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Whalen S, Tanious M. Temporary Embolic Agents. Semin Intervent Radiol 2024; 41:226-232. [PMID: 38993593 PMCID: PMC11236451 DOI: 10.1055/s-0044-1786708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Affiliation(s)
- Sydney Whalen
- University of Illinois College of Medicine, Chicago, Illinois
| | - Michael Tanious
- Department of Radiology, University of Illinois Health, Chicago, Illinois
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2
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Ghosh A, Lee S, Lim C, Vogelzang RL, Chrisman HB. Placenta Accreta Spectrum: An Overview. Semin Intervent Radiol 2023; 40:467-471. [PMID: 37927512 PMCID: PMC10622243 DOI: 10.1055/s-0043-1772815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Abheek Ghosh
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sean Lee
- Touro College of Osteopathic Medicine, New York City, New York
| | - Christina Lim
- Creighton University School of Medicine, Omaha, Nebraska
| | - Robert L. Vogelzang
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Howard B. Chrisman
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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Brown SR, Roane B, Caridi TM, Straughn JM, Gunn AJ. Short-term outcomes of uterine artery embolization for urgent or emergent abnormal uterine bleeding. Abdom Radiol (NY) 2023; 48:2443-2448. [PMID: 37145314 DOI: 10.1007/s00261-023-03928-8] [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: 02/19/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To evaluate the outcomes of uterine artery embolization (UAE) for patients with urgent or emergent abnormal uterine bleeding (AUB). MATERIALS AND METHODS Retrospective review of all patients from 1/2009-12/2020 who were treated urgently or emergently with UAE for AUB. Urgent and emergent cases were defined as those requiring inpatient admissions. Demographic data were collected for each patient including hospitalizations related to bleeding and length of stay (LOS) for each hospitalization. Hemostatic interventions other than UAE were collected. Hematologic data were collected before and after UAE including hemoglobin, hematocrit, and transfusion products. Data specific to the UAE procedure included complication rates, 30-day readmission, 30-day mortality, embolic agent, site of embolization, radiation dose, and procedure time. RESULTS 52 patients (median age: 39) underwent 54 urgent or emergent UAE procedures. The most common indications for UAE were malignancy (28.8%), post-partum hemorrhage (21.2%), fibroids (15.4%), vascular anomalies (15.4%), and post-operative bleeding (9.6%). There were no procedure-related complications. Following UAE, 44 patients (84.6%) achieved clinical success and required no additional intervention. Packed red blood cell transfusion decreased from a mean of 5.7 to 1.7 units (p < 0.0001). Fresh frozen plasma transfusion decreased from a mean of 1.8 to 0.48 units (p = 0.012). 50% of patients received a transfusion prior to UAE, while only 15.4% were transfused post-procedure (p = 0.0001). CONCLUSIONS Emergent or urgent UAE is a safe and effective procedure to control AUB hemorrhage secondary to a variety of etiologies.
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Affiliation(s)
- S Rodes Brown
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL, NHB62335249, USA
| | - Brandon Roane
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, WIC1025035233, USA
| | - Theresa M Caridi
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL, NHB62335249, USA
| | - J Michael Straughn
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, WIC1025035233, USA
| | - Andrew J Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL, NHB62335249, USA.
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Jeon GU, Jeon GS, Kim YR, Ahn EH, Jung SH. Uterine artery embolization for postpartum hemorrhage with placenta accreta spectrum. Acta Radiol 2023:2841851231154675. [PMID: 37093745 DOI: 10.1177/02841851231154675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND The reported success rate of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) differs by the cause of bleeding; in some reports, UAE shows less successful results in patients with placenta accreta spectrum (PAS). PURPOSE To evaluate the outcome of UAE for treating PPH associated with PAS. MATERIAL AND METHODS From September 2011 to September 2021, 227 patients (mean age = 34.67±4.06 years; age range = 19-47 years) underwent UAE for managing intractable PPH. Patients were divided into two groups: those with PAS (n = 46) and those without PAS (n = 181). Delivery details, embolization details, and procedure-related outcomes were compared between the two groups. P values <0.05 were considered statistically significant. RESULTS The technical success rate was 96.9% (n = 222) and the clinical success rate was 93.8% (n = 215). There were no significant differences in outcome of UAE between the two patient groups. The technical success rate was 95.7% (n = 44) in patients with PAS and 98.3% (n = 178) in patients without PAS (P = 0.267). The clinical success rate was 91.3% (n = 42) in patients with PAS and 95.6% (n = 173) in patients without PAS (P = 0.269). There were 24 cases of immediate complications, including pelvic pain (n = 20), urticaria (n = 3), and puncture site hematoma (n = 1). No major complication was reported. CONCLUSION UAE is a safe and effective method to control intractable PPH for patients with or without PAS.
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Affiliation(s)
- Go Un Jeon
- Department of Radiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Gyeong Sik Jeon
- Department of Radiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Young Ran Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Eun Hee Ahn
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Sang Hee Jung
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Shang J, Li J, Bai Q, Wang Y, Chen H, Li S. Ultrasound-Guided Urokinase in the Remedy of Spontaneous Vaginal Hematoma After Vaginal Delivery: A Case Report. Int J Womens Health 2023; 15:111-115. [PMID: 36756185 PMCID: PMC9901328 DOI: 10.2147/ijwh.s390835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Vaginal hematoma is commonly treated by traditional incision and sutures. In this report, we describe the treatment of a spontaneous vaginal hematoma after vaginal delivery by ultrasound-guided urokinase injection. Case Presentation A 32-year-old multipara developed a spontaneous vaginal hematoma after vaginal delivery. The hematoma diagnosed via ultrasound examination of the postpartum pelvic basin was located in the posterior vaginal wall, and measured to be 8.92 × 5.71 cm from transvaginal ultrasonography. After considering the size and position of the hematoma, treatment by urokinase injection under ultrasound guidance was selected and performed three times. Forty-two days after the last treatment, the hematoma had disappeared. Discussion and Conclusion For patients in stable condition, when incision and sutures of vaginal hematoma after natural delivery is difficult to perform, urokinase injection under ultrasound guidance can be an effective treatment method that helps in the absorption of the hematoma.
