarean section was the most common mode of delivery (13/26; 50%) while uterine atony was the most common cause of massive postpartum hemorrhage (14/26; 54%). B-lynch suture (24%) and balloon tamponade (60%) were used more commonly as compared to our previously reported experience. Cesarean hysterectomy was performed in 3 cases (12%) for control of massive postpartum hemorrhage. More than 80% compliance was observed in 8 out of 10 steps of the management protocol. Initiation of blood transfusion at 1500 ml blood loss (89%) and overall documentation of management (92%) were favorably observed in most cases. Conclusion This report details our experience with the practical implementation of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in a developing country. With the exception of arterial embolization, relatively newer, simpler and potentially safer techniques are now being employed for the management of massive postpartum hemorrhage at our institution. Particular attention should be paid to the documentation of the management steps while ensuring a stricter adherence to the formulated protocols and guidelines in order to further ameliorate patient outcomes in emergency obstetrical practice. More audits like the one we performed are important to recognize and rectify any deficiencies in obstetrical practice in developing countries. Dissemination of the same is pivotal to enable an open discourse on the improvement of existing obstetrical strategies.
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Paterson-Brown S, Singh C. Developing a care bundle for the management of suspected placenta accreta. ACTA ACUST UNITED AC 2011. [DOI: 10.1576/toag.12.1.021.27554] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
OBJECTIVE We sought to review the risks of placenta accreta, increta, and percreta, and provide guidance regarding interventions to improve maternal outcomes when abnormal placental implantation occurs. METHODS Relevant documents were identified through a search of the English-language literature for publications including ≥1 of the key words "accreta" or "increta" or "percreta" using PubMed (US National Library of Medicine; January 1990 through January 2010); with results limited to studies involving human beings. Additional information was obtained from references identified within selected articles; from additional review articles; and from guidelines by organizations including the American College of Obstetricians and Gynecologists. Each included article was evaluated according to study design and quality in accordance with the scheme outlined by the US Preventative Services Task Force. RESULTS AND RECOMMENDATIONS Abnormal placentation--encompassing placenta accreta, increta, and percreta--is increasingly common. While randomized controlled trials and large observational cohort studies that can be used to define best practice are lacking, strategies to enhance early diagnosis, enhance preparation, and coordinate peripartum management can be undertaken. Women with a placenta previa overlying a uterine scar should be evaluated for the potential diagnosis of placenta accreta. Women with a placenta previa or "low-lying placenta" overlying a uterine scar early in pregnancy should be reevaluated in the third trimester with attention to the potential presence of placenta accreta. When the diagnosis of placenta accreta is made remote from delivery, the need for hysterectomy should be anticipated and arrangements made for delivery in a center with adequate resources, including those for massive transfusion. Intraoperatively, attention should be paid to abdominal and vaginal blood loss. Early blood product replacement, with consideration of volume, oxygen-carrying capacity, and coagulation factors, can reduce perioperative complications.
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Aberrant ovarian and uterine feeding from the renal artery at the end of gestation: two cases. J Vasc Interv Radiol 2010; 21:1911-2. [PMID: 20980163 DOI: 10.1016/j.jvir.2010.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 07/20/2010] [Accepted: 08/22/2010] [Indexed: 11/22/2022] Open
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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: 72] [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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Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG 2010; 117:84-93. [PMID: 19832826 DOI: 10.1111/j.1471-0528.2009.02381.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To determine and compare the fertility and pregnancy outcomes following embolisation with or without uterine-sparing surgery for postpartum haemorrhage, and to attempt to identify specific risk factors associated with an increased likelihood of intrauterine synechia. DESIGN Retrospective study. SETTING University-affiliated tertiary referral centre. POPULATION All consecutive women who had an embolisation with or without uterine-sparing surgery (vessel ligation and/or uterine compression) for postpartum haemorrhage between 1994 and 2007 were included. METHODS Data were retrieved from medical files and telephone interviews. MAIN OUTCOME MEASURE(S) Fertility and pregnancy outcomes, synechia. RESULTS Data were available for 68 of the 85 women (80%) included in the study. Among the 15 women who complained of amenorrhoea or decreased flow of menstruation, synechia was found in all those who decided to undergo an ambulatory hysteroscopy (n = 8). Seventeen women had 26 pregnancies with 19 term deliveries, one ectopic pregnancy, two abortions and four miscarriages. The clinical courses of the 19 complete gestations were uneventful, but postpartum haemorrhage recurred in six women (31.6%) (caused by placenta accreta in two women). Fertility and pregnancy outcomes did not differ between women who had undergone embolisation versus both embolisation and a uterine-sparing surgical procedure. The occurrence of synechia was significantly associated with a higher rate of placenta accreta/percreta (P < 0.001) and postpartum fever above 38.5 degrees C (P = 0.04). CONCLUSIONS Embolisation, whether or not associated with a uterine-sparing surgical procedure, for postpartum haemorrhage does not appear to compromise a woman's subsequent fertility and obstetric outcome. Nevertheless, these women should be considered at high risk for postpartum haemorrhage during future deliveries.
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Affiliation(s)
- Loïc Sentilhes
- Department of Obstetrics and Gynaecology, Rouen University Hospital, Charles Nicolle, Rouen, France.
