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Chatani S, Inoue A, Lee T, Uemura R, Imai Y, Takaki K, Tomozawa Y, Murakami Y, Sonoda A, Tsuji S, Watanabe Y. Clinical outcomes and future fertility after uterine artery embolization for postpartum and post-abortion hemorrhage. Acta Radiol 2024; 65:670-677. [PMID: 38584381 DOI: 10.1177/02841851241244489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) and post-abortion hemorrhage (PAH) are life-threatening conditions. PURPOSE To evaluate the efficacy and safety of uterine arterial embolization (UAE) for PPH and PAH and to investigate future fertility after UAE. MATERIAL AND METHODS This study included 57 consecutive patients (mean age = 34 years) who underwent UAE for PPH (n = 46) and PAH (n = 11) at our institution between January 2011 and December 2022. Technical success, non-visualization of the peripheral portion of bilateral uterine arteries on angiography, and clinical success, complete hemostasis after UAE, were assessed. UAE-associated complications and factors related to clinical success were analyzed. Pregnancy outcomes after UAE and complications during subsequent pregnancy were investigated in 16 patients who desired fertility and were followed up for >1 year. RESULTS The technical and clinical success rates were 100% and 84.2%, respectively. Sepsis (n = 1) and uterine empyema (n = 1) were observed as severe complications. Placental disorder, bleeding within 24 h after delivery or abortion, ≥1.5 shock index, ≥6 units of transfusion erythrocytes, and ≥8 obstetrical disseminated intravascular coagulation score were significantly associated with unfavorable clinical outcomes. In total, 16 pregnancies were observed in 12 patients after UAE, three of which were miscarriages and 13 were successful live births. During pregnancy, uterine rupture (n = 1) and accreta (n = 1) were observed. CONCLUSION UAE is an effective treatment for PPH and PAH. Although UAE could preserve future fertility, careful attention should be paid to perinatal management for unusual complications.
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Affiliation(s)
- Shohei Chatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tokuko Lee
- Department of Radiology, Koseikai Takeda Hospital, Kyoto, Japan
| | - Ryo Uemura
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kai Takaki
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yuki Tomozawa
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoko Murakami
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
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2
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Akaishi T, Tarasawa K, Hamada H, Iwama N, Tomita H, Akaishi M, Fushimi K, Fujimori K, Yaegashi N, Saito M. Prenatal hypertension as the risk of eclampsia, HELLP syndrome, and critical obstetric hemorrhage. Hypertens Res 2024; 47:455-466. [PMID: 37993593 PMCID: PMC10838768 DOI: 10.1038/s41440-023-01511-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/28/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023]
Abstract
Critical bleeding is a common cause of maternal mortality in obstetric patients. However, the non-obstetric factors underlying critical obstetric bleeding remain uncertain. Therefore, this study aimed to clarify the impact of chronic hypertension on obstetric hemorrhage by evaluating a nationwide administrative database in Japan. Women who gave birth between 2018 and 2022 were enrolled. The primary outcome was critical hemorrhage requiring massive red blood cell (RBC) transfusion during childbirth. In total, 354, 299 eligible women were selected from the database. The maternal mortality rate was >1.0% among those who received a massive RBC transfusion (≥4000 cc), and this amount was used as the cutoff of the outcome. Critical hemorrhage was less frequent with elective Caesarean section (CS) compared with vaginal childbirth or emergent CS (odds ratio [OR], 0.38; 95% confidence interval, 0.30-0.47). Multiple logistic regression analysis adjusting for these obstetric risks revealed that a higher maternal age (adjusted OR [aOR] per 1 year, 1.07 [1.05-1.09]); oral medications with prednisolone (aOR, 2.5 [1.4-4.4]), anti-coagulants (aOR, 10 [5.4-19]), and anti-platelets (aOR, 2.9 [1.3-6.4]); and a prenatal history of hypertension (aOR, 2.5 [1.5-4.4]) and hypoproteinemia (aOR, 5.8 [1.7-20]) are the risks underlying critical obstetric hemorrhage. Prenatal history of hypertension was significantly associated with obstetric disseminated intravascular coagulation (OR, 1.9 [1.5-2.4]); Hemolysis, Elevated Liver enzymes, and Low platelet count (HELLP) syndrome (OR, 3.3 [2.7-4.2]); and eclampsia (OR, 6.1 [4.6-8.1]). In conclusion, a maternal prenatal history of hypertension is associated with the development of HELLP syndrome, eclampsia, and resultant critical hemorrhage. The incidence of HELLP syndrome and eclampsia increased more than fivefold in the presence of prenatal hypertension. However, the likelihood of subsequently developing DIC or experiencing critical bleeding did not change by the presence of prenatal hypertension.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirotaka Hamada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Iwama
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hasumi Tomita
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miho Akaishi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
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3
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An J. Subsequent pregnancy in women who have undergone bilateral uterine artery ligation during cesarean section: A case series. Exp Ther Med 2024; 27:9. [PMID: 38223319 PMCID: PMC10785031 DOI: 10.3892/etm.2023.12296] [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: 02/14/2023] [Accepted: 09/20/2023] [Indexed: 01/16/2024] Open
Abstract
Bilateral uterine artery ligation (BUAL) serves as an effective surgical devascularization procedure in obstetric emergencies. However, concerns regarding the impact of uterine devascularization have evoked dispute. Here, the fetal growth index and obstetrical outcomes during the subsequent pregnancy of women who had undergone BUAL during cesarean section are reported. The case series of women who underwent BUAL during cesarean section and had another delivery later at the Xiamen Women and Children's Hospital between 2011 and 2020 is described. Pregnancies that did not continue beyond 20 weeks of gestation were excluded. Cases were identified from neonatal and obstetric databases and the clinical data of all cases were extracted. A total of 12 cases were identified retrospectively. Fetal biometric parameters of subsequent pregnancies in all cases including biparietal diameter, head circumference, abdominal circumference, and femur length are presented graphically across the different gestational ages and were all within the range of the 3rd-97th percentile. No maternal or neonatal morbidity was observed. BUAL did not appear to compromise a woman's subsequent obstetric outcomes. As a safe and simple surgical technique, it is safe to recommend BUAL in clinical practice.
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Affiliation(s)
- Jian An
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian 361000, P.R. China
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4
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Lal A, Vijayvergiya R, Singhal M. Ipsilateral Uterine Artery Access Through Unilateral Transfemoral Approach Using Simple-Curve Catheter. Indian J Radiol Imaging 2023; 33:543-547. [PMID: 37811184 PMCID: PMC10556336 DOI: 10.1055/s-0043-1770086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Uterine artery embolization (UAE) is a technique for management of various obstetrical and gynecological problems. Transfemoral approach (TFA) is preferred which can be unilateral or bilateral; however, unilateral puncture is preferred due to lesser chances of puncture-related complications as compared to bilateral puncture. UAE through unilateral TFA is possible with use of reverse loop catheters (Roberts uterine catheter [RUC] or Gandras catheter) to access ipsilateral uterine artery. Other way of cannulating the ipsilateral uterine artery is by maneuvering catheters to form Waltman's loop/Simmon's reverse loop. With advent of RUC, unilateral TFA became standard of care. In the recent past, RUC was retracted from Indian market and its nonavailability had mandated use of either bilateral TFA or use of catheters and techniques used in the past for unilateral TFA. Herein, we describe a technique of doing UAE by unilateral TFA using simple gentle curve catheter (Picard) by making a reverse curve loop.