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Affiliation(s)
- Jin Shang
- Department of Ultrasound, The Third People’s Hospital of Yunnan, Kunming, People’s Republic of China
| | - Juan Li
- Department of Obstetrics, The Third People’s Hospital of Yunnan, Kunming, People’s Republic of China
| | - Qing Bai
- Department of Obstetrics, The Third People’s Hospital of Yunnan, Kunming, People’s Republic of China
| | - Yongmei Wang
- Department of Obstetrics, The Third People’s Hospital of Yunnan, Kunming, People’s Republic of China
| | - Hongjian Chen
- Department of Ultrasound, The Third People’s Hospital of Yunnan, Kunming, People’s Republic of China
| | - Shunxu Li
- Department of Obstetrics, The Third People’s Hospital of Yunnan, Kunming, People’s Republic of China,Correspondence: Shunxu Li, Department of Obstetrics, The Third People’s Hospital of Yunnan, No. 292 Beijing Road, Guandu District, Kunming, 650011, People’s Republic of China, Tel +86 15925210080, Fax +86 871 63196549, Email
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Kosai S, Higashihara H, Yano H, Kashiwagi E, Nagai K, Tanaka K, Ono Y, Miyake T, Tomiyama N. Risk Factors Associated with Clinical Failure of Uterine Artery Embolization for Postpartum Hemorrhage. J Vasc Interv Radiol 2023; 34:95-101. [PMID: 36167298 DOI: 10.1016/j.jvir.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 09/05/2022] [Accepted: 09/18/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To identify risk factors for clinical failure of uterine artery embolization (UAE) for postpartum hemorrhage (PPH), with particular attention to the uterine artery diameter. MATERIALS AND METHODS This retrospective study included 47 patients who underwent UAE for PPH between January 1, 2010, and January 31, 2021. Technical success was defined as the completion of embolization of the arteries thought to be the cause of the bleeding. Clinical success was defined as no recurrent bleeding or need for additional therapeutic interventions. Univariate and multivariate analyses were performed to examine the risk factors associated with clinical failure of UAE. RESULTS Of the 47 patients, 6 had recurrent bleeding. Of the 6 patients, 4 underwent hysterectomy, and 2 underwent repeat embolization. The clinical success rate was 87.2% (41/47), with no major adverse events such as uterine infarction or death. In univariate analysis, there were slight differences in multiparity (P = .115) and placental abruption (P = .128) and a significant difference in the findings of a narrow uterine artery on digital subtraction angiography (DSA) (P = .005). In multivariate analysis, only a narrow uterine artery on DSA was a significant factor (odds ratio, 18.5; 95% confidence interval, 2.5-134.8; P = .004). CONCLUSIONS A narrow uterine artery on DSA was a risk factor for clinically unsuccessful UAE for PPH. It may be prudent to conclude the procedure only after it is ensured that vasospasm has been relieved.
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Affiliation(s)
- Shinya Kosai
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of High Precision Image-guided Percutaneous Intervention, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Hiroki Yano
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Eiji Kashiwagi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keisuke Nagai
- Department of Diagnostic Radiology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Kaishu Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsuya Miyake
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Sinha P, Acharya N, Banode P. Repeat Uterine Artery Embolization for Obstetric Hemorrhages: A Rare Event in a Single Patient. Cureus 2022; 14:e29729. [PMID: 36324353 PMCID: PMC9617221 DOI: 10.7759/cureus.29729] [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] [Accepted: 09/29/2022] [Indexed: 11/25/2022] Open
Abstract
This is a case report of a single patient who had two episodes of obstetric hemorrhages, first in the puerperium and second one post medical termination of pregnancy for which the patient had to be managed by uterine artery embolization (UAE). This is a rare case in which this interventional radiological procedure proved life-saving twice in her obstetric history. A 29-year-old woman with an obstetric history of para two and living two (P2L2), presented with a complaint of per-vaginum (p/v) spotting with a history of recent intake of pills for medical termination of pregnancy (MTP). Retained products of conception (RPOC) were ruled out radiologically and she was managed conservatively. She subsequently presented with acute uterine bleed with severe anemia and lethargy. After initial resuscitation and failing of conservative therapy, she was promptly taken up for bilateral UAE. She had also undergone UAE 5 years ago during her puerperal period. Uterine artery embolization is a safe and effective life-saving procedure to control torrential uterine bleed and should be considered when the conservative approach has failed.
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Liu W, Yin W. Effect of Uterine Artery Ligation and Uterine Artery Embolization on Postpartum Hemorrhage Due to Uterine Asthenia after Cesarean Section and Its Effect on Blood Flow and Function of Uterine and Ovarian Arteries. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1337234. [PMID: 35356624 PMCID: PMC8959990 DOI: 10.1155/2022/1337234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/04/2022] [Indexed: 01/10/2023]
Abstract
Objective To investigate the efficacy of uterine artery ligation (UAL) and uterine artery embolization (UAE) in the treatment of uterine asthenia postpartum hemorrhage (PPH) after cesarean section and its effect on uterine and ovarian artery blood flow and function. Methods 100 patients with uterine asthenia PPH after cesarean section in our hospital from January 2018 to November 2020 were randomly divided into 50 cases in the UAL group and 50 cases in the UAE group. They were followed up for 12 months. The bleeding volume, operation time, immediate hemostasis rate, and hemostasis effective rate; lochia clearance time and menstrual rehydration time; RI and S/D; and serum FSH, E2, and LH levels were compared between the two groups. Results Compared with the UAL group, the amount of bleeding in the UAE group was significantly increased and the operation time was significantly shortened (p < 0.05). There was no significant difference in the immediate hemostatic rate and hemostatic effective rate between the two groups (p > 0.05). There was no significant difference in lochia clearance time and menstrual rehydration time between the two groups (p > 0.05). There was no significant difference in RI and S/D between the two groups (p > 0.05). Compared with before the operation, the levels of FSH and LH in the two groups decreased significantly, and the level of E2 increased significantly (p < 0.05). There was no significant difference between the two groups (p > 0.05). Conclusion The efficacy of UAL and UAE in the treatment of PPH with uterine asthenia after cesarean section and its effect on the blood flow and function of uterine and ovarian arteries are equivalent, but the amount of bleeding in UAL is less and the operation time of UAE is shorter. The appropriate operation method can be selected according to the actual situation.