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Arterial balloon occlusion of the internal iliac arteries for treatment of life-threatening massive postpartum haemorrhage: a series of 15 consecutive cases. Eur J Obstet Gynecol Reprod Biol 2010; 148:131-4. [DOI: 10.1016/j.ejogrb.2009.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 09/01/2009] [Accepted: 10/09/2009] [Indexed: 11/17/2022]
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Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Song L. Ovarian artery embolization supplementing hypogastric-uterine artery embolization for control of severe postpartum hemorrhage: report of eight cases. J Vasc Interv Radiol 2009; 20:971-6. [PMID: 19555891 DOI: 10.1016/j.jvir.2009.04.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 04/07/2009] [Accepted: 04/14/2009] [Indexed: 11/28/2022] Open
Abstract
Although transcatheter uterine artery embolization has been proved to be a life-saving technique in serious obstetrical hemorrhage, it does not always control bleeding. The causes of treatment failure may be multifactorial and vary in individual cases, but incomplete embolization of the blood supply from other sources may play an important role. Herein, the authors describe eight patients with massive postpartum hemorrhage that was not controlled with conventional hypogastric-uterine artery embolization. Their continued hemorrhage was due to an additional blood supply arising from ovarian arteries, which was confirmed with selective ovarian artery angiography and subsequently successfully embolized.
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Affiliation(s)
- Mao Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China.
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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: 5.0] [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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Gallot D, Chabrot P, Vendittelli F, Cassagnes L, Diop A, Bertrand A, Gaia G, Canis M, Bolandard F, Storme B, Lemery D, Boyer L. [Response of D. Gallot et al to the article of J.-P. Pelage and O. Limot. Role of arterial embolization in the care of serious hemorrhages immediately postpartum. Gynecol Obstet Fertil 2008;36:714-20]. ACTA ACUST UNITED AC 2009; 37:459-60. [PMID: 19403321 DOI: 10.1016/j.gyobfe.2009.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Delotte J, Novellas S, Koh C, Bongain A, Chevallier P. Obstetrical prognosis and pregnancy outcome following pelvic arterial embolisation for post-partum hemorrhage. Eur J Obstet Gynecol Reprod Biol 2009; 145:129-32. [PMID: 19398259 DOI: 10.1016/j.ejogrb.2009.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 02/16/2009] [Accepted: 03/24/2009] [Indexed: 12/23/2022]
Abstract
Post-partum hemorrhage is an obstetrical emergency. Pelvic artery embolisation offers an alternative to surgical intervention and increases the rate of conservative treatment. The objective of this review was to study the scientific literature on obstetrical outcomes following uterine-sparing arterial embolisation performed for post-partum hemorrhage in a prior pregnancy. A Medline and Sciencedirect search were performed in order to review all the French and English reports about pregnancy following pelvic arteries embolisation for post-partum hemorrhage. Nineteen articles were identified and 13 were selected for inclusion. We have included the fertility follow-up of a total of 168 women who underwent pelvic arteries embolisation for post-partum hemorrhage. We highlight the clinical success of embolisation in 154 of the 168 patients (92%). Following the embolisation procedures, 7 hysterectomies were required and 4 patients died. Two of the 4 deaths occurred in women who were transferred from an outlying institution to a tertiary referral center. In this population, 45 pregnancies were described. Among these pregnancies, 32 resulted in live births (71%), 8 were miscarriages (18%) and 5 patients carried out voluntary termination of pregnancy (11%). The cesarean section rate was 62%. Post-partum hemorrhage occurred in 6 cases leading to 2 hysterectomies. In conclusion, pelvic arterial embolisation offers a safe and conservative alternative to surgical interventions for post-partum hemorrhage in well-selected patients desiring to preserve future fertility.
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Fiori O, Deux JF, Kambale JC, Uzan S, Bougdhene F, Berkane N. Impact of pelvic arterial embolization for intractable postpartum hemorrhage on fertility. Am J Obstet Gynecol 2009; 200:384.e1-4. [PMID: 19217597 DOI: 10.1016/j.ajog.2008.11.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 08/09/2008] [Accepted: 11/14/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study was to determine the long-term outcomes of arterial pelvic embolization for intractable postpartum hemorrhage and particularly its effect on menses, fertility, and outcomes of subsequent pregnancies. STUDY DESIGN Fifty-six consecutive patients who underwent emergency pelvic arterial embolization for severe postpartum hemorrhage between April 1995 and July 2005 were included in the study. Patients were contacted to obtain information about menses and fertility after pelvic arterial embolization. RESULTS Thirty-four women (61.8%) were successfully contacted. One patient had a hysterectomy. Thirty women (91%) reported regular menses. Thirteen women (38.3%) had a total of 20 spontaneous pregnancies. Eight pregnancies ended during the first trimester. The 12 other pregnancies (60%) were all normal and all patients delivered vaginally healthy babies with normal weight for gestational age. CONCLUSION The current study suggests that fertility is not adversely affected by arterial pelvic embolization for intractable postpartum hemorrhage and that women can conceive after the procedure with normal pregnancy outcomes.
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Unusual complication of excision of pelvic endometriosis: pseudoaneurysm of the left uterine artery. Fertil Steril 2009; 93:264-6. [PMID: 19285669 DOI: 10.1016/j.fertnstert.2009.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 12/25/2008] [Accepted: 02/02/2009] [Indexed: 11/24/2022]
Abstract
We report on a patient who had a pseudoaneurysm arising from the left uterine artery after surgical excision of deep endometriosis. The diagnosis was based on contrast-enhanced multidetector computed tomography angiography. Transfemoral selective catheterization and embolization of the left uterine artery determined a quick improvement of the symptoms.
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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: 0.7] [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: 4.5] [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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