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Fernandez MG, Coutinho de Carvalho SF, Martins BA, Santos FDSM, Neto FAFP, Medeiros MODA, Bastos Metzger P. Uterine Artery Embolization Versus Hysterectomy in Postpartum Hemorrhage: A Systematic Review With Meta-Analysis. J Endovasc Ther 2024:15266028241252730. [PMID: 38733296 DOI: 10.1177/15266028241252730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
PURPOSE The objective of this study is to perform a meta-analysis comparing the effectiveness of uterine artery embolization (UAE) versus peripartum hysterectomy for acute refractory postpartum hemorrhage (PPH) control. MATERIALS AND METHODS We systematically searched 6 medical databases for studies comparing UAE and hysterectomy in PPH. Outcomes examined were mortality, hospitalization duration (HD) in days, and red blood cells (RBC) units utilization. Statistical analysis used RevMan 5.1.7 and random-effects models. Odds ratios (OR) and mean differences (MDs) with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. RESULTS We included 833 patients from 4 cohort studies, with 583 (70%) undergoing UAE. The UAE population required fewer RBC units (MD: -7.39; 95% CI: -14.73 to -0.04; p=0.05) and had shorter HD (MD: -3.22; 95% CI: -5.42 to -1.02; p=0.004). Lower mortality rates were noted for UAE in the pooled analysis, but no statistical significance. Uterine artery embolization demonstrated lower procedural complications (16.45% vs. 28.8%), in which UAE had less ureter and bladder lesions (OR: 0.05; 95% CI: 0.01-0.38; p=0.004 and OR: 0.02; 95% CI: 0.00-0.15; p<0.001, respectively). Only 35 (6%) required conversion to hysterectomy, while 27 (4.6%) underwent re-embolization with 100% bleeding control. Uterine artery embolization did not hinder fertility, with normal menstruation restored in 19 patients with postoligomenorrhea. CONCLUSION Uterine artery embolization for the control of PPH is associated with lower use of RBC units and HD, but similar rates of mortality are noted when compared to hysterectomy. These results associated with uterine preservation could support its importance for refractory PPH management. CLINICAL IMPACT Uterine Artery Embolization is associated with a shorter hospitalization duration and reduced use of red blood cell units when compared with hysterectomy in refractory postpartum hemorrhage. Although demonstrating similar mortality rates, these findings, together with fertility preservation, support the method incorporation as a valuable option in obstetric services.
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Kakinuma T, Kakinuma K, Matsuda Y, Yanagida K, Ohwada M, Kaijima H. Efficacy of transvaginal ultrasound-guided local injections of absolute ethanol for ectopic pregnancies with intrauterine implantation sites. World J Clin Cases 2023; 11:788-796. [PMID: 36818618 PMCID: PMC9928688 DOI: 10.12998/wjcc.v11.i4.788] [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: 11/18/2022] [Revised: 12/27/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cervical pregnancies, interstitial tubal pregnancies, and cesarean scar pregnancies, which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries. The development of high-sensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment. Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported. However, delayed resumption of infertility treatments after methotrexate therapy is indicated, and negative effects on the next pregnancy after uterine artery embolization have been reported.
AIM To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site.
METHODS In this study, we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital, between April 2010 and December 2018, and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes. We evaluated the treatment methods, treatment outcomes, presence of bleeding requiring hemostasis measures and blood transfusion, complications, and treatment periods. Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone.
RESULTS There were 21 total cases comprising 10 cervical pregnancies, 10 interstitial tubal pregnancies, and 1 cesarean scar pregnancy. All patients completed treatment with this method. No massive hemorrhaging or serious adverse reactions were observed during treatment. The mean gestation ages at the time of diagnosis were 5.9 wk (SD, ± 0.9 wk) for cervical and 6.9 wk (SD, ± 2.1 wk) for interstitial tubal pregnancies. The total ethanol doses were 4.8 mL (SD, ± 2.2 mL) for cervical pregnancies and 3.3 mL (SD, ± 2.2 mL) for interstitial pregnancies. The treatment period was 28.5 days (SD, ± 11.7 d) for cervical pregnancies and 30.0 ± 8.1 d for interstitial pregnancies. Positive correlations were observed between the blood β- human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose (r = 0.75; P = 0.00008), as well as between the total ethanol dose and treatment period (r = 0.48; P = 0.026).
CONCLUSION Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.
