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Mitoma T, Maki J, Suemori A, Kuriyama C, Hayata K, Masuyama H. Crucial factors for implementing treatment strategies in intractable atonic postpartum haemorrhage: early phase contrast medium extravasation on dynamic CT. Clin Radiol 2024; 79:73-79. [PMID: 37926646 DOI: 10.1016/j.crad.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
AIM To identify the relationship between contrast medium extravasation (CME) on dynamic contrast-enhanced computed tomography (DCT) and clinical information in intractable atonic postpartum haemorrhage (PPH) and its relevance to treatment with uterine artery embolisation (UAE). MATERIALS AND METHODS Of 90 patients who underwent DCT to diagnose PPH, 60 diagnosed with intractable atonic PPH were investigated retrospectively. Maternal background and clinical indicators were analysed to compare the positive and negative factors of early phase CME. Regression analysis was used to investigate the factors associated with CME. The sensitivity, specificity, and positive and negative predictive values of early phase CME for predicting UAE were calculated. Clinical outcomes were compared between the two groups according to the timing of the decision to undergo UAE. RESULTS Of the 60 patients with intractable atonic PPH, 21 underwent UAE, 20 of whom had early phase CME on DCT. Pre-DCT clinical parameters and clinical indices were not significantly different in presence of early phase CME. Early phase CME was associated with UAE performance, with a sensitivity of 95%, specificity of 87%, positive predictive value of 80%, and negative predictive value of 97%. In cases where UAE was performed after conservative management, there was a significant increase in blood loss and transfusion volume. CONCLUSION Early phase CME is not indicated by background factors or clinical findings. UAE is not required when CME cannot be detected in the uterine cavity. If early phase CME is present, UAE should be considered immediately.
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Affiliation(s)
- T Mitoma
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - J Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - A Suemori
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - C Kuriyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Hayata
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - H Masuyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
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2
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Chen Y, Cao Y, She JY, Chen S, Wang PJ, Zeng Z, Liang CY. Spontaneous rupture of an unscarred uterus during pregnancy: A rare but life-threatening emergency: Case series. Medicine (Baltimore) 2023; 102:e33977. [PMID: 37327264 PMCID: PMC10270498 DOI: 10.1097/md.0000000000033977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
RATIONALE In most cases, uterine rupture occurs during the third trimester of pregnancy or during labor. Even fewer reports have been published about the occurrence of this condition without a gynecologic history of any surgical procedure. Due to their scarcity and variable clinical presentation, early diagnosis of uterine rupture may be difficult, and if the diagnosis is not timely, the condition may be life-threatening. PATIENT CONCERNS Herein, 3 cases of uterine rupture from a single institution are described. Three patients are at different gestational weeks and all have no history of uterine surgery. They came to the hospital due to acute abdominal pain, which is characterized by severe and persistent pain in the abdomen, with no apparent vaginal bleeding. DIAGNOSES All 3 patients were diagnosed with uterine rupture during the operation. INTERVENTIONS One patient underwent uterine repair surgery; while the other 2 underwent subtotal hysterectomy due to persistent bleeding and pathological examination after surgery confirmed placenta implantation. OUTCOMES The patients recovered well after the operation, and no discomfort occurred in the follow-up. LESSONS Acute abdominal pain during pregnancy can pose both diagnostic and therapeutic challenges. It is important to consider the possibility of uterine rupture, even in cases where there is no history of prior uterine surgery. The key to the treatment of uterine rupture is to shorten the diagnosis time as much as possible, this potential complication should be carefully monitored for and promptly addressed to ensure the best possible outcomes for both the mother and the developing fetus.
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Affiliation(s)
- Yue Chen
- The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu, China
- Department of Obstetrics and Gynecology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Ying Cao
- Department of Obstetrics and Gynecology, Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jing-Yao She
- The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Si Chen
- Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu, China
- Department of Obstetrics and Gynecology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Pei-Juan Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu, China
- Department of Obstetrics and Gynecology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Zheng Zeng
- Department of Pathology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Chun-Yun Liang
- The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
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Kawakami N, Uchiyama F, Harada A, Yamada T, Nishimura JI. Two Case Studies on Inferior Mesenteric Artery Embolization for Primary Postpartum Hemorrhage. INTERVENTIONAL RADIOLOGY 2022; 7:26-29. [PMID: 35911872 PMCID: PMC9327405 DOI: 10.22575/interventionalradiology.2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality. Transcatheter arterial embolization (TAE) is an effective treatment option for PPH. Among the vessels embolized, the inferior mesenteric artery (IMA) is usually not the first choice for TAE, because it is a rare source of bleeding in PPH. In this report, we describe our experience with two patients with PPH, in whom the IMA was selected on the basis of contrast-enhanced computed tomography (CECT) findings, and prompt hemostasis was achieved with TAE. CECT can provide useful clues as to the culprit artery based on the anatomical location of the hematoma and extravasation. These useful findings of CECT allow prompt TAE of rare sources of bleeding in PPH, such as the IMA.