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Affiliation(s)
- Anupam Lal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Pyeon SY, Noh E, Cho GJ. Long-Term Effect on Ovarian Function After Uterine Artery Embolization During the Postpartum Period: A Nationwide Population-Based Study. Reprod Sci 2023; 30:2990-2995. [PMID: 37188980 DOI: 10.1007/s43032-023-01257-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/29/2023] [Indexed: 05/17/2023]
Abstract
Uterine artery embolization(UAE) is widely used in obstetrical indications, including postpartum bleeding and placental implantation abnormality, to manage many conditions to conserve the uterus. However, physicians are concerned about future fertility or ovarian function due to the occlusion of major pelvic vessels in the uterine artery embolization. However, there are limited data related to UAE usage during the postpartum period. This study was to evaluate the impact of UAE during the postpartum period on primary ovarian failure(POF), menstrual disorders, and infertility in women. Using the Korea National Health Insurance claims database, all pregnant women who delivered between January 2007 and December 2015 and underwent UAE during the postpartum period were identified. The occurrence of POF, female infertility, and menstrual disorders after delivery was evaluated. Using Cox proportional hazards models, the adjusted hazard ratios and 95% confidence intervals were estimated. 779,612 cases were analyzed in the study with 947 women in the UAE group. After delivery, the incidence of POF (0.84% vs.0.27%, P<.0001) and female infertility (10.24% vs. 6.89%, P<.0001) were higher in UAE group than in the control group. After adjusting for covariates, the POF risk was significantly higher in UAE group than in the control group (HR 2.37, 95% CI 1.16-4.82). The risk for the disorder of menstrual frequency (HR 1.28, 95% CI 1.10-1.50) and female infertility (HR 1.37, 95% CI 1.10-1.71) was significantly higher in UAE group than in the control group. This study confirmed UAE during the postpartum period is a risk factor for POF after delivery.
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Affiliation(s)
- Seung Yeon Pyeon
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Eunjin Noh
- Korea University Guro Hospital Smart Healthcare Center, Seoul, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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6
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Hörer TM, Ierardi AM, Carriero S, Lanza C, Carrafiello G, McGreevy DT. Emergent vessel embolization for major traumatic and non-traumatic hemorrhage: Indications, tools and outcomes. Semin Vasc Surg 2023; 36:283-299. [PMID: 37330241 DOI: 10.1053/j.semvascsurg.2023.04.011] [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: 02/10/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/19/2023]
Abstract
Endovascular embolization of bleeding vessels in trauma and non-trauma patients is frequently used and is an important tool for bleeding control. It is included in the EVTM (endovascular resuscitation and trauma management) concept and its use in patients with hemodynamic instability is increasing. When the correct embolization tool is chosen, a dedicated multidisciplinary team can rapidly and effectively achieve bleeding control. In this article, we will describe the current use and possibilities for embolization of major hemorrhage (traumatic and non-traumatic) and the published data supporting these techniques as part of the EVTM concept.
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Affiliation(s)
- Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Södra Grev Rosengatan, 701 85 Örebro, Sweden; Department of Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden; Carmel Lady Davis Hospital, Technion Medical Faculty, Haifa, Israel.
| | - Anna Maria Ierardi
- Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Serena Carriero
- Post Graduate School of Radiology, University of Milan, Milan, Italy
| | - Carolina Lanza
- Post Graduate School of Radiology, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - David T McGreevy
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Södra Grev Rosengatan, 701 85 Örebro, Sweden
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7
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Wu CH, Wu PW, Wong YC, Chueh HY. Trans-arterial embolization for intractable primary postpartum hemorrhage caused by arterial aneurysms with arteriovenous fistulas in the lower vagina bilaterally: a case report. J Int Med Res 2023; 51:3000605221150137. [PMID: 36694466 PMCID: PMC9893089 DOI: 10.1177/03000605221150137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Failure of conservative management for controlling postpartum hemorrhage (PPH) is not uncommon, particularly when PPH is caused by vascular lesions. Awareness of this possibility and initiating timely trans-arterial embolization (TAE) are essential for improving the outcome. Herein, we describe the case of a 34-year-old woman presenting with arterial aneurysms with arteriovenous fistulas in the lower vagina bilaterally, which caused intractable PPH. Conservative management failed to resolve the PPH; however, TAE successfully controlled the bleeding, and the patient recovered smoothly. Knowledge of this possible etiology for intractable PPH is crucial for timely TAE. This case report aims to highlight the pivotal role of TAE in detecting and treating this unusual cause of PPH.
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Affiliation(s)
- Cheng-Hsien Wu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan,Cheng-Hsien Wu, Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsing Street, Gueishan, Taoyuan, 333, Taiwan.
| | - Patricia Wanping Wu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yon-Cheong Wong
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ho-Yen Chueh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan and Chang Gung University College of Medicine, Taoyuan, Taiwan
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8
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Effectiveness of Uterine Arterial Embolization and Risk Factors Associated with Its Failure in Patients with Primary Postpartum Hemorrhage After Cesarean Section. IRANIAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.5812/iranjradiol-128424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Postpartum hemorrhage (PPH), a serious labor-related complication, is the leading cause of maternal mortality, which requires an emergent intervention. Uterine arterial embolization (UAE) is an effective treatment for hemostasis of intractable PPH. Several risk factors have been reported for the failure of UAE. Objectives: To evaluate the clinical outcomes of UAE for the treatment of primary PPH following cesarean section (CS) and to determine the risk factors associated with the failure of this procedure. Methods: This retrospective, single-center study was approved by the institutional review board, and the requirement to obtain informed consent was waived. All patients referred to a tertiary care center, who underwent UAE for primary PPH between January 2018 and December 2020, were included. The patients’ medical records and radiological findings, including the patients’ characteristics, mode of delivery, initial vital signs and laboratory findings after hospitalization, procedure details, and embolization outcomes, were evaluated for data collection. Technical success was defined as appropriate embolization of target vessels on a completion angiogram. Clinical success was defined as adequate cessation of bleeding after the first embolization, without any need for subsequent embolization or surgical intervention. Statistical analysis was performed to determine factors related to the clinical failure of UAE in CS cases. Results: UAE was performed for 25 patients (mean age, 37.2 years; range, 25 - 45 years). The technical success rate was estimated at 100% (n = 25), and the clinical success rate was 76% (n = 19). There were no patients with permanent adverse sequelae or death. The univariate analyses showed that hemodynamic instability (P = 0.006), lower hemoglobin levels (P = 0.02), and prolonged activated partial thromboplastin time (aPTT) (P = 0.017) were related to clinical failure. The logistic regression analysis adjusted for age showed that the area under the curve (AUC) was 0.86 for hemoglobin (95% CI: 0.7 - 1; cutoff value: 0.667), 0.816 for aPTT (95% CI: 0.625 - 1; cutoff value: 0.411), and 0.868 for hemodynamic instability (95% CI: 0.661 - 1; cutoff value: 0.622). Conclusions: UAE is a safe and effective treatment for primary PPH following CS. Hemodynamic instability, low hemoglobin levels, and prolonged aPTT can be predictive factors for the poor outcomes of UAE in CS patients. These factors are rapid and straightforward criteria, which can be simply applied, even in emergency situations.
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9
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Bridwell R, Long B, Montrief T, Gottlieb M. Post-abortion Complications: A Narrative Review for Emergency Clinicians. West J Emerg Med 2022; 23:919-925. [DOI: 10.5811/westjem.2022.8.57929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
An abortion is a procedure defined by termination of pregnancy, most commonly performed in the first or second trimester. There are several means of classification, but the most important includes whether the abortion was maternally “safe” (performed in a safe, clean environment with experienced providers and no legal restrictions) or “unsafe” (performed with hazardous materials and techniques, by person without the needed skills, or in an environment where minimal medical standards are not met). Complication rates depend on the procedure type, gestational age, patient comorbidities, clinician experience, and most importantly, whether the abortion is safe or unsafe. Safe abortions have significantly lower complication rates compared to unsafe abortions. Complications include bleeding, retained products of conception, retained cervical dilator, uterine perforation, amniotic fluid embolism, misoprostol toxicity, and endometritis. Mortality rates for safe abortions are less than 0.2%, compared to unsafe abortion rates that range between 4.7-13.2%. History and physical examination are integral components in recognizing complications of safe and unsafe abortions, with management dependent upon the diagnosis. This narrative review provides a focused overview of post-abortion complications for emergency clinicians.