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Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Yoshio Matsuda
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
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Effectiveness of transarterial embolisation for intractable postpartum haemorrhage in a disseminated intravascular coagulation state, despite emergency hysterectomy. Clin Radiol 2023; 78:55-60. [PMID: 36307234 DOI: 10.1016/j.crad.2022.08.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE We evaluated the effectiveness of transarterial embolization (TAE) for intractable postpartum hemorrhage in patients with disseminated intravascular coagulation (DIC) despite emergency hysterectomy. MATERIALS AND METHODS We retrospectively assessed TAE performed after emergency hysterectomy in 15 patients between July 2008 and January 2022. Underlying condition, technical success, clinical success, angiographic findings, laboratory findings, pregnancy-modified DIC score (The International Society on Thrombosis and Haemostasis), blood transfusion, ICU (Intensive care unit) admission day, hospital day, in-hospital mortality, and long-term sequelae were evaluated. RESULTS All patients were diagnosed with DIC before embolization, with a 43.9 mean DIC score. All patients showed positive angiographic findings for active bleeding. Thirty-eight bleeding arteries were confirmed. The remnant uterine artery (n=25) was the most common focus of persistent bleeding, followed by the cervicovaginal artery (n=6), pudendal artery (n=3), obturator artery (n=2), vesical artery (n=1), and unspecified artery from the internal iliac artery (n=1). Technical and clinical success rates were 100% (15/15) and 93.3% (14/15), respectively. Mean nadir hemoglobin (Hb) level before embolization was 4.9 g/dL. All patients underwent massive transfusion before embolization (mean 33.2 packs of RBC). Postoperatively, a smaller amount of blood was transfused than before the procedure (mean 10.6 packs of RBC). Mean nadir Hb level after embolization was 8.2 g/dL. There was one instance each of in-hospital death, hypoxic brain damage, and ischemic acute kidney injury. CONCLUSION Despite hysterectomy for postpartum bleeding, there could be multiple residual or uncontrolled bleeding foci, especially in case of DIC, for which TAE could be an effective treatment.
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Kakinuma T, Kakinuma K, Matsuda Y, Ohwada M, Yanagida K, Kaijima H. Ultrasound-guided local ethanol injection for fertility-preserving cervical pregnancy accompanied by fetal heartbeat: Two case reports. World J Clin Cases 2022; 10:3587-3592. [PMID: 35582054 PMCID: PMC9048546 DOI: 10.12998/wjcc.v10.i11.3587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/07/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of cervical pregnancy is increasing due to the recent widespread application of assisted reproductive technology. Although hysterectomy has been a treatment option, high-sensitivity human chorionic gonadotropin testing and improved accuracy of transvaginal ultrasound imaging have increased possibility of uterine preservation. Dilation and curettage with methotrexate therapy and uterine artery embolization have been reported as treatments with fertility preservation; however, certain disadvantages limit their use.
CASE SUMMARY In our two reported cases, we avoided massive bleeding and immediately resumed infertility treatment using ultrasound-guided local ethanol injection for cervical pregnancies with fetal heartbeats.
CONCLUSION This treatment may be a new fertility-preserving option for cervical pregnancy.
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Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Yoshio Matsuda
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
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Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, Lloyd I, Chandraharan E, Miller S, Burke T, Ossanan G, Andres Carvajal J, Ramos I, Hincapie MA, Loaiza S, Nasner D. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet 2022; 157 Suppl 1:3-50. [PMID: 35297039 PMCID: PMC9313855 DOI: 10.1002/ijgo.14116] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Maria Fernanda Escobar
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Tygerberg Hospital, Cape Town, South Africa
| | - Eythan R Barnea
- Society for Investigation or Early Pregnancy (SIEP), New York, New York, USA
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Diana Ramasauskaite
- Center of Obstetrics and Gynecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Isabel Lloyd
- Department of Obstetrics and Gynecology, Universidad de Panamá, Panama City, Panamá.,Hospital Santo Tomas, Panama City, Panamá
| | - Edwin Chandraharan
- Department of Obstetrics and Gynecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Thomas Burke
- Division of Global Health and Human Rights, Massachusetts General Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, USA
| | - Gabriel Ossanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Javier Andres Carvajal
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Isabella Ramos
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Maria Antonia Hincapie
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Sara Loaiza
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Daniela Nasner
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
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- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia