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Affiliation(s)
- Wufen Liu
- Obstetrics and Reproductive Center, Affiliated Hospital of Yunnan University, Kunming 650021, China
| | - Wei Yin
- Obstetrics and Reproductive Center, Affiliated Hospital of Yunnan University, Kunming 650021, China
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Zhu X, Tang J, Huang X, Zhou Y. Diagnostic value of fibrinogen combined with thromboelastogram in postpartum hemorrhage after vaginal delivery. Am J Transl Res 2022; 14:1877-1883. [PMID: 35422901 PMCID: PMC8991141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the diagnostic value of fibrinogen (Fib) combined with thromboelastogram (TEG) in postpartum hemorrhage (PPH) after vaginal delivery. METHODS A total of 120 women who underwent vaginal delivery in our hospital were divided into a PPH group (n=50) and a non-PPH group (n=70). The reaction time (R), clotting time (K), Fib, and D-dimer (D-D) levels were compared between the two groups. Patients in the PPH group were sub-divided into a mild hemorrhage group (n=28) and a severe hemorrhage group (n=22). The receiver operator characteristic curves of R, K, Fib, and D-D for predicting PPH were plotted respectively. RESULTS The levels of R, K, and D-D in the PPH group were significantly higher than those in the non-PPH group. The Fib level was significantly lower than that in the non-PPH group (P<0.05). The severe hemorrhage group had significantly higher maternal R, K, and D-D levels and a significantly lower Fib level than the mild hemorrhage group (P<0.05). Correlation analysis showed that Fib was negatively correlated with R and K, and the D-D was positively correlated with R and K (P<0.05). The area under the curves of R, K, Fib, and D-D were 0.9690, 0.9917, 0.8512, and 0.8771, respectively (P<0.05). CONCLUSION Fib and TEG have good diagnostic values for PPH in women who underwent vaginal delivery, and can better predict PPH, providing evidence for clinical prevention and treatment of PPH.
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Affiliation(s)
- Xiaojuan Zhu
- Department of Ultrasound, Huzhou Central Hospital, Affiliated Hospital of Huzhou UniversityHuzhou 313000, Zhejiang Province, China
| | - Jie Tang
- Department of Gynaecology and Obstetrics, Huzhou Central Hospital, Affiliated Hospital of Huzhou UniversityHuzhou 313000, Zhejiang Province, China
| | - Xiaohong Huang
- Department of Gynaecology and Obstetrics, Huzhou Central Hospital, Affiliated Hospital of Huzhou UniversityHuzhou 313000, Zhejiang Province, China
| | - Ying Zhou
- Department of Gynaecology and Obstetrics, Huzhou Central Hospital, Affiliated Hospital of Huzhou UniversityHuzhou 313000, Zhejiang Province, China
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Affiliation(s)
- Stephanie Wong
- Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Charles E. Ray
- Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois,Address for correspondence Charles E. Ray, Jr., MD, PhD, FSIR 1747 W. Roosevelt Rd., ChicagoIL 60608
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Utilization and Comparative Effectiveness of Uterine Artery Embolization vs. Hysterectomy for Severe Postpartum Hemorrhage: A National Inpatient Sample Study. J Vasc Interv Radiol 2021; 33:427-435.e4. [PMID: 34915166 DOI: 10.1016/j.jvir.2021.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess if uterine artery embolization conferred a lower risk of mortality or prolonged hospital stay compared to hysterectomy in severe post-partum hemorrhage (PPH) and to analyze if geographical or clinical determinants affected which therapy was received. MATERIALS AND METHODS This National Inpatient Sample study from 2005-2017 included all patients with live-birth deliveries. Severe PPH was defined as those requiring transfusion, hysterectomy, or uterine artery embolization (UAE). Propensity score weighting adjusted demographic, maternal, and delivery risk factors were used to assess mortality and prolonged hospital stay. RESULTS Of 9.8 million identified live births, PPH occurred in 31.0 per 1,000. The most common intervention for PPH was transfusion (116.4 per 1,000 cases of PPH). Hysterectomy was used more frequently than UAE (20.4 vs 12.9 per 1,000). The following factors predicted hysterectomy would be used more commonly than UAE: previous cesarean delivery, breech fetal position, placenta previa, transient hypertension of pregnancy without pre-eclampsia, pre-existing hypertension without pre-eclampsia, pre-existing hypertension with pre-eclampsia, unspecified maternal hypertension, and gestational diabetes (all p<0.001). Delivery risk factors associated with greater utilization of hysterectomy over UAE included post-dates pregnancy, premature rupture of membranes, cervical laceration, forceps vaginal delivery, and shock (all p<0.001). There was no difference in mortality between hysterectomy and UAE. After balancing demographic, maternal, and delivery risk factors, the odds of prolonged hospital stay were 0.38 times lower with UAE than hysterectomy (p<0.001). CONCLUSION Despite similar mortality and shorter hospital stays, UAE is used far less than hysterectomy in the management of severe PPH.
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Zhang L, Yang C, Dong W, Du Y, Wang R. Effects of Fu Fang Yi Mu Cao capsules combined with Yiqi Xiaoyu decoction on lochia. Am J Transl Res 2021; 13:12868-12874. [PMID: 34956502 PMCID: PMC8661228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the effects of Fu Fang Yi Mu Cao (FFYMC) capsules combined with Yiqi Xiaoyu (YX) decoction on persistent lochia after birth. METHODS In this retrospective analysis, 120 patients with lochia treated in our hospital from January 2014 to October 2020 were enrolled as study subjects. Sixty of each were randomly allocated into the study group (60 cases, treated with FFYMC capsules and YX decoction) and the control group (60 cases, treated with YX decoction). The two groups were compared in terms of efficacy, volume of lochia and changes in Traditional Chinese Medicine Syndrome Score (TCMSS) before and after intervention, and the incidence of adverse reactions. RESULTS (1) The total effective rate in the study group was 100.00%, which was significantly higher than that in the control group (P<0.05); (2) The difference in volume of lochia between two groups before the intervention was not statistically significant (P>0.05), and was significantly lower in the study group than in the control group at day 4 and day 7 of the intervention (P<0.05); (3) The difference in TCMSS between two groups before the treatment was not statistically significant (P>0.05). TCMSS was lower in the study group than in the control group after treatment (P<0.05); (4) The decreased height of uterine fundus in the study group was higher than that in the control group at 5 d after treatment (P<0.05); (5) The plasma viscosity in the study group was significantly lower than that in the control group (P<0.05); (6) The total incidence of adverse reactions in the study group was 8.33%, which was not significantly different from the control group which was 11.67% (P>0.05). CONCLUSION FFYMC capsule and YX decoction could improve the treatment effect for primiparas with lochia in terms of reducing volume of lochia and improving clinical symptoms with high safety.