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Affiliation(s)
- Rachel Bridwell
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Tim Montrief
- Jackson Memorial Health System, Department of Emergency Medicine, Miami, Florida
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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10
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Khera PS, Garg PK, Yadav T, Tiwari S, Ghosh TS, Sureka B, Rajagopal R. Emergency Uterine Bleeding: A Pictorial Essay of Imaging and Endovascular Management. Curr Probl Diagn Radiol 2022; 51:858-867. [DOI: 10.1067/j.cpradiol.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/16/2022] [Accepted: 04/18/2022] [Indexed: 11/22/2022]
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Kulkarni S, Shetty NS, Gupta A, Rao S, Bansal H. Interventional Radiology in Obstetric Emergencies. Indian J Crit Care Med 2022; 25:S273-S278. [PMID: 35615607 PMCID: PMC9108784 DOI: 10.5005/jp-journals-10071-24090] [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] [Indexed: 11/23/2022] Open
Abstract
Postpartum hemorrhage (PPH) is one of the common causes of morbidity as well as mortality among pregnant women. Obstetric hemorrhage embolization (OHE)/uterine artery embolization (UAE) is the preferred treatment for PPH which has failed medical therapy. In cases of placental accreta spectrum (PAS), balloon catheter can be prophylactically placed in internal iliac arteries (IIAs) bilaterally before delivery to enable postpartum control of bleeding. An inferior vena cava (IVC) filter can be placed under fluoroscopy for a pregnant woman with deep vein thrombosis (DVT) for whom anticoagulation is contraindicated or needs to be stopped at the time of labor. Injection of chemical into the gestational sac can be performed under ultrasonography (USG) guidance to treat ectopic pregnancy. Percutaneous or transvaginal drainage of a collection can be done by ultrasound or computed tomography (CT) guidance for puerperal sepsis. Percutaneous nephrostomy (PCN) is performed for obstructive ureterolithiasis in case of urosepsis or significant stone burden. Sonography should be used for the guidance of interventional radiology (IR) procedures whenever possible. Fluoroscopy must be used only if necessary, giving special attention to radiation-sparing maneuvers.
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Affiliation(s)
- Suyash Kulkarni
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nitin S Shetty
- Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Nitin S Shetty, Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India, Phone: +91 9757092013, e-mail:
| | - Anurag Gupta
- Department of Interventional Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Saketh Rao
- Department of Interventional Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Harshit Bansal
- Department of Radio-diagnosis, University College of Medical Sciences, New Delhi, India
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12
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Das CJ, Rathinam D, Manchanda S, Srivastava DN. Endovascular uterine artery interventions. Indian J Radiol Imaging 2021; 27:488-495. [PMID: 29379246 PMCID: PMC5761178 DOI: 10.4103/ijri.ijri_204_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs), as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE) may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH), placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes.
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Affiliation(s)
- Chandan J Das
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Rathinam
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Srivastava
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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13
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Loya MF, Garcia-Reyes K, Gichoya J, Newsome J. Uterine Artery Embolization for Secondary Postpartum Hemorrhage. Tech Vasc Interv Radiol 2021; 24:100728. [PMID: 34147195 DOI: 10.1016/j.tvir.2021.100728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Postpartum hemorrhage (PPH) affects approximately 14 million women yearly, accounts for 25% of delivery-related deaths in the world and is the main cause of emergency peripartum hysterectomy. Traditionally, PPH is defined as at least 500 mL of blood loss after vaginal delivery or 1000 mL of blood loss after cesarean-section. However, several authors have suggested a simpler definition to include women who experience hemodynamic instability after birth regardless of amount of blood loss. Secondary PPH is defined as bleeding that occurs after 24 hours to 12 weeks from delivery, and can fail medical management. It is imperative that the clinical team recognize the signs and symptoms of secondary PPH and, if necessary, consult the interventional radiology service for a minimally invasive option of uterine artery embolization, which has shown up to 95% success rate.
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Affiliation(s)
- Mohammed F Loya
- Emory University Hospital, Interventional Radiology, Department of Radiology and Imaging Sciences, Atlanta, GA.
| | - Kirema Garcia-Reyes
- Emory University Hospital, Interventional Radiology, Department of Radiology and Imaging Sciences, Atlanta, GA
| | - Judy Gichoya
- Emory University Hospital, Interventional Radiology, Department of Radiology and Imaging Sciences, Atlanta, GA
| | - Janice Newsome
- Emory University Hospital, Interventional Radiology, Department of Radiology and Imaging Sciences, Atlanta, GA
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14
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Corvino F, Giurazza F, Vallone M, Mosca S, Fischer MJ, Corvino A, Niola R. Postpartum Hemorrhage: Rescue. Semin Ultrasound CT MR 2021; 42:75-84. [PMID: 33541591 DOI: 10.1053/j.sult.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Severe postpartum hemorrhage (PPH) occurs in around 1%-2% of deliveries and is a leading cause of maternal mortality and morbidity worldwide. Different treatments of PPH are proposed by the scientific society's guidelines; to date, pelvic artery embolization is an effective therapeutic strategy with the advantages of fast speed, repeatability, and the possibility of future fertility preservation. We compared the different PPH treatments, focusing especially on the role of interventional radiology reviewing pelvic vascular anatomy and emphasizing on the timing of embolization and various clinical conditions of PPH.
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Affiliation(s)
- Fabio Corvino
- Interventional Radiology Department, AORN "A. Cardarelli," Naples, Italy.
| | - Francesco Giurazza
- Interventional Radiology Department, AORN "A. Cardarelli," Naples, Italy
| | - Mario Vallone
- Radiology Department, "Ospedale Civico Di Cristina e Benfratelli," Palermo, Italy
| | - Stefano Mosca
- Interventional Radiology Department, "Ospedale Santa Maria della Misericordia di Perugia," Perugia, Italy
| | - Matthias Joachim Fischer
- Interventional Radiology Department, "Ospedale Santa Maria della Misericordia di Perugia," Perugia, Italy
| | - Antonio Corvino
- Motor Science and Wellness Department, University of Naples "Parthenope,", Naples, Italy
| | - Raffaella Niola
- Interventional Radiology Department, AORN "A. Cardarelli," Naples, Italy
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15
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Orlowski MH, Soares WE, Kerrigan KA, Zerden ML. Management of Postabortion Complications for the Emergency Medicine Clinician. Ann Emerg Med 2020; 77:221-232. [PMID: 33341294 DOI: 10.1016/j.annemergmed.2020.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 02/02/2023]
Abstract
Although induced abortion is generally a safe outpatient procedure, many patients subsequently present to the emergency department, concerned about a postabortion complication. It is helpful for emergency physicians to understand the medications and procedures used in abortion care in the United States to effectively and efficiently triage and treat women presenting with potential complications from an abortion. Furthermore, because many states are experiencing increased abortion restrictions that limit access to care, emergency medicine physicians may encounter more patients presenting after self-managed abortions, which presents additional challenges. This article reviews the epidemiology and background of abortion care, including the range of symptoms and adverse effects that are within the scope of an uncomplicated procedure. This review also offers a comprehensive overview of management of abortion complications, including algorithms for more common complications and descriptions of less common but more severe adverse events. The article concludes with a recognition of the social stigma and legal regulations unique to abortion care.