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Affiliation(s)
- Naoki Kawakami
- Department of Interventional Radiology, Japanese Red Cross Medical Center
| | - Fumiya Uchiyama
- Department of Interventional Radiology, Japanese Red Cross Medical Center
| | - Akinori Harada
- Department of Interventional Radiology, Japanese Red Cross Medical Center
| | - Tetsuhisa Yamada
- Department of Interventional Radiology, Japanese Red Cross Medical Center
| | - Jun-ichi Nishimura
- Department of Interventional Radiology, Japanese Red Cross Medical Center
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Menon BE, Kaufman CS, Kennedy AM, Ingraham CR, Monroe EJ. Postpartum hemorrhage - what the interventional radiologist should know. CVIR Endovasc 2021; 4:86. [PMID: 34902107 PMCID: PMC8669075 DOI: 10.1186/s42155-021-00277-9] [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: 11/03/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
Postpartum hemorrhage is a leading cause of maternal morbidity and mortality around the world and can be caused by multiple etiologies. Distinguishing between the various etiologies that lead to PPH and identifying high risk features are crucial to implementing effective clinical management. In this review, the diagnostic imaging features and management principles of some of the most important causes of postpartum hemorrhage are discussed, with an emphasis on the pearls and pitfalls when minimally invasive treatment via interventional radiologic techniques are employed.
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Affiliation(s)
- Blaine E Menon
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Claire S Kaufman
- Department of Radiology & Imaging Sciences, University of Utah, 30 North 1900 East, Salt Lake City, Utah, 84132-2140, USA.
| | - Anne M Kennedy
- Department of Radiology & Imaging Sciences, University of Utah, 30 North 1900 East, Salt Lake City, Utah, 84132-2140, USA
| | - Christopher R Ingraham
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Eric J Monroe
- Department of Radiology, University of Wisconsin, 1675 Highland Avenue, Madison, WI, 53792, USA
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Imaging evaluation of uterine perforation and rupture. Abdom Radiol (NY) 2021; 46:4946-4966. [PMID: 34129055 DOI: 10.1007/s00261-021-03171-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022]
Abstract
Uterine perforation and rupture, denoting iatrogenic and non-iatrogenic uterine wall injury, respectively, are associated with substantial morbidity,and at times mortality. Diverse conditions can result in injury to both the gravid and the non-gravid uterus, and imaging plays a central role in diagnosis of such suspected cases. Ultrasound (US) is the initial imaging modality of choice, depicting the secondary signs associated with uterine wall injury and occasionally revealing the site of perforation. Computed tomography can be selectively used to complement US findings, to provide a more comprehensive picture, and to investigate complications beyond the reach of US, such as bowel injury. In certain scenarios, magnetic resonance imaging can be an important problem-solving tool as well. Finally, catheter angiography is a valuable tool with both diagnostic and therapeutic capability, with potential for fertility preservation. In this manuscript, we will highlight the clinical and imaging approach to uterine perforation and rupture, while emphasizing the value of various imaging modalities in this context. In addition, we will review the multi-modality imaging features of uterine perforation and rupture and will address the role of the radiologist as a crucial member of the management team. Finally, a summary diagrammatic depiction of imaging approach to patients presenting with uterine perforation or rupture is provided.
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Sasaki K, Okada T, Yamaguchi M, Ahmed M, Gentsu T, Ueshima E, Sofue K, Tanimura K, Yamada H, Sugimoto K, Murakami T. Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery. Emerg Radiol 2021; 28:1127-1133. [PMID: 34302560 PMCID: PMC8575751 DOI: 10.1007/s10140-021-01971-w] [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: 05/14/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
Purpose To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery. Methods We evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups. Results The combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003). Conclusion S-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.