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Affiliation(s)
- Liqiao Zhang
- Department of Obstetrics, Xingtai People’s HospitalXingtai 054001, Hebei, China
| | - Chunyan Yang
- Department of Obstetrics, Xingtai People’s HospitalXingtai 054001, Hebei, China
| | - Wei Dong
- Department of Obstetrics, Xingtai People’s HospitalXingtai 054001, Hebei, China
| | - Yaqing Du
- Department of TCM Internal Medicine, Xingtai People’s HospitalXingtai 054001, Hebei, China
| | - Ruiping Wang
- Department of Obstetrics, Xingtai People’s HospitalXingtai 054001, Hebei, China
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Giacalone S, Kottmann A, Darioli V, Carron PN, Desseauve D, Albrecht R, Pasquier M. Clinical characteristics and haemodynamic state of patients undergoing interhospital transfer for postpartum haemorrhage: A study of a single-centre helicopter emergency medical service. Eur J Obstet Gynecol Reprod Biol 2021; 268:48-55. [PMID: 34800817 DOI: 10.1016/j.ejogrb.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Uterine artery embolization is an attractive option for the management of postpartum haemorrhage, however it is not available in every hospital. We compared the clinical characteristics and haemodynamic state of patients with postpartum haemorrhage, before and after helicopter transfer to a tertiary hospital for possible uterine artery embolization. We also analysed whether the type of treatment could modify the outcome. STUDY DESIGN Between 1999 and 2019 in Switzerland, we retrospectively found 82 consecutive patients with postpartum haemorrhage who were transferred by a physician-staffed helicopter emergency medical service to the tertiary hospital for potential uterine artery embolization. The collected data included the type of delivery, estimated blood loss, shock index and blood lactate levels before transfer and at destination, uterine artery embolization rate and hospital mortality rate. Our primary outcome was to describe the clinical characteristics, outcomes and haemodynamic state of the patients with postpartum haemorrhage before and after helicopter transfer. Our secondary outcome was to report the treatments performed at the tertiary hospital. The collected data were analysed with Stata version 14 (Stata Corporation, College Station, TX, USA). Continuous data are compared by using the Student's t-test or the Mann-Whitney U test, as appropriate. RESULTS We included 69 patients. Postpartum haemorrhage occurred after vaginal delivery in 38 cases (55%). Blood loss prior to transfer exceeded 2 L in 34% of cases. The median shock index was 1 (IQR 0.8-1.1) before transfer and 0.9 (IQR 0.8-1.1) after transfer (p = 0.41). The median lactate level was 2.9 mmol/L (IQR 2.1-6.8) before, and 2.1 mmol/L (IQR 1.55-3.5) after transfer (p = 0.90). Forty-four patients underwent uterine artery embolization (64%), with an overall success rate of 93%. One patient died (1.4%), from a haemorrhagic shock of abdominal origin. CONCLUSIONS Interhospital helicopter transfer of patients with postpartum haemorrhage to a tertiary hospital seems to be safe in our setting, despite a significant proportion of patients exhibiting signs of haemodynamic instability. Decision criteria would be helpful to better guide choices regarding the transfer of patients with postpartum haemorrhage.
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Affiliation(s)
- S Giacalone
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - A Kottmann
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland; Swiss Air Ambulance (Rega), Zürich, Switzerland
| | - V Darioli
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - P N Carron
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - D Desseauve
- Department of Gynaecology and Obstetrics, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - R Albrecht
- Swiss Air Ambulance (Rega), Zürich, Switzerland
| | - M Pasquier
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland.
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Sugai S, Nonaka T, Tamegai K, Sato T, Haino K, Enomoto T, Nishijima K. Successful repeated uterine artery embolization in postpartum hemorrhage with disseminated intravascular coagulation: a case report and literature review. BMC Pregnancy Childbirth 2021; 21:710. [PMID: 34686156 PMCID: PMC8532337 DOI: 10.1186/s12884-021-04191-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/12/2021] [Indexed: 01/24/2023] Open
Abstract
Background Postpartum hemorrhage (PPH) is a potentially fatal condition requiring urgent and appropriate intervention. Uterine artery embolization (UAE) has a high hemostatic capacity for PPH, but it may fail. Disseminated intravascular coagulation (DIC) has been reported as a risk factor associated with the failure of UAE. Case presentation A 37-year-old primigravida with dichorionic diamniotic twins and placenta previa underwent cesarean section. The blood loss during surgery was 4950 mL. Hemostasis was achieved using an intrauterine balloon tamponade device. However, she lost a further 2400 mL of blood 5 h after surgery. We embolized both uterine arteries using gelatin sponges and confirmed hemostasis. She was suffering from DIC and received ample blood transfusions. However, a further 1300 mL of blood was lost 18 h after surgery and we performed repeated UAE, with complete recanalization of the uterine arteries on both sides and re-embolization with gelatin sponges. Her DIC was treated successfully by blood transfusions at this time, and she showed no further bleeding after the repeated UAE. Conclusions DIC is a risk factor for the failure of UAE. Repeated UAE may be effective after sufficient improvement of the hematological status in patients with PPH and DIC.