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Affiliation(s)
| | - William E Soares
- University of Massachusetts Medical School at Baystate Medical Center, Springfield, MA
| | - Kathleen A Kerrigan
- University of Massachusetts Medical School at Baystate Medical Center, Springfield, MA
| | - Matthew L Zerden
- Planned Parenthood South Atlantic, Chapel Hill, and WakeMed Health & Hospitals, Raleigh, NC
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16
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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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17
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Radaelli T, Ferrari MM, Duiella SF, Gazzola FG, Campoleoni M, Merlini C, Martinetti L, Ambrosini MT, Ossola MW, Nicolini A. Prophylactic intraoperative uterine artery embolization for the management of major placenta previa. J Matern Fetal Neonatal Med 2020; 35:3359-3364. [PMID: 32928020 DOI: 10.1080/14767058.2020.1818218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Placenta previa is a major cause of maternal morbidity and mortality, associated to a high risk of peripartum hemorrhage and hysterectomy. We aimed to verify if prophylactic intraoperative uterine artery embolization in patients with placenta previa and at least one additional risk of bleeding (major placenta previa), can reduce hemorrhage, need for blood transfusions, peripartum hysterectomy and maternal morbidity. MATERIALS AND METHODS We enrolled 76 patients with major placenta previa; a specific multidisciplinary protocol was designed for management, including ultrasound evaluation, hospitalization at 34 weeks, antenatal corticosteroids and scheduled cesarean section at 35-36 weeks. 44 patients (control group or CTR) were treated with elective cesarean section, 32 patients (embolized group or EMB) underwent selective catheterization of bilateral uterine arteries before cesarean section and subsequent uterine embolization. In both cases cesarean section was performed by a senior surgeon. RESULTS Significant differences were found in term of intraoperative blood loss (CTR: 1431 ml; EMB: 693 ml); despite an high percentage of CTR patients had a bleeding greater than 1000 ml (56%), the need for blood transfusion was not significantly different between the two groups. Time of surgery was higher in the EMB group, considering that embolization procedure required approximatively 30 min. Three patients from the CTR group needed hysterectomy and ICU admission, compared to none in the EMB group. Duration of hospitalization and neonatal outcome were similar. Uterine embolization was not related to any short or long-term complications; return to normal menses and preservation of fertility were confirmed at follow up. CONCLUSIONS Our results are promising, although we believe that a major contribution is referable to the multidisciplinary approach rather than the procedure itself. Nevertheless, we demonstrated the feasibility and safety of preventive uterine embolization in patients with placenta previa; in order to establish its prophylactic role in the prevention of peripartum hemorrhage, randomized trial should be carried out, on a larger population.
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Affiliation(s)
- Tatjana Radaelli
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Maria M Ferrari
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Silvia F Duiella
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Federica G Gazzola
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Mauro Campoleoni
- Department of Medical Physics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Claudia Merlini
- Department of Anesthesiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Laura Martinetti
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Maria T Ambrosini
- Department of Anesthesiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Manuela W Ossola
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Antonio Nicolini
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
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18
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Ji SM, Cho C, Choi G, Song J, Kwon MA, Park JH, Kim S. Successful management of uncontrolled postpartum hemorrhage due to morbidly adherent placenta with Resuscitative endovascular balloon occlusion of the aorta during emergency cesarean section - A case report. Anesth Pain Med (Seoul) 2020; 15:314-318. [PMID: 33329830 PMCID: PMC7713836 DOI: 10.17085/apm.19051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/30/2019] [Accepted: 10/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background Morbidly adherent placenta (MAP) may cause life-threatening postpartum hemorrhage (PPH) requiring massive transfusions. Furthermore, it could endanger the lives of both mother and baby. Despite various efforts, such as adjuvant endovascular embolization and hysterectomy, massive PPH due to MAP still occurs and is difficult to overcome. Case Herein, we described the case of a 40-year-old woman with placenta previa totalis who experienced massive bleeding during a cesarean section. We used resuscitative endovascular balloon occlusion of the aorta (REBOA) and it improved the condition of the surgical field and the hemodynamic stability of the patient temporarily. The patient was successfully managed without further complications. Conclusions REBOA can be used as a rescue procedure for uncontrolled bleeding situations in patients with MAPs. Anesthesiologists should consider and recommend REBOA as another resuscitative therapeutic option in the case of massive PPH.
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Affiliation(s)
- Sung Mi Ji
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Chaemin Cho
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Gunhwa Choi
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jaegyok Song
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Min A Kwon
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jeong Heon Park
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Seokkon Kim
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
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19
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Kim MJ, Kim IJ, Kim S, Park IY. Postpartum hemorrhage with uterine artery embolization: the risk of complications of uterine artery embolization. MINIM INVASIV THER 2020; 31:276-283. [PMID: 32662700 DOI: 10.1080/13645706.2020.1789662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the efficacy and adverse effects of uterine artery embolization (UAE) to treat postpartum hemorrhage (PPH) and determine the factors associated with clinical outcomes. MATERIAL AND METHODS This study included 117 patients who underwent UAE for PPH between January 2010 and November 2018. Their medical records were retrospectively reviewed to assess the mode of delivery, causes of bleeding, detailed laboratory results, clinical outcomes, time from delivery to UAE, and embolizing material used. RESULTS The clinical UAE success rate was 99.1%. Late complications were found in 11 patients. Two total hysterectomies were performed. Most PPH cases treated with UAE had early-onset PPH caused by uterine atony. Late-onset PPH was caused by placenta-related problems (remnant placenta, placenta accreta). Body mass index, cesarean section, the use of mixed embolizing materials, placenta abruption as the cause of PPH, and transferred patients were associated with uterine necrosis. Age, re-embolization, and the use of mixed embolizing materials were associated with adverse complications. CONCLUSIONS Although UAE is a safe and effective way to manage PPH, a long-term follow-up is needed to determine the complications of UAE. When uterine necrosis is suspected, prompt and adequate treatment should be performed due to the effects of necrosis on menstrual cycles, fertility, and subsequent pregnancies.
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Affiliation(s)
- Min Jung Kim
- Department of Obstetrics and Gynecology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Il Jung Kim
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shinyoung Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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20
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Makris GC, Byrne G. Post-partum Hemorrhage and Maternal Mortality in Low-Income Countries and the Forgotten Role of Interventional Radiology. Cardiovasc Intervent Radiol 2019; 42:1810-1811. [DOI: 10.1007/s00270-019-02339-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
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21
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LIN X, SUN D, FU J, ZHONG H. [Outcome of re-pregnancy in women with uterine artery embolization for postpartum hemorrhage]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:540-545. [PMID: 31901029 PMCID: PMC8800795 DOI: 10.3785/j.issn.1008-9292.2019.10.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the outcome of re-pregnancy in women with uterine artery embolization(UAE)for postpartum hemorrhage(PPH). METHODS Clinical data of 117 pregnant women with previous PPH admitted in Ningbo Women and Children's Hospital from January 2010 to January 2016 were retrospectively analyzed. Among them 40 cases were treated with UAE (UAE group) and 77 cases were not treated with UAE (control group). The outcomes of re-pregnancy were followed up and compared between two groups. RESULTS There were significant differences in the incidence of induced abortion in early pregnancy and cesarean scars pregnancy (CSP) between the two groups (P<0.05 or P<0.01). In the UAE group, the incidence of PPH, placental accretion and hysterectomy rate was significantly higher than that of control group (P<0.05 or P<0.01). Multivariate analysis showed that UAE was independent risk factor for CSP, placenta accretion, PPH and hystere-ctomy (P<0.05 or P<0.01). CONCLUSIONS The overall fertility and re-pregnant outcomes in women with previous UAE for PPH are favorable. However, the risk of CSP, placenta accretion and associated recurrence of PPH and hysterectomy is higher in women receiving UAE during subsequent pregnancy.