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Utilization and Comparative Effectiveness of Uterine Artery Embolization vs. Hysterectomy for Severe Postpartum Hemorrhage: A National Inpatient Sample Study. J Vasc Interv Radiol 2021; 33:427-435.e4. [PMID: 34915166 DOI: 10.1016/j.jvir.2021.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess if uterine artery embolization conferred a lower risk of mortality or prolonged hospital stay compared to hysterectomy in severe post-partum hemorrhage (PPH) and to analyze if geographical or clinical determinants affected which therapy was received. MATERIALS AND METHODS This National Inpatient Sample study from 2005-2017 included all patients with live-birth deliveries. Severe PPH was defined as those requiring transfusion, hysterectomy, or uterine artery embolization (UAE). Propensity score weighting adjusted demographic, maternal, and delivery risk factors were used to assess mortality and prolonged hospital stay. RESULTS Of 9.8 million identified live births, PPH occurred in 31.0 per 1,000. The most common intervention for PPH was transfusion (116.4 per 1,000 cases of PPH). Hysterectomy was used more frequently than UAE (20.4 vs 12.9 per 1,000). The following factors predicted hysterectomy would be used more commonly than UAE: previous cesarean delivery, breech fetal position, placenta previa, transient hypertension of pregnancy without pre-eclampsia, pre-existing hypertension without pre-eclampsia, pre-existing hypertension with pre-eclampsia, unspecified maternal hypertension, and gestational diabetes (all p<0.001). Delivery risk factors associated with greater utilization of hysterectomy over UAE included post-dates pregnancy, premature rupture of membranes, cervical laceration, forceps vaginal delivery, and shock (all p<0.001). There was no difference in mortality between hysterectomy and UAE. After balancing demographic, maternal, and delivery risk factors, the odds of prolonged hospital stay were 0.38 times lower with UAE than hysterectomy (p<0.001). CONCLUSION Despite similar mortality and shorter hospital stays, UAE is used far less than hysterectomy in the management of severe PPH.
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The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience. J Clin Med 2021; 10:jcm10184082. [PMID: 34575193 PMCID: PMC8468128 DOI: 10.3390/jcm10184082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Indications for the use of transarterial embolization (TAE) for postpartum hemorrhage (PPH) have been established. However, the efficacy of TAE for PPH complicated by disseminated intravascular coagulation (DIC) remains controversial. In this study, we investigated the efficacy of TAE for PPH complicated by DIC. A database review was conducted to identify patients who were treated with TAE for PPH at our hospital. TAE was performed in 41 patients during the study period. Effective hemostasis was achieved in all cases, but additional procedures, such as re-embolization or hysterectomy, were required in five patients (12.2%). The typical causes of PPH included uterine atony (18 cases), placenta previa (15 cases), amniotic fluid embolism (DIC-type) (11 cases), and placenta accreta spectrum (10 cases). The mean blood loss was 3836 mL. The mean obstetrical DIC and the International Society on Thrombosis and Hemostasis DIC scores were 7.9 and 2.6, respectively. The efficacy of hemostasis was comparable between patients with and without DIC. However, the complete success rate of TAE was lower in patients with DIC as the condition worsened than that in non-DIC patients. Overall, TAE is effective as a minimally invasive treatment for PPH complicated by DIC.
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The Emergent Pelvic Artery Embolization in the Management of Postpartum Hemorrhage: A Systematic Review and Meta-analysis. Obstet Gynecol Surv 2021; 76:234-244. [PMID: 33908615 PMCID: PMC8081441 DOI: 10.1097/ogx.0000000000000887] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Postpartum hemorrhage (PPH) is an emergent obstetric complication and the leading cause of maternal mortality. Pelvic arterial embolization (PAE) is an effective treatment for intractable PPH. However, a unique protocol has not been accepted in obstetrical practice. Objective To evaluate its efficiency, safety, complications, and outcomes, we conducted a systematic review and meta-analysis of PAE for PPH in the literature. Evidence Acquisition The Medline, the database of abstract of reviews, the index to allied health literature, and the Chinese database Sino-Med were searched on March 31, 2020, for studies on PAE for PPH. The data for PAE indication, agents, arteries, success rate, complications, and outcomes were extracted and syncretized for meta-analysis. Results From 1075 identified articles, 113 abstracts or full articles were retrieved and 43 studies were finally identified as meeting the including criteria. The results demonstrated that the indications for PAE were as follows: uterine atony, placental abnormality, delivery tract injury, disseminated intravascular coagulation, arteriovenous malformation, and vaginal hematoma. The embolization agents mostly in order were gelatin sponge particles, polyvinyl alcohol particles, Gelfoam, N-butyl cyanoacrylate, microcoil, and glue; for arteries, they were mostly uterine artery and internal iliac artery. The clinical success rate was 90.5%, whereas the technical success rate was 99.3%. The most common complications of PAE were postembolization syndrome and menstrual abnormality. Conclusions and Relevance The emergent PAE is a safe and effective method with high success rate in life-threatening PPH management. Gelatin sponge granules measuring 500 to 1000 μm in diameter have safe results. Pelvic arterial embolization may affect the recovery of menses and increase PPH in the subsequent pregnancy, but there was no noted correlation with fetal growth restriction.