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Affiliation(s)
- Koji Sasaki
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan.
| | - Masato Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Mostafa Ahmed
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Tomoyuki Gentsu
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Kenji Tanimura
- Department of Obstetrics and Gynaecology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Hideto Yamada
- Department of Obstetrics and Gynaecology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Koji Sugimoto
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
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Zulfiqar M, Shetty A, Yano M, McGettigan M, Itani M, Naeem M, Ratts VS, Siegel CL. Imaging of the Vagina: Spectrum of Disease with Emphasis on MRI Appearance. Radiographics 2021; 41:1549-1568. [PMID: 34297630 DOI: 10.1148/rg.2021210018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The vagina is a median fibromuscular structure of the female reproductive system that extends from the vulva inferiorly to the uterine cervix superiorly. As most vaginal lesions are detected at gynecologic examination, imaging performed for nongynecologic indications can frequently cause concomitant vaginal pathologic conditions to be overlooked. The vagina is often underevaluated at routinely performed pelvic transvaginal US because of a narrow scan area and probe positioning. MRI has progressively become the imaging method of choice for vaginal pathologic conditions, as it provides excellent soft-tissue detail with unparalleled delineation of the complex pelvic floor anatomy and helps establish a diagnosis for most vaginal diseases. It is important that radiologists use a focused approach toward understanding and correctly recognizing different vaginal entities that may otherwise go unnoticed. In this case-based review, the authors discuss the key imaging features of wide-ranging vaginal pathologic conditions, with emphasis on appearance at MRI. Knowledge of vaginal anatomy and embryology is helpful in evaluating congenital anomalies at imaging. Often seen incidentally, vaginal inflammation can cause diagnostic confusion. Because of its central location in the pelvis, the vagina can form fistulas to the urinary bladder, colon, rectum, or anus. Vaginal masses can be neoplastic and nonneoplastic and include a myriad of benign and malignant conditions, some of which have characteristic imaging features. Therapeutic and nontherapeutic vaginal foreign bodies include pessaries, vaginal mesh, and packing that can be seen with or without associated complications. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Anup Shetty
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Motoyo Yano
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Melissa McGettigan
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Muhammad Naeem
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Valerie S Ratts
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
| | - Cary Lynn Siegel
- From the Mallinckrodt Institute of Radiology (M.Z., A.S., M.I., M.N., C.L.S.) and Department of Obstetrics and Gynecology (V.S.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (M.Y.); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla (M.M.); and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M.M.)
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Rand T, Patel R, Magerle W, Uberoi R. CIRSE standards of practice on gynaecological and obstetric haemorrhage. CVIR Endovasc 2020; 3:85. [PMID: 33245432 PMCID: PMC7695782 DOI: 10.1186/s42155-020-00174-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
This CIRSE Standards of Practice document provides best practices for obstetric haemorrhage embolisation (OHE) in the management of postpartum haemorrhage (PPH). The document is aimed at interventional radiologists involved in treating postpartum haemorrhage, and has been developed by a writing group established by the CIRSE Standards of Practice Committee. CIRSE Standards of Practice documents are not clinical practice guidelines and do not intend to impose a standard of care, rather provide reasonable approaches to and best practices for specific interventional radiology treatments and techniques.
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Affiliation(s)
- Thomas Rand
- Institute for Interventional and Diagnostic Radiology, Klinik Floridsdorf, Brünnerstr.68, 1210, Vienna, Austria. .,Scientific research in diagnostics and interventional radiology, Karl Landsteiner Society, St. Pölten, Austria.
| | - Rafiuddin Patel
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Raman Uberoi
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Jung YM, Kim HJ, Choi WS, Park JY, Seong NJ, Oh KJ, Hong JS, Yoon CJ. CT angiography for the management of postpartum hemorrhage refractory to conservative treatment. J Matern Fetal Neonatal Med 2020; 35:4081-4088. [PMID: 33207995 DOI: 10.1080/14767058.2020.1846708] [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] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality. Computerized tomographic (CT) angiography is a useful tool to identify hemorrhage from various conditions. However, the feasibility of CT angiography for the management of PPH has not been well evaluated. OBJECTIVE To evaluate the clinical usefulness of CT angiography in the management of PPH refractory to the conservative treatment. METHODS This retrospective cohort study consisted of 528 consecutive patients who were transferred to our institute after delivery at 28 primary maternity hospitals for the management of PPH between 2009 and 2017. Immediate intervention such as arterial embolization and hysterectomy were performed on 278 patients. Of the remaining 250 patients, CT angiography was performed on 61 patients with hemodynamic stability but with sustained hemorrhage refractory to medical treatment. The diagnostic index was assessed using conventional angiography as the reference standard. The clinical outcome was compared between patients with and without contrast extravasation on CT angiography. RESULTS (1) The prevalence of contrast extravasation was found in 61% of patients (37/61); (2) conventional angiography and arterial embolization were performed in 78% of patients (29/37) with contrast extravasation on CT angiography. Contrast extravasation was confirmed in 83% of patients (24/29) by conventional angiography; (3) among the 24 patients without contrast extravasation on CT angiography, 96% (23/24) were managed conservatively; (4) the patients with contrast extravasation on CT angiography received more packed red blood cell (PRBC) transfusion than those without that condition (7.3 ± 5.2 units vs. 3.8 ± 2.9 units, p = .009). Massive transfusion (defined as transfusion of 10 or more units of PRBC) was more common in patients with contrast extravasation than in those without (27% [10/37] vs. 0% [0/24], p = .004). CONCLUSIONS Conservative treatment succeeded in 96% of patients without contrast extravasation on CT angiography. CT angiography is useful to identify patients requiring intervention in the management of hemorrhage refractory to medical treatment.
