Abstract
Purpose
To evaluate the efficacy and safety of superselective embolization of the uterine arteries in a postpartum hemorrhage.
Materials and Methods
Between November 2004 and January 2011, a total of 44 consecutive women (median ± standard deviation age 34 ± 3 years, range 23–41 years) were referred to our institution for postpartum intractable hemorrhage management. All patients were embolized with a microcatheter that was placed deep into the uterine arteries upstream of the cervical arteries. The embolic agent was a mixture of contrast medium and 5 × 5 × 5 cm pieces of gelfoam (Gelita-Spon) modified into a gelatin emulsion as follows: rapid mixing through a three-way stopcock with two 2.5-ml syringes. A 1-ml syringe was used for injection. One month after embolization, all patients underwent magnetic resonance imaging and clinical examination.
Results
Technical and clinical success was obtained in all cases. Thirty-five patients experienced bleeding related to poor retraction of the uterus, 7 patients because of a tear of the cervix and 2 because of a vaginal hematoma. Pre- and postembolization red blood cell transfusions were (mean ± standard deviation [SD]) 6 ± 1.2 (range 3–8) U and 2 ± 0.7 (range 2–4) U, respectively. One-month magnetic resonance imaging follow-up revealed no sign of ischemic myometrium or necrosis, and no instances of uterine rupture and no pelvic vein thrombosis. Incidental findings included two small intramyometrial hematic collections. All uterine arteries were patent via magnetic resonance angiography. Seventeen patients had concomitant fibroids, all of which appeared hypovascular.
Conclusion
This technique permits good, safe clinical results with no marked damage to the uterine arteries or the uterus itself.
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Abbreviations
- PPH:
-
Postpartum hemorrhage
- IR:
-
Interventional radiology
- UEA:
-
Uterine arterial embolization
- ICU:
-
Intensive care unit
- MRI:
-
Magnetic resonance image
- MRA:
-
Magnetic resonance angiography
- EPR:
-
Electronic patients record
References
Khan KS, Wojdyla D, Say L et al (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367(9516):1066–1074
Centers for Disease Control and Prevention (1999) Healthier mothers and babies, 1900–1999. JAMA 282:1807–1810
Devine PC (2009) Obstetric hemorrhage. Semin Perinatol 33:76–81
Elbourne DR, Prendiville WJ, Carroli G et al (2001) Prophylactic use of oxytocin in the third stage of labour. Cochrane Database Syst Rev (4):CD001808
Jouppila P (1995) Postpartum haemorrhage. Curr Opin Obstet Gynecol 7:446–450
Varner M (1991) Postpartum hemorrhage. Crit Care Clin 7:883–897
Heaston DK, Mineau DE, Brown BJ, Miller FJ Jr (1979) Transcatheter arterial embolization for control of persistent massive puerperal hemorrhage after bilateral surgical hypogastric artery ligation. AJR Am J Roentgenol 133:152–154
Brown BJ, Heaston DK, Poulson AM et al (1979) Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol 54:361–365
Mousa HA, Alfirevic Z (2009) Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 1:CD003249
Pelage JP, Le Dref O, Jacob D et al (1999) Selective arterial embolization of the uterine arteries in the management of intractable post-partum hemorrhage. Acta Obstet Gynecol Scand 78:698–703
Bros S, Chabrot P, Kastler A, Ouchchane L, Cassagnes L, Gallot D, Boyer L (2011) Recurrent bleeding within 24 hours after uterine artery embolization for severe postpartum hemorrhage: are there predictive factors? Cardiovasc Intervent Radiol
Pelage JP, Soyer P, Repiquet D et al (1999) Secondary postpartum hemorrhage: treatment with selective arterial embolization. Radiology 212:385–389
Pelage JP, Le Dref O, Mateo J et al (1998) Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology 208:359–362
Sentilhes L, Gromez A, Clavier E et al (2009) Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Obstet Gynecol 113:992–999
Noonan JB, Coakley FV, Qayyum A et al (2003) MR imaging of retained products of conception. AJR Am J Roentgenol 181:435–439
Dicle O, Kucukler C, Pirnar T et al (1997) Magnetic resonance imaging evaluation of incision healing after cesarean sections. Eur Radiol 7:31–34
Louail B, Sapoval M, Bonneau M et al (2006) A new porcine sponge material for temporary embolization: an experimental short-term pilot study in swine. Cardiovasc Intervent Radiol 29:826–831
Ganguli S, Stecker MS, Pyne D et al (2011) Uterine artery embolization in the treatment of postpartum uterine hemorrhage. J Vasc Interv Radiol 22:169–176
Courbiere B, Jauffret C, Provansal M et al (2008) Failure of conservative management in postpartum haemorrhage: uterine necrosis and hysterectomy after angiographic selective embolization with gelfoam. Eur J Obstet Gynecol Reprod Biol 140:291–293
Coulange L, Butori N, Loffroy R et al (2009) Uterine necrosis following selective embolization for postpartum hemorrhage using absorbable material. Acta Obstet Gynecol Scand 88:238–240
Kirby JM, Kachura JR, Rajan DK et al (2009) Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol 20:1036–1045
Sone M, Arai Y, Shimizu T et al (2010) Phase I/II multiinstitutional study of uterine artery embolization with gelatin sponge for symptomatic uterine leiomyomata: Japan Interventional Radiology in Oncology Study Group study. J Vasc Interv Radiol 21:1665–1671
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Pellerin, O., Bats, AS., Di Primio, M. et al. Postpartum Hemorrhage Treated with Gelfoam Slurry Embolization Using the Superselective Technique: Immediate Results and 1-Month MRI Follow-up. Cardiovasc Intervent Radiol 36, 98–104 (2013). https://doi.org/10.1007/s00270-012-0355-7
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DOI: https://doi.org/10.1007/s00270-012-0355-7