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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: 15] [Impact Index Per Article: 3.8] [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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Ono Y, Kariya S, Nakatani M, Ueno Y, Yoshida A, Maruyama T, Komemushi A, Tanigawa N. Clinical results of transarterial embolization for post-partum hemorrhage in 62 patients. J Obstet Gynaecol Res 2020; 47:226-232. [PMID: 33108016 DOI: 10.1111/jog.14476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/30/2020] [Accepted: 08/30/2020] [Indexed: 12/01/2022]
Abstract
AIM The pathology of post-partum hemorrhage (PPH) differs depending on its cause, background and timing of bleeding, and the effectiveness of transarterial embolization (TAE) is thought to vary based on these characteristics. The aim of this study is to evaluate the treatment outcomes of TAE for PPH. METHODS Technical success, initial clinical success (hemostasis without repeat TAE or surgical treatment after initial TAE) and final clinical success (hemostasis with or without repeat TAE, but without surgical treatment) were assessed in 62 Japanese patients. Factors affecting final clinical success were analyzed using univariate analysis. Values of P < 0.05 were considered statistically significant. Further, the clinical course and factors associated with rebleeding, return of menstruation and fertility, and complications of TAE were assessed. RESULTS Final clinical success rate was significantly lower in cases with obstetrical disseminated intravascular coagulation (DIC) or the International Society on Thrombosis and Hemostasis (ISTH) DIC (P = 0.01, 0.03). Rebleeding (n = 9, 14.5%) was more common in patients with retained products of conception (RPOC) (P = 0.006). On long-term follow-up in 23 patients, return of menstruation was confirmed in 17 (73.9%) of these patients. Subsequent pregnancy was confirmed in seven patients (30.4%). TAE-related complications were seen in 6 patients (9.0%). There were no maternal deaths. CONCLUSIONS Obstetrical and ISTH DIC reduced the success rate of TAE for PPH (P = 0.01, 0.03). Rebleeding, which is observed significantly more frequently in PPH caused by RPOC (P = 0.006), can be effectively treated by repeat TAE.
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Affiliation(s)
- Yasuyuki Ono
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, Japan
| | - Shuji Kariya
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, Japan
| | - Miyuki Nakatani
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, Japan
| | - Yutaka Ueno
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, Japan
| | - Asami Yoshida
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, Japan
| | - Takuji Maruyama
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, Japan
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, Japan
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Methotrexate infusion followed by uterine artery embolisation for the management of placental adhesive disorders: a case series. Clin Radiol 2019; 74:378-383. [DOI: 10.1016/j.crad.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
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Lee HJ, Cho HY, Peck MJ, Ki HJ, Moon MJ, Kim HC, Jang SW, Kim YR. Uterine artery embolization versus cesarean hysterectomy in the management of postpartum hemorrhage. MINIM INVASIV THER 2019; 28:351-358. [DOI: 10.1080/13645706.2018.1562943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hyun Jung Lee
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Hee Young Cho
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Min Joo Peck
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Hyo Jin Ki
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Myoung Jin Moon
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Hyeon Chul Kim
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Sung Woon Jang
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Young Ran Kim
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
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Ko HK, Shin JH, Ko GY, Gwon DI, Kim JH, Han K, Lee SW. Efficacy of Prophylactic Uterine Artery Embolization before Obstetrical Procedures with High Risk for Massive Bleeding. Korean J Radiol 2017; 18:355-360. [PMID: 28246515 PMCID: PMC5313523 DOI: 10.3348/kjr.2017.18.2.355] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/20/2016] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. Materials and Methods A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D&C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D&C for retained placenta with vascularity (n = 5), and D&C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. Results All women received successful bilateral prophylactic UAE followed by D&C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. Conclusion Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.