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Affiliation(s)
- Shunya Sugai
- Departments of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, 951-8510, Niigata, Japan.
| | - Taro Nonaka
- Departments of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, 951-8510, Niigata, Japan
| | - Kana Tamegai
- Departments of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, 951-8510, Niigata, Japan
| | - Tatsuhiko Sato
- Radiology and Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazufumi Haino
- Departments of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, 951-8510, Niigata, Japan
| | - Takayuki Enomoto
- Departments of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, 951-8510, Niigata, Japan
| | - Koji Nishijima
- Departments of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, 951-8510, Niigata, Japan
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15
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A systematic review and meta-analysis of obstetric and maternal outcomes after prior uterine artery embolization. Sci Rep 2021; 11:16914. [PMID: 34413380 PMCID: PMC8377070 DOI: 10.1038/s41598-021-96273-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/09/2021] [Indexed: 12/29/2022] Open
Abstract
This study aimed to review the obstetric complications during subsequent pregnancies after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) by exploring the relationship between prior UAE and obstetric complications through a meta-analysis. We conducted a systematic literature review through March 31, 2021, using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials in compliance with the PRISMA guidelines and determined the effect of prior UAE for PPH on the rate of placenta accreta spectrum (PAS), PPH, placenta previa, hysterectomy, fetal growth restriction (FGR), and preterm birth (PTB). Twenty-three retrospective studies (2003–2021) met the inclusion criteria. They included 483 pregnancies with prior UAE and 320,703 pregnancies without prior UAE. The cumulative results of all women with prior UAE indicated that the rates of obstetric complications PAS, hysterectomy, and PPH were 16.3% (34/208), 6.5% (28/432), and 24.0% (115/480), respectively. According to the patient background-matched analysis based on the presence of prior PPH, women with prior UAE were associated with higher rates of PAS (odds ratio [OR] 20.82; 95% confidence interval [CI] 3.27–132.41) and PPH (OR 5.32, 95% CI 1.40–20.16) but not with higher rates of hysterectomy (OR 8.93, 95% CI 0.43–187.06), placenta previa (OR 2.31, 95% CI 0.35–15.22), FGR (OR 7.22, 95% CI 0.28–188.69), or PTB (OR 3.00, 95% CI 0.74–12.14), compared with those who did not undergo prior UAE. Prior UAE for PPH may be a significant risk factor for PAS and PPH during subsequent pregnancies. Therefore, at the time of delivery, clinicians should be more attentive to PAS and PPH when women have undergone prior UAE. Since the number of women included in the patient background-matched study was limited, further investigations are warranted to confirm the results of this study.
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16
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Himiniuc LM, Murarasu M, Toma B, Popovici R, Grigore AM, Scripcariu IS, Oancea M, Grigore M. Transradial Embolization, an Underused Type of Uterine Artery Embolization Approach: A Systematic Review. ACTA ACUST UNITED AC 2021; 57:medicina57020083. [PMID: 33498309 PMCID: PMC7909283 DOI: 10.3390/medicina57020083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: The most utilized approach for the embolization of uterine arteries is the transfemoral path. However, the transradial approach (TRA) has been gaining popularity among cardiologic interventions in the last years but only few studies have shown its applicability in uterine myoma treatment. The objective of this paper is to assess the feasibility, safety and efficacy of TRA when compared with the transbrachial, transulnar or transfemoral approach (TFA) for uterine arteries embolization (UAE). Materials and methods: A systematic review of the literature that analyzes the TRA for UAE it was carried out, in order to assess its safety and effectiveness. It was systematically searched the literature (Google Scholar, PubMed/MEDLINE, Cochrane Library and Embase) using the words ''uterine artery embolization''/''uterine embolization'' and ''transradial''/''radial''. All the relevant papers published until March 2020 were retrieved and analyzed. Results: Ten studies were considered eligible for this topic. TRA is a comparable method with TFA for uterine artery embolization. Conclusions: These studies allowed us to conclude that TRA is as safe and efficient as TFA. Its advantages include few complications, shorter hospitalization period, and rapid mobilization but a steeper learning curve has the disadvantage of a longer learning curve compared to TFA. Yet, these findings are built on few reports and more research is needed.
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Affiliation(s)
- Loredana Maria Himiniuc
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
- Obstetrics and Gynecology Clinical Hospital “Cuza Voda”, 700038 Iasi, Romania;
| | - Mara Murarasu
- Obstetrics and Gynecology Clinical Hospital “Cuza Voda”, 700038 Iasi, Romania;
| | - Bogdan Toma
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
- Obstetrics and Gynecology Clinical Hospital “Cuza Voda”, 700038 Iasi, Romania;
- Correspondence: (B.T.); (M.O.); Tel.: +40-746-054-647 (B.T.); +40-744-374-782 (M.O.)
| | - Razvan Popovici
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
| | - Ana-Maria Grigore
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
| | - Ioana-Sadiye Scripcariu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
| | - Mihaela Oancea
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Iuliu Hateganu”, 400012 Cluj-Napoca, Romania
- Correspondence: (B.T.); (M.O.); Tel.: +40-746-054-647 (B.T.); +40-744-374-782 (M.O.)
| | - Mihaela Grigore
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Gr. T. Popa”, 700015 Iasi, Romania; (L.M.H.); (R.P.); (A.-M.G.); (I.-S.S.); (M.G.)
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17
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Liu S, Li W. Intra-arterial lidocaine for pain control after uterine artery embolization: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2020; 35:4162-4167. [PMID: 33172315 DOI: 10.1080/14767058.2020.1847079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The efficacy of intra-arterial lidocaine for pain control of uterine artery embolization remains controversial. We conduct a systematic review and meta-analysis to explore the influence of intra-arterial lidocaine versus placebo on the postoperative pain intensity of uterine artery embolization. METHODS We searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through April 2020 for randomized controlled trials (RCTs) assessing the effect of intra-arterial lidocaine versus placebo on pain control of uterine artery embolization. This meta-analysis is performed using the random-effect model. RESULTS Three RCTs were included in the meta-analysis. Overall, compared with control group for uterine artery embolization, intra-arterial lidocaine was associated with substantially reduced pain scores at 4 h (SMD = -0.85; 95% CI = -1.31 to -0.38; p = .0003) and analgesic consumption (SMD = -0.84; 95% CI = -1.26 to -0.42; p < .0001), but has no obvious influence on pain scores at 7 h (SMD = -0.19; 95% CI = -0.63 to 0.25; p = .40) or pain scores at 24 h (SMD = -0.55; 95% CI = -1.25 to 0.16; p = .13). CONCLUSIONS Intra-arterial lidocaine is effective for pain control after uterine artery embolization.