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Affiliation(s)
| | | | | | - Huizhen ZHONG
- 钟惠珍(1966-), 女, 硕士, 主任医师, 硕士生导师, 主要从事妇产科微创治疗及妇科肿瘤研究; E-mail:
;
https://orcid.org/0000-0002-1760-9483
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22
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Fu CJ, Irama W, Wong YC, Tseng HJ, Wang LJ, Yeow KM, Wu CH. Transarterial embolization for postpartum hemorrhage: lessons learned. Acta Radiol 2018; 59:1451-1457. [PMID: 29667848 DOI: 10.1177/0284185118769691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although transarterial embolization (TAE) can powerfully control postpartum hemorrhage (PPH), clinical failure of TAE is not uncommon. PURPOSE To discover whether any parameters could predict timely clinical failure of TAE, then whether a supplementary intervention could be promptly initiated. MATERIAL AND METHODS We retrospectively analyzed 118 TAE procedures in 113 patients with PPH performed at our institution between January 2012 and May 2015. The patients were divided into the following groups: clinically successful TAE and failed TAE. Successful TAE was defined as obviation of supplementary embolization or surgical intervention for hemostasis. Gestational conditions, angiographic factors, maternal vital signs, and laboratory data were compared between the two groups. RESULTS In total, 100 (84.8%) TAEs were clinically successful. Multivariate logistic regression analyses revealed independent risk factors of TAE clinical failure, including the requirement for augmented embolic agents, placental retention, and international normalized ratio > 1.3 ( P = 0.009, 0.001, and 0.005, respectively). The post-TAE shock index was significantly associated with TAE failure, using a cut-off value of 0.8. CONCLUSION The discovered independent risk factors of TAE clinical failure existed before or during the TAE procedure and could not reflect the post-TAE conditions. Although the post-TAE shock index was not an independent factor, it reflected the conditions after TAE and could indicate TAE clinical failure timely.
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Affiliation(s)
- Chen-Ju Fu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Wiwan Irama
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Yon-Cheong Wong
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Hsiao-Jung Tseng
- Center for Big Data Analytics and Statistics, Chang Gung Memorial University, Taiwan
| | - Li-Jen Wang
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Kee-Min Yeow
- Department of Medical Imaging and Intervention, Division of Gastrointestinal Radiology, Chang Gung Memorial Hospital, Chang Gung University, Gueishan, Taoyuan, Taiwan
| | - Cheng-Hsien Wu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
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23
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Meller CH, Garcia-Monaco RD, Izbizky G, Lamm M, Jaunarena J, Peralta O, Otaño L. Non-conservative Management of Placenta Accreta Spectrum in the Hybrid Operating Room: A Retrospective Cohort Study. Cardiovasc Intervent Radiol 2018; 42:365-370. [DOI: 10.1007/s00270-018-2113-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/01/2018] [Indexed: 11/24/2022]
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24
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Manzano-Nunez R, Escobar-Vidarte MF, Orlas CP, Herrera-Escobar JP, Galvagno SM, Melendez JJ, Padilla N, McCarty JC, Nieto AJ, Ordoñez CA. Resuscitative endovascular balloon occlusion of the aorta deployed by acute care surgeons in patients with morbidly adherent placenta: a feasible solution for two lives in peril. World J Emerg Surg 2018; 13:44. [PMID: 30258488 PMCID: PMC6154816 DOI: 10.1186/s13017-018-0205-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 09/11/2018] [Indexed: 02/04/2023] Open
Abstract
Morbidly adherent placenta (MAP), which includes accreta, increta, and percreta, is a condition characterized by the invasion of the uterine wall by placental tissue. The condition is associated with higher odds of massive post-partum hemorrhage. Several interventions have been developed to improve hemorrhage-related outcomes in these patients; however, there is no evidence to prefer any intervention over another. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular intervention that may be useful and effective to reduce hemorrhage and transfusions in MAP patients. The objective of this narrative review is to summarize the evidence for REBOA in patients with MAP. We posit that acute care surgeons can perform REBOA for patients with MAP.
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Affiliation(s)
- Ramiro Manzano-Nunez
- 1Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia.,2Center for Surgery and Public Health - Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Maria F Escobar-Vidarte
- 6Critical Care Obstetrics, Department of Gynecology and Obstetrics, Fundacion Valle del Lili, Cali, Colombia
| | - Claudia P Orlas
- 1Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia.,3Trauma and Acute Care Surgery Division, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia
| | - Juan P Herrera-Escobar
- 2Center for Surgery and Public Health - Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, MA USA
| | | | - Juan J Melendez
- 5Trauma Division and Trauma and Emergency Surgery Fellowship, Universidad del Valle, Cali, Colombia
| | | | - Justin C McCarty
- 2Center for Surgery and Public Health - Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Albaro J Nieto
- 6Critical Care Obstetrics, Department of Gynecology and Obstetrics, Fundacion Valle del Lili, Cali, Colombia
| | - Carlos A Ordoñez
- 3Trauma and Acute Care Surgery Division, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia.,5Trauma Division and Trauma and Emergency Surgery Fellowship, Universidad del Valle, Cali, Colombia
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25
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Kim JE, So YH, Kim BJ, Kim SM, Choi YH, Sung CK. Postpartum hemorrhage from non-uterine arteries: clinical importance of their detection and the results of selective embolization. Acta Radiol 2018; 59:932-938. [PMID: 29065701 DOI: 10.1177/0284185117738547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Identification of the source of postpartum hemorrhage (PPH) is important for embolization because PPH frequently originates from non-uterine arteries. Purpose To evaluate the clinical importance of identifying the non-uterine arteries causing the PPH and the results of their selective embolization. Material and Methods This retrospective study enrolled 59 patients who underwent embolization for PPH from June 2009 to July 2016. Angiographic findings and medical records were reviewed to determine whether non-uterine arteries contributed to PPH. Arteries showing extravasation or hypertrophy accompanying uterine hypervascular staining were regarded as sources of the PPH. The results of their embolization were analyzed. Results Of 59 patients, 19 (32.2%) underwent embolization of non-uterine arteries. These arteries were ovarian (n = 7), vaginal (n = 5), round ligament (n = 5), inferior epigastric (n = 3), cervical (n = 2), internal pudendal (n = 2), vesical (n = 1), and rectal (n = 1) arteries. The embolic materials used included n-butyl cyanoacrylate (n = 9), gelatin sponge particles (n = 8), gelatin sponge particles with microcoils (n = 1), and polyvinyl alcohol particles (n = 1). In 13 patients, bilateral uterine arterial embolization was performed. Re-embolization was performed in two patients with persistent bleeding. Hemostasis was achieved in 17 (89.5%) patients. Two patients underwent immediate hysterectomy due to persistent bleeding. One patient experienced a major complication due to pelvic organ ischemia. One patient underwent delayed hysterectomy for uterine infarction four months later. Conclusion Non-uterine arteries are major sources of PPH. Detection and selective embolization are important for successful hemostasis.
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Affiliation(s)
- Jeong-Eun Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Seoul, Republic of Korea
| | - Young Ho So
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sun Min Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Ho Choi
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Chang Kyu Sung
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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26
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Chen C, Lee SM, Kim JW, Shin JH. Recent Update of Embolization of Postpartum Hemorrhage. Korean J Radiol 2018; 19:585-596. [PMID: 29962865 PMCID: PMC6005941 DOI: 10.3348/kjr.2018.19.4.585] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/06/2017] [Indexed: 12/14/2022] Open
Abstract
Postpartum hemorrhage (PPH) is a life-threatening condition and remains a leading cause of maternal mortality. Transcatheter arterial embolization (TAE) is an effective therapeutic strategy for PPH with the advantages of fast speed, repeatability, and the possibility of fertility preservation. We reviewed the vascular anatomy relevant to PPH, the practical details of TAE emphasizing the timing of embolization, and various clinical conditions of PPH according to a recent literature review.