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Affiliation(s)
- Heung Kyu Ko
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Gi Young Ko
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Dong Il Gwon
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Jin Hyung Kim
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Kichang Han
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
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Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate. Cardiovasc Intervent Radiol 2016; 40:236-244. [DOI: 10.1007/s00270-016-1496-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
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15
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Farasatinasab M, Moghaddas A, Dashti-Khadivaki S, Raoofi Z, Nasiripour S. Management of Abnormal Placenta Implantation with Methotrexate: A Review of Published Data. Gynecol Obstet Invest 2016; 81:481-496. [PMID: 27384687 DOI: 10.1159/000447556] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/13/2016] [Indexed: 04/13/2024]
Abstract
Abnormally invasive placenta is characterized by direct attachment of chorionic villi to the uterine wall. This adherent placenta traditionally has been managed by peripartum hysterectomy. Nowadays, there is a lot of interest toward gradual shift from traditional management of invasive placentation to conservative ones leaving the placenta in situ to avoid the surgical morbidity of hysterectomy and loss of future fertility. Administration of methotrexate (MTX), as an adjunctive antimetabolite drug, resulted in conflicting data during conservative management of abnormal placentation. This review assessed all published data on efficacy and safety of MTX therapy as conservative management of invasive placentation. Fifty-three articles including one prospective cohort study, 2 retrospective cohort studies, 10 case series and 40 case reports were identified. Conservative management has beneficial effects on the avoidance of major surgery with the consequent morbidity and the preservation of future fertility. Infection and vaginal bleeding were main complications of MTX therapy. Although MTX therapy may result in accelerated involution or expulsion of placenta and has some beneficial effects on hemorrhagic events, but there is not enough evidence on its efficacy and safety to recommend its routine uses in all cases of invasive placenta.
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Affiliation(s)
- Maryam Farasatinasab
- Department of Clinical Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Nakamura Y, Aoki S, Takebayashi S, Hirahara F. Effect of transarterial embolization for post-partum hemorrhage on subsequent pregnancy. J Obstet Gynaecol Res 2016; 42:1186-9. [PMID: 27225817 DOI: 10.1111/jog.13029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/18/2016] [Indexed: 02/03/2023]
Abstract
Although pregnancy after transarterial embolization (TAE) has occasionally been reported, gelatin sponge was used as the embolic agent in most of these cases. Reports on the effect of TAE with permanent embolic agents such as N-butyl cyanoacrylate or coil on subsequent pregnancies are rare. We describe placenta accreta associated with difficult hemostasis in two patients who became pregnant after TAE with permanent embolic agents. In pregnancy after TAE with permanent embolic agents, placenta accreta occurs frequently and well-developed collateral vessels are highly likely, resulting in difficult hemostasis. Although the acceptability of pregnancy after TAE with permanent embolic agents is controversial, patients should be informed that pregnancy is extremely high risk.
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Affiliation(s)
- Yuko Nakamura
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan.
| | - Shigeo Takebayashi
- Department of Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Japan
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17
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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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19
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 527] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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20
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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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21
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Song Y, Shin JH, Yoon HK, Kim JW, Ko GY, Won HS. Bleeding after dilatation and curettage: the efficacy of transcatheter uterine artery embolisation. Clin Radiol 2015; 70:1388-92. [PMID: 26382745 DOI: 10.1016/j.crad.2015.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 04/19/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
AIM To evaluate safety and clinical outcomes of uterine artery embolisation (UAE) for bleeding after dilatation and curettage (D&C) performed for abortion or termination. MATERIALS AND METHODS The outcomes were analysed in 11 patients who underwent UAE for bleeding after D&C for missed abortions (n=8), caesarean scar pregnancies (n=2), or planned termination (n=1) between October 2001 and December 2013. Angiograms and medical records were retrospectively reviewed in order to obtain the patients' baseline characteristics, technical/clinical success rate, complications, and follow-up data regarding menstruation. RESULTS Technical success, defined as successful catheterisation of both uterine arteries with embolisation to haemostasis, was 100%, whereas clinical success, defined as cessation of bleeding after the initial session of UAE and without the need for additional UAE or surgery for the purpose of haemostasis, was 81.8% (nine of 11). In the two patients with clinical failure due to recurrent vaginal bleeding after UAE, one patient underwent repeat UAE and showed a successful outcome, whilst the other patient required hysterectomy with pathological results of placenta increta. Two other patients underwent hysterectomy for placenta percreta or hydatidiform mole-mimicking remnant placenta. None of the patients included in the present series had procedure-related complications. Menstruation resumed in all eight patients with an intact uterus during the mean follow-up period. CONCLUSION UAE may be a safe and effective treatment for bleeding after D&C, especially for women who wish to preserve their fertility; however, hysterectomy may be indicated for patients with a placental abnormality.