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Affiliation(s)
- Shudong Liu
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Wenyan Li
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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18
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Nakashima M, Shimohira M, Nagai K, Ohta K, Sawada Y, Ohba S, Nakayama K, Shibamoto Y. Embolization for acute arterial bleeding: use of the triaxial system and N-butyl-2-cyanoacrylate. MINIM INVASIV THER 2020; 31:389-395. [PMID: 33140983 DOI: 10.1080/13645706.2020.1830801] [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: 01/20/2023]
Abstract
PURPOSE The aim of this study was to evaluate the usefulness of transcatheter arterial embolization (TAE) using the triaxial system with N-butyl-2-cyanoacrylate (NBCA) for acute arterial bleeding in comparison to TAE using the triaxial system with gelatin sponges (GS) and/or coils. MATERIAL AND METHODS Between October 2013 and November 2018, 95 patients with acute arterial bleeding underwent emergency TAE using the triaxial system. Six patients underwent multiple TAEs and thus, 104 TAEs using the triaxial system were performed. In 26 of the 104 cases, TAE were performed with NBCA (NBCA group), and in the remaining 78 cases, TAE were performed with GS and/or coils (control group). RESULTS Hemorrhagic shock and coagulopathy more often occurred in the NBCA group. Procedure time was shorter in the NBCA group. The technical success rate was 100% in both groups (p > 0.99). The clinical success rate in the NBCA and control groups was 92% and 96%, respectively (p = 0.6). There was one minor complication (4%, 1/26) of liver dysfunction in a patient of the NBCA group, but no complication in the control group (p = 0.26). CONCLUSION TAE using the triaxial system with NBCA may be useful for acute arterial bleeding, especially in patients with hemorrhagic shock and coagulopathy.
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Affiliation(s)
- Masahiro Nakashima
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Keiichi Nagai
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Sawada
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Shota Ohba
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Keita Nakayama
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
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19
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Abstract
Postpartum hemorrhage is a leading cause of severe maternal morbidity and mortality worldwide and the United States. While the rates of maternal mortality attributable to hemorrhage are declining, severe maternal morbidity continues to be a growing problem. Efforts in recent years to more appropriately identify patients at risk, define significant hemorrhage, quantify blood loss, and standardize approaches to care in pregnancy and postpartum have led to an increasing preventability of PPH. We aim to review the most current recommendation for the prevention and effective management of obstetric hemorrhage.
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Affiliation(s)
- Veronica Gonzalez-Brown
- Division Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Patrick Schneider
- Division Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA.
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20
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Soyer P, Barat M, Loffroy R, Barral M, Dautry R, Vidal V, Pellerin O, Cornelis F, Kohi MP, Dohan A. The role of interventional radiology in the management of abnormally invasive placenta: a systematic review of current evidences. Quant Imaging Med Surg 2020; 10:1370-1391. [PMID: 32550143 DOI: 10.21037/qims-20-548] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abnormally invasive placenta (AIP) is a potentially severe condition. To date, arterial embolization in women with postpartum hemorrhage due to AIP is the treatment option for which highest degrees of evidence are available. However, other techniques have been tested, including prophylactic catheter placement, balloon occlusion of the iliac arteries and abdominal aorta balloon occlusion. In this systematic review, we provide an overview of the currently reported interventional radiology procedures that are used for the treatment of postpartum hemorrhage due to AIP and suggest recommendations based on current evidences. Owing to a high rate of adverse events, prophylactic occlusion of internal iliac arteries should be used with caution and applied when the endpoint is hysterectomy. On the opposite, when a conservative management is considered to preserve future fertility, uterine artery embolization should be the preferred option as it is associated with a hysterectomy rate of 15.5% compared to 76.5% with prophylactic balloon occlusion of the internal iliac arteries and does not result in fetal irradiation. Limited data are available regarding the application of systematic prophylactic embolization and no comparative studies with arterial embolization are available.
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Affiliation(s)
- Philippe Soyer
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
| | - Maxime Barat
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, UFR des Sciences de Santé, Université de Bourgogne/Franche-Comté, Dijon, France
| | - Matthias Barral
- Department of Radiology, Hopital Tenon, Assistance Publique - Hopitaux de Paris, Paris, France.,Sorbonne University, Paris, France
| | - Raphael Dautry
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, LIIE, CERIMED Aix Marseille Univ, Marseille, France
| | - Olivier Pellerin
- Université de Paris, Descartes-Paris 5, Paris, France.,Department of Interventional Radiology, Hopital Européen Georges Pompidou, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Francois Cornelis
- Department of Radiology, Hopital Tenon, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
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21
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Jitsumori M, Matsuzaki S, Endo M, Hara T, Tomimatsu T, Matsuzaki S, Miyake T, Takiuchi T, Kakigano A, Mimura K, Kobayashi E, Ueda Y, Kimura T. Obstetric Outcomes of Pregnancy After Uterine Artery Embolization. Int J Womens Health 2020; 12:151-158. [PMID: 32184677 PMCID: PMC7064279 DOI: 10.2147/ijwh.s236443] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/20/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Uterine artery embolization (UAE) is used to treat severe postpartum hemorrhage (PPH). According to a few studies, UAE for PPH was associated with preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) in subsequent pregnancies. These previous studies, however, lacked controls, and to the best of our knowledge, no systematic literature reviews have been conducted thus far. We report the results of our retrospective case-control study of pregnancies after UAE at a single center and include a literature review to evaluate the risk of PAS in pregnancies after UAE. METHODS We retrospectively reviewed data from deliveries at our hospital between January 2012 and October 2017. We divided the delivery data into cases with previous UAEs performed for PPH (the post-UAE group) and those without UAEs (the non-UAE group, which included women without previous PPH). We defined PAS as cases in which hysterectomy was performed and pathological examination confirmed the diagnosis. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS We used data from 3155 patients in this study, of whom 16 patients had undergone UAE (post-UAE group) and 3139 had not (non-UAE group). We found no differences between the groups in terms of frequency of preterm births (12.5% versus 14.2%, respectively; OR, 0.863; 95% CI, 0.218 to 3.414; P = 0.84) or FGR (6.2% versus 10.0%, respectively; OR, 0.602; 95% CI, 0.104 to 3.584; P = 0.61). However, cases of PAS were significantly more common in the post-UAE group (37.5%) than in the non-UAE group (1.2%; OR, 50.303; 95% CI, 17.38 to 145.592; P < 0.01). CONCLUSION Our results suggest that previous UAE is a significant risk factor for PAS.