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Affiliation(s)
- Chengshi Chen
- Department of Radiology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, China.,Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
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27
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Nicholson PJ, O'Connor O, Buckley J, Spence LD, Greene RA, Tuite DJ. Prophylactic Placement of Internal Iliac Balloons in Patients with Abnormal Placental Implantation: Maternal and Foetal Outcomes. Cardiovasc Intervent Radiol 2018; 41:1488-1493. [PMID: 29777276 DOI: 10.1007/s00270-018-1983-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 05/06/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To report on outcomes following the use of prophylactic internal iliac artery occlusion balloons in patients with abnormal placental implantation. METHODS A retrospective analysis was undertaken of patients with abnormal placental implantation who underwent prophylactic iliac balloon placement prior to delivery in a University Maternity Hospital. Various clinical and technical factors were analysed, including technical success of balloon placement, blood loss and number of blood units transfused, duration of surgery, length of stay, hysterectomy rates, complications related to the balloon insertion, foetal pH and infant Apgar scores. RESULTS Twenty-two patients with placenta accreta or a variant thereof underwent caesarean section after first undergoing prophylactic placement of bilateral internal artery balloons. Average follow-up duration was 2.08 years. The average gestational age was 37 weeks 6 days, and the mean gravidity was 2.8. The mean number of previous caesarean sections was 2.4, while the mean maternal age was 35 years. The mean intraoperative blood loss was 1.4 L, and the mean number of blood units transfused was 2. Mean duration of surgery was 90 min, mean total length of hospital stay 7.5 days, while the mean duration of ICU/HDU stay was 1.2 days. The balloons were inflated in 60% of cases and two patients (2/22-9%) underwent subsequent hysterectomy. There were no major maternal complications due to the procedure. CONCLUSION Prophylactic placement of arterial balloons prior to caesarean section in patients with placenta accreta is well tolerated and leads to satisfactory maternal and foetal outcomes with minimal complications.
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Affiliation(s)
| | - Owen O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - John Buckley
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Liam D Spence
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - David J Tuite
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
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Vascular complication after embolization of uterine arteries for postpartum hemorrhage, a case of external iliac artery injury. Eur J Obstet Gynecol Reprod Biol 2018; 224:199-200. [PMID: 29636245 DOI: 10.1016/j.ejogrb.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/08/2018] [Indexed: 11/23/2022]
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Choi W, Shin JH, Kim PH, Han K, Ohm JY, Kim JH, Kim JW. Clinical outcomes of 23 patients who had repeat pelvic arterial embolisation for uncontrolled post-partum haemorrhage at a single centre. Clin Radiol 2018; 73:665-671. [PMID: 29622362 DOI: 10.1016/j.crad.2018.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/13/2018] [Indexed: 01/23/2023]
Abstract
AIM To evaluate the safety and efficacy of repeated pelvic arterial embolisation (PAE) for uncontrolled postpartum haemorrhage (PPH) after a single session of PAE and to compare angiographic findings between the two sessions of PAE. MATERIALS AND METHODS A total of 23 consecutive patients (age range, 23-44 years) who underwent repeated PAE for uncontrolled PPH between March 2001 and January 2016 in Severance Hospital were reviewed. The interval times between the two sessions of PAE, the angiographic findings, embolic materials, arteries embolised during PAE, and the clinical outcomes were reviewed retrospectively. RESULTS Overall clinical success was achieved after repeated PAE in 21 of 23 patients (91.3%). There were no procedure-related, major complications. On angiography, active bleeding from the uterine collateral arteries was more frequently observed in the second session of PAE (p>0.05), and embolisation of the anterior division of the internal iliac artery was significantly higher during the second session of PAE. Use of permanent embolic materials was significantly higher during the second session of PAE. Recanalisation of a previously embolised artery was identified in 14 patients (60.9%) during the second session. CONCLUSION Repeated PAE is safe and effective for managing recurrent bleeding after a single session of PAE. Repeated PAE is related to a higher chance of embolisation of the anterior division of the internal iliac artery, with the use of permanent embolic materials. Recanalisation of a previously embolised artery seems to be a principal source of rebleeding during a repeated session of PAE.
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Affiliation(s)
- W Choi
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - J H Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - P H Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - K Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - J Y Ohm
- Department of Radiology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - J H Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - J W Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
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Lindquist JD, Vogelzang RL. Pelvic Artery Embolization for Treatment of Postpartum Hemorrhage. Semin Intervent Radiol 2018; 35:41-47. [PMID: 29628615 PMCID: PMC5886774 DOI: 10.1055/s-0038-1636520] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Postpartum hemorrhage (PPH) is the leading cause of maternal perinatal morbidity and mortality worldwide. Defined as greater than 500 mL blood loss after vaginal delivery, and greater than 1,000 mL blood loss after cesarean delivery, PPH has many causes, including uterine atony, lower genital tract lacerations, coagulopathy, and placental anomalies. Correction of coagulopathy and identification of the cause of bleeding are mainstays of treatment. Medical therapies such as uterotonics, balloon tamponade, pelvic artery embolization, and uterine-sparing surgical options are available. Hysterectomy is performed when conservative therapies fail. Pelvic artery embolization is safe and effective, and is the first-line therapy for medically refractory PPH. A thorough knowledge of pelvic arterial anatomy is critical. Recognition of variant anatomy can prevent therapeutic failure. Pelvic embolization is minimally invasive, has a low complication rate, spares the uterus, and preserves fertility.
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Affiliation(s)
- Jonathan D. Lindquist
- Division of Interventional Radiology, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Robert L. Vogelzang
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital and McGaw Medical Center, Chicago, Illinois
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Chen T, Xu XQ, Shi HB, Yang ZQ, Zhou X, Pan Y. Conventional MRI features for predicting the clinical outcome of patients with invasive placenta. Diagn Interv Radiol 2018; 23:173-179. [PMID: 28345524 DOI: 10.5152/dir.2016.16412] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate whether morphologic magnetic resonance imaging (MRI) features could help to predict the maternal outcome after uterine artery embolization (UAE)-assisted cesarean section (CS) in patients with invasive placenta previa. METHODS We retrospectively reviewed the MRI data of 40 pregnant women who have undergone UAE-assisted cesarean section due to suspected high risk of massive hemorrhage caused by invasive placenta previa. Patients were divided into two groups based on the maternal outcome (good-outcome group: minor hemorrhage and uterus preserved; poor-outcome group: significant hemorrhage or emergency hysterectomy). Morphologic MRI features were compared between the two groups. Multivariate logistic regression analysis was used to identify the most valuable variables, and predictive value of the identified risk factor was determined. RESULTS Low signal intensity bands on T2-weighted imaging (P < 0.001), placenta percreta (P = 0.011), and placental cervical protrusion sign (P = 0.002) were more frequently observed in patients with poor outcome. Low signal intensity bands on T2-weighted imaging was the only significant predictor of poor maternal outcome in multivariate analysis (P = 0.020; odds ratio, 14.79), with 81.3% sensitivity and 84.3% specificity. CONCLUSION Low signal intensity bands on T2-weighted imaging might be a predictor of poor maternal outcome after UAE-assisted cesarean section in patients with invasive placenta previa.
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Affiliation(s)
- Ting Chen
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Newsome J, Martin JG, Bercu Z, Shah J, Shekhani H, Peters G. Postpartum Hemorrhage. Tech Vasc Interv Radiol 2017; 20:266-273. [DOI: 10.1053/j.tvir.2017.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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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Predelivery uterine arteries embolization in patients affected by placental implant anomalies. Radiol Med 2017; 123:71-78. [PMID: 28756581 DOI: 10.1007/s11547-017-0796-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study is to report on a single center experience of managing patients affected by placenta previa major and/or accretism by embolizing uterine arteries immediately before the cesarean delivery to reduce blood loss and secondary the rate of hysterectomies. MATERIALS AND METHODS Sixty-nine patients have been prospectively enrolled. Inclusion criteria were radiological diagnosis of placenta anomalies and risk factors for peri/postpartum hemorrhage. The delivery was electively scheduled between the 35th week and the 36th week of pregnancy. The embolization procedure was performed in the gynecological operating room with a mobile C-arm by injecting calibrated microparticles 500-700 μm. A contrast-enhanced MRI was acquired in a subgroup of 10 patients 6 months after the delivery to evaluate the uterine wall status. RESULTS Hysterectomy had been performed in 43.5%; 52.2% did not require blood transfusions; 1.2 blood units per patient had been meanly transfused. The mean fluoroscopy beam-on time was 195 s per patient. The mean uterine dose was 26.75 mGy. No pH anomalies were measured from the umbilical cord blood; the Apgar score at 5 min was ≥8. The analysis of the neuro-developmental milestones showed normal cognitive development in all children at 6 months. The uterine wall enhancement evaluated with contrast-enhanced MRI 6 months after the embolization procedure showed preserved myometrial perfusion without area of necrosis. CONCLUSIONS In this series of patients, the predelivery uterine arteries' embolization was a safe and effective procedure; this may represent a technical alternative that interventional radiologists can consider when facing this challenging scenario.