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Affiliation(s)
- Y Song
- 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, South Korea
| | - J H 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, South Korea.
| | - H-K 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, South Korea
| | - J W Kim
- 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, South Korea
| | - G-Y 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, South Korea
| | - H-S Won
- 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, South Korea
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22
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The use of a Rusch intrauterine balloon to cause tamponade on a severe hemorrhage in a case of endometrial cancer. Int J Gynecol Cancer 2015; 24:946-9. [PMID: 24844224 DOI: 10.1097/igc.0000000000000133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Intractable vaginal bleeding is a complication of gynecological tumors of the cervix and endometrium. The management of torrential bleeding usually requires laparotomy or laparoscopy, or less invasive techniques such as uterine artery embolization. This case report describes the use of an intrauterine Rusch balloon catheter, previously only used in the obstetric setting. This is a safe and inexpensive method of management, which does not need specific training. We also review all the current options for the management of severe bleeding as a complication of gynecological cancers.
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23
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Sakaguchi I, Ohba T, Ikeda O, Yamashita Y, Katabuchi H. Embolization for post-partum rupture of ovarian artery aneurysm: Case report and review. J Obstet Gynaecol Res 2014; 41:623-7. [DOI: 10.1111/jog.12561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/05/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Isao Sakaguchi
- Department of Obstetrics and Gynecology; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
| | - Takashi Ohba
- Department of Obstetrics and Gynecology; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
| | - Osamu Ikeda
- Department of Diagnostic Radiology; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
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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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Khan M, Sachdeva P, Arora R, Bhasin S. Conservative management of morbidly adherant placenta – A case report and review of literature. Placenta 2013; 34:963-6. [DOI: 10.1016/j.placenta.2013.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/11/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
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26
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Uterine damage in swine following uterine artery embolization: comparison among gelatin sponge particles and two concentrations of N-butyl cyanoacrylate. Jpn J Radiol 2013; 31:685-92. [DOI: 10.1007/s11604-013-0236-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
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Takeda J, Makino S, Ota A, Tawada T, Mitsuhashi N, Takeda S. Spontaneous uterine rupture at 32 weeks of gestation after previous uterine artery embolization. J Obstet Gynaecol Res 2013; 40:243-6. [PMID: 23945024 DOI: 10.1111/jog.12122] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Abstract
Uterine artery embolization (UAE) is a common treatment for post-partum hemorrhage and uterine fibroids. However, the effects of UAE on subsequent pregnancies have not been established. Here, we present a case of spontaneous uterine rupture after previous UAE. A 31-year-old woman underwent UAE for a cervical ectopic pregnancy. Contrast-enhanced magnetic resonance imaging (MRI) at days 5 and 25 post-UAE suggested a regionally decreased blood supply in the mid-posterior wall of the uterine fundus. During a subsequent pregnancy at age 35 years, she underwent an emergency cesarean delivery due to spontaneous uterine rupture at the mid-posterior wall of the uterus at 32 weeks of gestation. Obstetricians should be attentive to the possibility of spontaneous uterine rupture in pregnant women who have previously undergone UAE. Detection of ischemic uterine muscle on MRI may predict potential for uterine rupture in a subsequent pregnancy.
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Affiliation(s)
- Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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28
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Usefulness of pelvic artery embolization in cesarean section compared with vaginal delivery in 176 patients. J Vasc Interv Radiol 2013; 24:103-9. [PMID: 23273701 DOI: 10.1016/j.jvir.2012.09.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/17/2012] [Accepted: 09/26/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of transcatheter arterial embolization of the pelvic arteries for the treatment of postpartum hemorrhage (PPH) associated with cesarean section compared with vaginal delivery. MATERIALS AND METHODS A retrospective analysis of 176 patients undergoing transcatheter arterial embolization of the pelvic arteries for PPH from January 2006 through August 2011 was conducted at two institutions. The mean patient age was 33.9 years (range, 24-46 years). Data including delivery details, hematology and coagulation results, embolization details, and clinical outcomes were collected. Technical success was defined as cessation of bleeding on angiography or angiographically successful embolization of the bleeding artery. Clinical success was defined as the obviation of repeated embolization or surgical intervention. RESULTS The technical success rate was 98.8% (n = 174), and the clinical success rate was 89.7% (n = 158). Among 176 patients, 71 had cesarean sections, and 105 underwent normal vaginal deliveries. Of the 105 patients who underwent normal vaginal deliveries, 11 (10.5%) required repeat embolization or surgical intervention. Of the 71 patients who had cesarean sections, 7 (9.8%) required repeat embolization or surgical intervention. The clinical success rate and complication rate were not related to the mode of delivery. All women resumed menses after transcatheter arterial embolization, and most (n = 125) described their menses as unchanged. Subsequent spontaneous pregnancies occurred in 13 women. CONCLUSIONS The cesarean mode of delivery is not a predictor of poorer outcomes of transcatheter arterial embolization; however, further study is needed to clarify this relationship.