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Affiliation(s)
- Mariko Jitsumori
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeya Hara
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoko Matsuzaki
- Department of Obstetrics and Gynecology, Otemae Hospital, Osaka, Japan
| | - Tatsuya Miyake
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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22
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Lee AY, Ballah D, Moreno I, Dong PR, Cochran R, Picel A, Lee EW, Moriarty J, Padgett M, Nelson K, Kohi MP. Outcomes of balloon occlusion in the University of California Morbidly Adherent Placenta Registry. Am J Obstet Gynecol MFM 2019; 2:100065. [PMID: 33345981 DOI: 10.1016/j.ajogmf.2019.100065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/20/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Morbidly adherent placenta, also known as placenta accreta spectrum, is associated with severe maternal morbidity and mortality. Multiple adjunctive procedures have been proposed to improve outcomes, and at many institutions, interventional radiologists will play a role in assisting obstetricians in these cases. OBJECTIVE The objective of the study was to evaluate the outcomes of women with morbidly adherent placenta who underwent cesarean hysterectomy with aortic balloon occlusion or internal iliac artery balloon occlusion catheters, compared with cesarean hysterectomy with surgical ligation of the iliac arteries, or cesarean hysterectomy without adjunctive procedures. STUDY DESIGN A retrospective review of women with morbidly adherent placenta treated with cesarean hysterectomy was performed at 5 institutions from May 2014 to April 2018. The balloon occlusion group had either prophylactic aortic or iliac balloons placed prior to cesarean hysterectomy. Comparison groups included those who underwent internal iliac artery ligation prior to hysterectomy or a control group if they underwent cesarean hysterectomy without adjuvant procedures. Evaluated outcomes include estimated blood loss, transfusion requirements, intensive care unit admission, and adverse event rates. RESULTS There were 171 women with morbidly adherent placenta included in the study. Twenty-eight had balloon placement prior to cesarean hysterectomy, 18 had intraoperative internal iliac artery ligation, and there were 125 control women who underwent cesarean hysterectomy without any adjunctive procedures. Compared with the women who underwent cesarean hysterectomy without adjunctive procedures, women who underwent aortic or iliac artery balloon occlusion prior to hysterectomy had significantly lower estimated blood loss (30.9% decrease, P < .001), transfusion requirements (76.8% decrease, P < .001), intensive care unit admission rates (0% vs 15.2%, P < .001), and intensive care unit stay lengths (0.0 vs 3.1 days, P < .001). Compared with women who underwent surgical ligation of the internal iliac arteries prior to hysterectomy, women who underwent aortic or iliac artery balloon occlusion prior to cesarean hysterectomy had lower estimated blood loss (54.2% decrease, P < .01), transfusion requirements (90.5% decrease, P < .001), operating room times (40.0% decrease, P < .01), intensive care unit admissions rates (0% vs 77.8%, P < .001), intensive care unit stay lengths (0.0 vs 1.4 days, P < .001), and adverse events (3.6% vs 44.4%, P < .01). CONCLUSION Aortic and iliac artery balloon occlusion are associated with lower estimated blood loss, transfusion requirements, intensive care unit admission rates, and adverse event rates compared with women who underwent internal iliac artery ligation prior to cesarean hysterectomy or women who had no adjunctive interventions prior to cesarean hysterectomy for morbidly adherent placenta.
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Affiliation(s)
- Andrew Y Lee
- Department of Radiology, University of California, Davis, Sacramento, CA
| | - Deddeh Ballah
- Department of Radiology, University of California, San Francisco, San Francisco, CA
| | - Ismael Moreno
- Department of Radiology, University of California, Davis, Sacramento, CA
| | - Paul R Dong
- Department of Radiology, University of California, Davis, Sacramento, CA; Department of Radiology, Sutter Medical Group, Northern California, Sacramento, CA
| | - Rory Cochran
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Andrew Picel
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Edward W Lee
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA
| | - John Moriarty
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA
| | - Max Padgett
- Department of Radiology, University of California, Irvine, Orange, CA
| | - Kari Nelson
- Department of Radiology, University of California, Irvine, Orange, CA
| | - Maureen P Kohi
- Department of Radiology, University of California, San Francisco, San Francisco, CA.
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23
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Ramler PI, Henriquez DDCA, van den Akker T, Caram-Deelder C, Groenwold RHH, Bloemenkamp KWM, van Roosmalen J, van Lith JMM, van der Bom JG. Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study. Acta Obstet Gynecol Scand 2019; 98:1473-1482. [PMID: 31240693 DOI: 10.1111/aogs.13679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The aim of this study was to compare the outcomes of women who were initially managed by intrauterine balloon tamponade or uterine artery embolization because of persistent postpartum hemorrhage demanding an immediate intervention to control bleeding. MATERIAL AND METHODS Propensity score-matched cohort study including women who had intrauterine balloon tamponade or uterine artery embolization as initial management strategy to control persistent postpartum hemorrhage, that is, refractory to first-line therapy combined with at least one uterotonic agent. The primary outcome measure was a composite of peripartum hysterectomy and/or maternal mortality. Secondary outcomes measures were total volume of blood loss and total number of packed red blood cells transfused. RESULTS Our 1:1 propensity score-matched cohort comprised of 50 women who had intrauterine balloon tamponade and 50 women who underwent uterine artery embolization at a blood loss between 1000 and 7000 mL. There was no statistically significant difference in the hysterectomy risk between the two groups (n = 6 in each group, odds ratio [OR] 1.00, 95% confidence interval [CI] .30-3.34), in total volume of blood loss (median 4500 mL, interquartile range [IQR] 3600-5400) for balloon vs 4000 mL (IQR 3250-5000) for embolization, P = 0.382) or in total units of packed red blood cells transfused (median 7 (IQR 5-10) for balloon vs 6 [IQR 4-9] for embolization, P = 0.319). Fifteen women (30%) who were initially managed by an intrauterine balloon still underwent uterine artery embolization, of whom one had an embolization-related thrombo-embolic event. Maternal mortality occurred in neither of the intervention groups. CONCLUSIONS No difference in the risk of peripartum hysterectomy and/or maternal death was observed between women who had intrauterine balloon tamponade and women who underwent uterine artery embolization as an initial management for persistent postpartum hemorrhage. Although this study was underpowered to demonstrate equivalence, our study design provides a framework for future research in which intrauterine balloon tamponade may prove to be a suitable intervention of first choice in the management of persistent postpartum hemorrhage.