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Angileri SA, Mailli L, Raspanti C, Ierardi AM, Carrafiello G, Belli AM. Prophylactic occlusion balloon placement in internal iliac arteries for the prevention of postpartum haemorrhage due to morbidly adherent placenta: short term outcomes. Radiol Med 2017; 122:798-806. [PMID: 28551762 DOI: 10.1007/s11547-017-0777-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate outcomes of uterine conserving surgery with occlusion balloon technique. A critical review of the complications was performed. MATERIALS AND METHODS Between 2010 and 2016, pregnant women, with a prenatal diagnosis of morbidly adherent placenta (MAP), were treated with occlusion balloon catheters in both internal iliac arteries. Parameters such as need for hysterectomy, incidence of PPH, grade of MAP, estimated blood loss during delivery (EBL) and transfusion requirements, mean recovery time and duration of the balloon inflation, were collected and reviewed. Complications requiring further management were analysed. RESULTS Thirty-seven women with MAP underwent prophylactic occlusion balloon placement (POBC). Mean recovery was 4.48 days (range 2-10). Catheters were successfully positioned and balloons inflated in obstetric theatre following caesarean delivery in 100% of the cases. The uterus was conserved in every case. The MAP grades were 20 percreta, 3 increta and 14 accreta. The EBL was not statistically different between the different grades of placentation. There was a statistically significant association in the number of patients requiring blood transfusions and the degree of placental invasion (p = 0. 0119). PPH occurred in 5 patients (13.5%) and arterial thrombosis in 4 patients (11%). The EBL during delivery was significantly higher (2811 mL) in patients with complications (p = 0.0102). Furthermore, the group of patients that had complications required statistically significant more blood transfusions compared to those without complications (p = 0.0001). No maternal mortality or foetal morbidity occurred. CONCLUSION The utilisation of Prophylactic occlusion balloon catheters allows uterine conserving surgery to be performed safely with few maternal complications.
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Affiliation(s)
- Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì 8, Milan, 20142, Italy
| | - Leto Mailli
- Radiology Department, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Claudio Raspanti
- Interventional Radiology Unit, Careggi Academic and Regional Hospital of Florence, Largo Brambilla 3, Florence, 50134, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì 8, Milan, 20142, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì 8, Milan, 20142, Italy.
| | - Anna-Maria Belli
- Radiology Department, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
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Transcatheter arterial embolization as first-line rescue in intractable primary postpartum hemorrhage: Assessment, outcome, and subsequent fertility. J Formos Med Assoc 2017; 116:380-387. [DOI: 10.1016/j.jfma.2016.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022] Open
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Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1562432. [PMID: 28251148 PMCID: PMC5303842 DOI: 10.1155/2017/1562432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/20/2016] [Accepted: 01/04/2017] [Indexed: 11/17/2022]
Abstract
Although it is widely accepted that uterine artery embolization (UAE) is an effective therapeutic strategy for postpartum hemorrhage (PPH), no consensus has been reached regarding the efficacy of UAE in patients with PPH with disseminated intravascular coagulation (DIC). This single-center retrospective cohort study included patients treated with UAE using NBCA for PPH between 2010 and 2015. The patients were divided into DIC and non-DIC groups, according to the obstetrical DIC score and the overt DIC diagnostic criteria issued by the International Society of Thrombosis and Haemostasis (ISTH), and their clinical outcomes were compared. There were 28 patients treated with UAE using NBCA. Complete hemostasis was achieved by UAE in 19 of 28 patients. In eight of nine patients with unsuccessful hemostasis, surgical hemostatic interventions were performed after UAE, and hemostasis was achieved in seven patients. UAE using NBCA showed no significant intergroup differences in complete hemostasis according to the presence or absence of DIC based on obstetrical DIC score (70% versus 62.5%, P = 1.000) or ISTH DIC score (54.5% versus 76.5%, P = 0.409). UAE using NBCA may be a useful first-choice treatment for PPH with DIC.
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Rosero EB, Joshi GP. Ambulatory Anesthesia in Remote Locations. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pei R, Wang G, Wang H, Huang X, Yan X, Yang X. Efficacy and Safety of Prophylactic Uterine Artery Embolization in Pregnancy Termination with Placenta Previa. Cardiovasc Intervent Radiol 2016; 40:375-380. [PMID: 27853824 DOI: 10.1007/s00270-016-1507-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To appraise the efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa. METHODS A cohort of 54 consecutive patients with placenta previa underwent prophylactic uterine artery embolization before vaginal delivery from February 2012 to March 2015. Vaginal delivery was attempted in all patients. Cesarean section or hysterectomy was introduced when vaginal delivery failed. RESULTS Vaginal delivery succeeded in 50 patients (93.6%) and failed in 4 patients (6.4%), thereupon converted to cesarean delivery. No patients resorted to hysterectomy. Six patients (11.1%) underwent blood transfusion. None of clinical characteristics, including maternal age, gestational age, history of abortion, history of cesarean delivery, and volume of vaginal bleeding, was significantly associated with complete placenta previa (P > 0.05). However, patients with complete placenta previa had a significantly lower successful rate of vaginal delivery than did patients without complete placenta previa (81 vs 100%, P = 0.038). The rate of complications was 3.7%. No major complications were observed. CONCLUSION Uterine artery embolization is an effective and safe technique to assist pregnancy termination with placenta previa, which may lower the risk of cesarean section, hysterectomy, and blood transfusion.
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Affiliation(s)
- Renguang Pei
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China.
| | - Guoxiang Wang
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Heping Wang
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Xinyu Huang
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Xiaoxing Yan
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Xiaohua Yang
- Department of Interventional Therapy, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
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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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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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Niola R, Giurazza F, Nazzaro G, Silvestre M, Nasti G, Di Pasquale MA, Albano G, Valentino L, Sirimarco F, Maglione F. Uterine Artery Embolization before Delivery to Prevent Postpartum Hemorrhage. J Vasc Interv Radiol 2016; 27:376-82. [PMID: 26806693 DOI: 10.1016/j.jvir.2015.12.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the safety and outcomes of uterine artery embolization (UAE) performed before delivery in patients with placental implant anomalies at high risk for peripartum or postpartum hemorrhage. MATERIALS AND METHODS From January 2013 to January 2015, 50 consecutive patients with placental implant anomalies at 35-36 weeks of pregnancy were recruited. UAE was performed superselectively by injecting reabsorbable pledgets. We applied 5 dosimeters to patients' backs to measure the uterine radiation dose, considered to be the same radiation dose that the fetus received. Newborns were assessed immediately after birth and at 6-month follow-up. RESULTS All procedures were technically successful. Of patients, 64% did not require transfusions. Mean blood units transfused was 0.7 U (range, 0-4 U). No patient was transferred to the intensive care unit. Hysterectomy was performed in 13 patients (26%). Mean fluoroscopy operative time was 3 minutes 42 seconds (range, 1 min 21 s-6 min 58 s), and mean uterine radiation dose was 15.61 mGy (range, 8.15-38.18 mGy). Mean time between embolization and delivery was 6 minutes 4 seconds (range, 4 min 18 s-8 min 12 s). The 1-minute and 5-minute Apgar scores were 8-9 in all newborns; 8 newborns were lost to follow-up at 6 months. A normal cognitive outcome was evident in all 42 children studied. CONCLUSIONS UAE before delivery appeared to reduce bleeding during cesarean sections in this consecutive series of patients with placental implant anomalies. In the hands of experienced staff, radiation dose to the fetus was minimal.