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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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30
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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: 1.1] [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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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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Agarwal N, Deinde O, Willmott F, Bojahr H, MacCallum P, Renfrew I, Beski S. A case series of interventional radiology in postpartum haemorrhage. J OBSTET GYNAECOL 2012; 31:499-502. [PMID: 21823848 DOI: 10.3109/01443615.2011.566388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Postpartum haemorrhage (PPH) remains a significant cause of maternal morbidity and mortality in both developed and developing countries. In some instances, PPH can be anticipated and recent improvements in obstetric imaging techniques allow earlier and more reliable diagnosis of abnormalities associated with haemorrhage such as morbid placentation. However, the majority of PPH is unpredicted. Good practice notes published by the Royal College of Obstetricians and Gynaecologists state interventional radiology should be used as emergency intervention in PPH and should be considered when primary management has failed allowing arteries to be embolised to achieve haemostasis. Through collaboration between interventional radiology and maternity, appropriate guidelines need to be developed, on both emergency and elective of interventional radiology in the prevention and management of PPH. As there is mapping for neonatal services, in the future there should be consideration to develop obstetric trauma units. Maternity units which lack facilities for interventional radiology would be able to refer their cases (like placenta accreta) for safe management in units with 24 h interventional radiology services.
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Affiliation(s)
- N Agarwal
- Department of Obstetrics and Gynaecology, Barts and The London School of Medicine, Rolyal London Hospital, London, UK.
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Kanematsu M, Watanabe H, Kondo H, Goshima S, Kato H, Furui T, Toyoki H, Morishige KI. Postpartum Hemorrhage in Coagulopathic Patients: Preliminary Experience with Uterine Arterial Embolization with N-Butyl Cyanoacrylate. J Vasc Interv Radiol 2011; 22:1773-6. [PMID: 22115582 DOI: 10.1016/j.jvir.2011.08.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 08/10/2011] [Accepted: 08/11/2011] [Indexed: 11/30/2022] Open
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Honiden S, Abdel-Razeq SS, Siegel MD. The management of the critically ill obstetric patient. J Intensive Care Med 2011; 28:93-106. [PMID: 21841145 DOI: 10.1177/0885066611411408] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hypertensive disorders, postpartum hemorrhage, and sepsis are the most common indications for intensive care unit admission among obstetric patients. In general, ICU mortality is low, and better than would be predicted using available mortality prediction tools. Provision of care to this special population requires an intimate understanding of physiologic changes that occur during pregnancy. Clinicians must be aware of the way various diagnostic and treatment choices can affect the mother and fetus. Most clinically necessary radiographic tests can be safely performed and fall under the maternal radiation exposure limit of less than 0.05 Gray (Gy). Careful attention must be paid to acid-base status, oxygenation, and ventilation when faced with respiratory failure necessitating intubation. Cesarean delivery can be justified after 4 minutes of cardiac arrest and may improve fetal and maternal outcomes. The treatment of obstetric patients in the ICU introduces complexities and challenges that may be unfamiliar to many critical care physicians; teamwork and communication with obstetricians is crucial.
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Affiliation(s)
- Shyoko Honiden
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
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Bilbao JI, Martínez-Cuesta A, Urtasun F, Cosín O. Complications of embolization. Semin Intervent Radiol 2011; 23:126-42. [PMID: 21326756 DOI: 10.1055/s-2006-941443] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Embolization is a remarkably versatile procedure used in nearly all vascular and nonvascular systems to treat a wide range of pathology. The published literature is rich with studies demonstrating the enormous therapeutic potential offered by embolization procedures, and the possibilities continue to expand with the advent of new embolization agents and techniques. Unfortunately, with this variety and innovation comes a wide spectrum of potential complications, not always easy to classify and summarize, associated with embolization. This article reviews the procedures and associated complications of arterial and venous embolization procedures, organized by vascular distribution.