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Affiliation(s)
- Paul I Ramler
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Dacia D C A Henriquez
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK.,Faculty of Science, Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands
| | - Camila Caram-Deelder
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Center Wilhelmina Children Hospital, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Faculty of Science, Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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24
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Katz D, Beilin Y. Management of post-partum hemorrhage and the role of the obstetric anesthesiologist. J Matern Fetal Neonatal Med 2019; 34:1487-1493. [PMID: 31257973 DOI: 10.1080/14767058.2019.1638360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW The landscape of post-partum hemorrhage management is rapidly changing. Modifications to definitions, bundles, and care plans occur frequently with management strategies becoming more complex. It has become apparent that the management of these patients requires a multidisciplinary approach with the involvement of obstetricians, anesthesiologists, gynecologist/oncologists, nursing, and care associates. This review article is meant to be an evidence-based review of post-partum hemorrhage with practical recommendations and a look at future directions of the management of post-partum hemorrhage from the vantage point of the obstetric anesthesiologist in an effort to enhance the collaborative treatment of this at risk population.
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Affiliation(s)
- Daniel Katz
- Anesthesiology, Pain, and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yaakov Beilin
- Anesthesiology, Pain, and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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25
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Wang M, Ballah D, Wade A, Taylor AG, Rizzuto G, Li B, Lucero J, Chen LM, Kohi MP. Uterine Artery Embolization following Cesarean Delivery but prior to Hysterectomy in the Management of Patients with Invasive Placenta. J Vasc Interv Radiol 2019; 30:687-691. [PMID: 30922797 PMCID: PMC10468213 DOI: 10.1016/j.jvir.2018.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate outcomes of patients with placenta accreta spectrum (PAS) disorders who underwent uterine artery embolization (UAE) following cesarean delivery but before hysterectomy. MATERIALS AND METHODS A retrospective review of patients with PAS treated with cesarean-hysterectomy (C-hyst) was performed. Patients in the UAE group underwent UAE after cesarean delivery but before hysterectomy; patients in the control group underwent C-hyst alone. Estimated blood loss (EBL), transfusion requirements, length of intensive care unit (ICU) stay, and adverse events were evaluated. RESULTS The study included 31 patients, 7 in the UAE group and 24 in the control group. Median EBL, transfusion requirements, and length of ICU stay in the UAE group compared with control group were 1,500 mL (range, 500-2,000 mL) vs 2,000 mL (range, 1,000-4,500 mL) (P = .04), 150 mL (range, 0-650 mL) vs 550 mL (range, 0-3,125 mL) (P = .10), and 0 d (range, 0-1 d) vs 0.5 d (range, 0-2 d) (P = .07). All patients in the UAE group had placenta increta; patients in the control group had placenta accreta (29%), increta (54%), and percreta (17%) (P = .10). Subgroup analysis of patients with placenta increta demonstrated that the UAE group had a significant decrease in median EBL (P = .004), transfusion requirements (P = .009), and length of ICU stay (P = .04). No adverse events following UAE were noted. CONCLUSIONS UAE following cesarean delivery but before hysterectomy in patients with placenta increta appears to be safe and effective in decreasing EBL, transfusion requirements, and length of ICU stay compared with C-hyst alone.
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Affiliation(s)
- Melinda Wang
- Weill Cornell Medical College, New York, New York
| | - Deddeh Ballah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Alana Wade
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Andrew G Taylor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Gabrielle Rizzuto
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | - Benjamin Li
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Jennifer Lucero
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
| | - Lee-May Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
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26
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Tang F, Du S, Zhao Y, Sun G, Lin Y, Li R, Wu X. Clinical analysis of uterine artery embolization combined with double balloon catheter plus curettage for patients with placenta previa who underwent pregnancy termination and suffered antenatal massive hemorrhage in the 2nd trimester: Three case reports. Medicine (Baltimore) 2019; 98:e14266. [PMID: 30681626 PMCID: PMC6358389 DOI: 10.1097/md.0000000000014266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE It is very difficult to treat patients with placenta previa who underwent pregnancy termination and suffered antenatal massive hemorrhage in the 2nd trimester. PATIENT CONCERNS In this study, case 1 was with fetal malformation of 18-trisomy syndrome at gestation of 19 weeks + 2 days, case 2 was with fetal malformation of 18-trisomy syndrome at gestation of 22 weeks + 1 day, and case 3 was for intrauterine fetal death at gestation of 27 weeks. All the 3 cases were completely placenta previa. DIAGNOSES For the 3 patients, completely placenta previa was confirmed by ultrasound examination after hospitalization and underwent pregnancy termination for fetal death or fetal malformation in the 2nd trimester. INTERVENTIONS The 3 patients with placenta previa underwent pregnancy termination by mifepristone combined with ethacridine lactate in the 2nd trimester for intrauterine fetal death or fetal malformation from June 2017 to May 2018, and suffered antenatal massive hemorrhage during termination. Uterine artery embolization (UAE) was immediately performed to achieve hemostasis, then double balloon catheter (DBC) was carried out to promote cervical ripen, at last curettage was implemented with the help of ultrasound. After all these procedures, the clinical outcomes were observed. OUTCOMES The antenatal bleeding volume of these 3 patients were about 500, 600, and 550 mL. After implementing the combined treatment, all patients completed the abortion. The UAE-DBC time interval and DBC-curettage time interval were 58.4 and 6.0 hours, respectively, for case 1, whereas almost 0 (i.e., immediately) for cases 2 and 3. Case 1 had a fever lasting for 3 days, and the maximum body temperature was up to 39°C after UAE. Moreover, the blood culture was positive for Escherichia coli after curettage in case 1, whereas it was negative in the other 2 cases. LESSONS The UAE-DBC-curettage combined treatment is safe and effective for patients with placenta previa who undergo pregnancy termination and suffered massive antenatal hemorrhage in the 2nd trimester. Future studies are needed to advance our observation.
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Affiliation(s)
- Fei Tang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology
| | - Shuguo Du
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology
| | - Guoqiang Sun
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology
| | - Ying Lin
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology
| | - Ruyan Li
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology
| | - Xufeng Wu
- Department of Gynecology and Oncology, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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