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Affiliation(s)
- Raffaella Niola
- Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Francesco Giurazza
- Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy; Radiology Department, Università Campus Bio-Medico di Roma, Via Alvaro Del Portillo 200, Rome 00198, Italy.
| | - Giuseppe Nazzaro
- Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Mattia Silvestre
- Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy; Radiology Department, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Gennaro Nasti
- Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Maria Antonella Di Pasquale
- Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Giuseppe Albano
- Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Liliana Valentino
- Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Fabio Sirimarco
- Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Franco Maglione
- Interventional Radiology Department, Gynecology Department, Physics Department, and Neonatology Department, A.O.R.N. Antonio Cardarelli, Naples, Italy
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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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Eskandari A, Mukherjee A, McHugh J. Transarterial embolization for management of severe postcoital bleeding. SAGE Open Med Case Rep 2016; 4:2050313X16662803. [PMID: 27551425 PMCID: PMC4976789 DOI: 10.1177/2050313x16662803] [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: 02/17/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management. Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion. Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils. Conclusion: Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.
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Affiliation(s)
- Armen Eskandari
- Internal Medicine Program, Riverside County Regional Medical Center, Department of Internal Medicine, University of California Riverside School of Medicine, Moreno Valley, CA, USA
| | - Ashis Mukherjee
- Department of Cardiovascular Medicine, St. Bernardine Medical Center and University of California Riverside School of Medicine, San Bernardino, CA, USA
| | - John McHugh
- Department of Obstetrics and Gynecology, St. Bernardine Medical Center, San Bernardino, CA, USA
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45
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Prophylactic abdominal aorta balloon occlusion during caesarean section: a retrospective case series. Int J Obstet Anesth 2015; 27:3-8. [PMID: 26775894 DOI: 10.1016/j.ijoa.2015.12.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 11/16/2015] [Accepted: 12/05/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The management of patients with morbidly adherent placenta has been described using vascular balloon catheters placed in the iliac arteries, but rarely in the aorta. This case series presents our experience with prophylactic lower abdominal aorta balloon occlusion in 45 women. METHODS The records of patients in our centre who underwent caesarean section between May 2013 and June 2014 were retrospectively analysed for the use of prophylactic lower abdominal aorta balloon occlusion. RESULTS Forty-five cases were identified. All patients had a morbidly adherent placenta, including placenta accreta (n=22), placenta increta (n=20) and placenta percreta (n=3). A subtotal hysterectomy was performed in four cases. Eleven of the 45 patients received red blood cell transfusion of a mean of 1.7 units. Mean preoperative and postoperative haemoglobin concentrations were 10.1g/dL and 9.4g/dL, respectively. Mean estimated blood loss was 835mL [range 200-6000mL]. The incidence of complications was 4.4% (2/45), including one case of lower extremity arterial thrombosis and one case of ischaemic injury to the femoral nerve. Follow up at one year was completed in 22 patients at which time all babies were well. CONCLUSIONS Prophylactic lower abdominal aorta balloon occlusion has the potential to reduce intraoperative blood loss, transfusion and hysterectomy rate in patients with morbidly adherent placenta undergoing caesarean section. Careful patient selection is critical as the technique may be associated with potentially serious complications.
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46
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Soyer P, Dohan A, Dautry R, Guerrache Y, Ricbourg A, Gayat E, Boudiaf M, Sirol M, Ledref O. Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications. Cardiovasc Intervent Radiol 2015; 38:1068-81. [DOI: 10.1007/s00270-015-1054-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/07/2015] [Indexed: 12/21/2022]
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47
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Izbizky G, Meller C, Grasso M, Velazco A, Peralta O, Otaño L, Garcia-Monaco R. Feasibility and Safety of Prophylactic Uterine Artery Catheterization and Embolization in the Management of Placenta Accreta. J Vasc Interv Radiol 2015; 26:162-9; quiz 170. [DOI: 10.1016/j.jvir.2014.10.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/12/2014] [Accepted: 10/13/2014] [Indexed: 11/29/2022] Open
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48
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Park KJ, Shin JH, Yoon HK, Gwon DI, Ko GY, Sung KB. Postpartum hemorrhage from extravasation or pseudoaneurysm: efficacy of transcatheter arterial embolization using N-butyl cyanoacrylate and comparison with gelatin sponge particle. J Vasc Interv Radiol 2014; 26:154-61. [PMID: 25454736 DOI: 10.1016/j.jvir.2014.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 08/16/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) using N-butyl cyanoacrylate (NBCA) for the treatment of active postpartum hemorrhage (PPH) and compare the efficacy of NBCA with gelatin sponge particles. MATERIALS AND METHODS From January 2004 to September 2013, 26 patients with PPH underwent TAE using NBCA as the primary embolic material. All patients were actively bleeding, and 12 (46.2%) had coagulopathy. TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil with or without use of a coil or gelatin sponge. To compare the efficacy of NBCA with conventional embolic material, 50 patients with active bleeding who underwent TAE using gelatin sponge were also analyzed. RESULTS Angiograms demonstrated pseudoaneurysm or extravasation or both. The technical and clinical success rates were 100% and 92.3% (24 of 26 patients), respectively, for NBCA and 98% and 86.0% (43 of 50 patients), respectively, for gelatin sponge. In the NBCA group, one patient recovered with conservative management, and the other patient died because of multiorgan dysfunction. There were no major or minor procedure-related complications. CONCLUSIONS TAE using NBCA as the primary embolic agent is an effective method for treating PPH with extravasation or pseudoaneurysm; NBCA is comparable to gelatin sponge particles. TAE using NBCA seems to fill pseudoaneurysms and make devascularization more effective than using gelatin sponge.
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Affiliation(s)
- Kye Jin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea..
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
| | - Dong-Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea
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49
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Kim D, Moon NR, Lee SR, Won YD, Lee HJ, Park TC, Kim YH. Acquired uterine arteriovenous malformation in a cesarean scar pregnancy. Taiwan J Obstet Gynecol 2014; 52:590-2. [PMID: 24411051 DOI: 10.1016/j.tjog.2013.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/06/2013] [Indexed: 12/23/2022] Open
Affiliation(s)
- Doa Kim
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Na Rae Moon
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Su Rim Lee
- Department of Radiology, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Yu Dong Won
- Department of Radiology, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Hee Joung Lee
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Tai Chul Park
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Yeon Hee Kim
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea.
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50
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Miyahara Y, Makihara N, Yamasaki Y, Ebina Y, Deguchi M, Yamada H. In vitro fertilization-embryo transfer pregnancy was a risk factor for hemorrhagic shock in women with placental polyp. Gynecol Endocrinol 2014; 30:502-4. [PMID: 24693852 DOI: 10.3109/09513590.2014.907259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the risk factors for hemorrhagic shock in women with placental polyp. MATERIALS AND METHODS Twelve women (group A) developed hemorrhagic shock (shock index<1.5) and received uterine artery embolization (UAE). The other 25 women (group B) had shock index<1.5 and did not receive UAE. All women underwent transcervical resection (TCR). The risk factors for the development of hemorrhagic shock, including the age, conception mode, numbers of previous abortion, gestational weeks at termination of pregnancy (TOP), blood loss weights at TOP and at TCR, were analyzed. RESULTS When compared with group B, group A had higher in vitro fertilization-embryo transfer (IVF-ET) pregnancy rate (58.3 versus 12.0%, p<0.01), number of previous abortion (median 1.58 versus 0.68, p<0.05), gestational weeks at TOP (median 36.5 versus 17.0 weeks, p<0.05), and blood loss weight at TOP (median 2151 versus 40 g, p<0.05). A logistic regression analysis reveled that IVF-ET (OR 41, 95% CI 1.3-1264) and blood loss weight at TOP (1.0025, 1.0006-1.0044) were independent risk factors for hemorrhagic shock. CONCLUSIONS For the first time, IVF-ET pregnancy was found to be a risk factor for the development of hemorrhagic shock in women with placental polyp.
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Affiliation(s)
- Yoshiya Miyahara
- Department of Obstetrics and Gynecology, Kobe University , Kobe , Japan
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