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Affiliation(s)
- José I Bilbao
- Department of Radiology, Clínica Universitaria de Navarra, Pamplona, Spain
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Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJLM, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2011; 81:1400-33. [PMID: 20956045 DOI: 10.1016/j.resuscitation.2010.08.015] [Citation(s) in RCA: 361] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
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Fertility after embolization of the uterine arteries to treat obstetrical hemorrhage: a review of 53 cases. Fertil Steril 2010; 94:2574-9. [DOI: 10.1016/j.fertnstert.2010.02.052] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 02/23/2010] [Accepted: 02/23/2010] [Indexed: 02/07/2023]
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Soar J, Perkins G, Abbas G, Alfonzo A, Barelli A, Bierens J, Brugger H, Deakin C, Dunning J, Georgiou M, Handley A, Lockey D, Paal P, Sandroni C, Thies KC, Zideman D, Nolan J. Kreislaufstillstand unter besonderen Umständen: Elektrolytstörungen, Vergiftungen, Ertrinken, Unterkühlung, Hitzekrankheit, Asthma, Anaphylaxie, Herzchirurgie, Trauma, Schwangerschaft, Stromunfall. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1374-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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: 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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Placenta Accreta: Management with Uterine Artery Embolization in 17 Cases. J Vasc Interv Radiol 2010; 21:644-8. [DOI: 10.1016/j.jvir.2010.01.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 12/09/2009] [Accepted: 01/26/2010] [Indexed: 11/24/2022] Open
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Pérez Solaz A, Ferrandis Comes R, Llau Pitarch JV, Alcántara Noalles MJ, Abengochea Cotaina A, Barberá Alacreu M, Belda Nácher FJ. [Obstetric bleeding: an update]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:224-235. [PMID: 20499801 DOI: 10.1016/s0034-9356(10)70209-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Massive bleeding in obstetrics still ranks among the most frequent causes of maternal morbidity and mortality worldwide. The most frequent type is primary postpartum hemorrhage, which is usually the result of an atonic uterus. The clinical priorities are to assure hemodynamic stability and to correct coagulation abnormalities. If pharmacologic treatment cannot achieve these goals, invasive methods such as interventional vascular radiology or artery ligation must be used. Hysterectomy is the last resort when the previous methods fail. For the best prognosis, in terms of preventing death, maintaining maternal fertility and minimizing morbidity, every maternity ward should have a well-defined multidisciplinary protocol that facilitates diagnosis and immediate treatment.
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Lee NK, Kim S, Lee JW, Sol YL, Kim CW, Hyun Sung K, Jang HJ, Suh DS. Postpartum hemorrhage: Clinical and radiologic aspects. Eur J Radiol 2010; 74:50-9. [DOI: 10.1016/j.ejrad.2009.04.062] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 04/23/2009] [Indexed: 11/25/2022]
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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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Identification of Bleeding Sites in Patients With Postpartum Hemorrhage: MDCT Compared With Angiography. AJR Am J Roentgenol 2010; 194:383-90. [DOI: 10.2214/ajr.09.3073] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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BOYLE RK, WATERS BA, OâROURKE PK. Blood transfusion for caesarean delivery complicated by placenta praevia. Aust N Z J Obstet Gynaecol 2009; 49:627-30. [DOI: 10.1111/j.1479-828x.2009.01089.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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: 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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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: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Uterine artery embolization along with the administration of methotrexate for cervical ectopic pregnancy: technical and clinical outcomes. AJR Am J Roentgenol 2009; 192:1601-7. [PMID: 19457824 DOI: 10.2214/ajr.08.1921] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate the technical and clinical outcomes of uterine artery embolization (UAE) along with the administration of methotrexate (MTX) for cervical ectopic pregnancy with vaginal bleeding as an alternative nonsurgical treatment to control bleeding and preserve fertility. MATERIALS AND METHODS Eight patients (age range, 24-37 years; mean age, 30.1 years) with cervical ectopic pregnancy were treated with UAE using gelatin sponge particles to control vaginal bleeding. In seven patients, the administration of MTX was performed before, after, or before and after UAE. The follow-up periods after UAE ranged from 4 to 46 months (median, 8 months). We evaluated the UAE technique, clinical outcomes, complications, and fertility. RESULTS In all patients, UAE could control active vaginal bleeding on gynecologic examination. In six patients, the cervical ectopic pregnancy was dramatically resolved. In the other two patients presenting with both fetal heartbeat before UAE and persistent high HCG levels, active vaginal rebleeding was observed. The rebleeding was successfully controlled by a second UAE procedure. No major complication related to UAE was detected. The uterus could be preserved in all patients. In seven patients, normal menses resumed within 2 months after UAE. In only one patient, amenorrhea continued 8 months after UAE. In all three patients who could be followed for 2 years or more, three had subsequent successful natural pregnancies, and two patients had live births. CONCLUSION UAE along with the administration of MTX is effective in treating cervical ectopic pregnancy with vaginal bleeding while allowing the preservation of fertility.
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