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Affiliation(s)
- Young Mi Jung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won Seok Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nak Jong Seong
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University, Seoul, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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10
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Uyeda JW, George E, Reinhold C, Akin EA, Ascher SM, Brook OR, Henrichsen TL, Henwood PC, Learman LA, Maturen KE, Patlas MN, Robbins JB, Sadowski EA, Saphier C, Wall DJ, Glanc P. ACR Appropriateness Criteria® Postpartum Hemorrhage. J Am Coll Radiol 2020; 17:S459-S471. [PMID: 33153557 DOI: 10.1016/j.jacr.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
Postpartum hemorrhage (PPH) can be categorized as primary or early if occurring in the first 24 hours after delivery, whereas late or delayed PPH occurs between 24 hours and 6 weeks. Most of the causes of PPH can be diagnosed clinically, but imaging plays an important role in the diagnosis of many causes of PPH. Pelvic ultrasound (transabdominal and transvaginal with Doppler) is the imaging modality of choice for the initial evaluation of PPH. Contrast-enhanced CT of the abdomen and pelvis and CT angiogram of the abdomen and pelvis may be appropriate to determine if active ongoing hemorrhage is present, to localize the bleeding, and to identify the source of bleeding. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Elizabeth George
- Research Author, University of California San Francisco, San Francisco, California
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Patricia C Henwood
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts; American College of Emergency Physicians
| | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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11
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Ogoyama M, Nakamura H, Ugajin A, Nagayama S, Suzuki H, Takahashi H, Baba Y, Usui R, Matsubara S, Ohkuchi A. Usefulness of dynamic computed tomography for diagnosing and evaluating uterine artery pseudoaneurysms in women with late post‐partum hemorrhage not complicated by retained products of conception. J Obstet Gynaecol Res 2020; 46:249-255. [DOI: 10.1111/jog.14174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/17/2019] [Accepted: 11/19/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Manabu Ogoyama
- Department of Obstetrics and GynecologyJichi Medical University School of Medicine Tochigi Japan
| | - Hiroyasu Nakamura
- Department of RadiologyJichi Medical University School of Medicine Tochigi Japan
| | - Atsushi Ugajin
- Department of RadiologyJichi Medical University School of Medicine Tochigi Japan
| | - Shiho Nagayama
- Department of Obstetrics and GynecologyJichi Medical University School of Medicine Tochigi Japan
| | - Hirotada Suzuki
- Department of Obstetrics and GynecologyJichi Medical University School of Medicine Tochigi Japan
| | - Hironori Takahashi
- Department of Obstetrics and GynecologyJichi Medical University School of Medicine Tochigi Japan
| | - Yosuke Baba
- Department of Obstetrics and GynecologyJichi Medical University School of Medicine Tochigi Japan
| | - Rie Usui
- Department of Obstetrics and GynecologyJichi Medical University School of Medicine Tochigi Japan
| | - Shigeki Matsubara
- Department of Obstetrics and GynecologyJichi Medical University School of Medicine Tochigi Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and GynecologyJichi Medical University School of Medicine Tochigi Japan
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12
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Gui B, Corvino M, Grimaldi PP, Russo L, Marco MD, Valentini AL, Carducci B, Lanzone A, Manfredi R. Multidetector CT appearance of the pelvis after vaginal delivery: normal appearances and abnormal acute findings. ACTA ACUST UNITED AC 2020; 25:210-218. [PMID: 31063140 DOI: 10.5152/dir.2019.18127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaginal delivery is the most commonly performed delivery in the world and accounts for nearly two-thirds of all deliveries in the United States. It is a secure method but may be associated with some acute complications, especially in the immediate postpartum days, which can potentially be fatal for the mother. The most frequent acute complications are hemorrhages/hematomas, uterine rupture, endometritis, retained product of conception (RPOC), ovarian thrombosis and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). A first evaluation of the clinical status of the patients is executed by the clinicians who, depending on their experience, perform ultrasonography by themselves and eventually may request further radiologic exams in doubtful cases. Radiologists may play an important role recognizing early postpartum complications and differentiating them from physiologic postoperative findings. In this setting, the use of multidetector computed tomography (MDCT) is important for diagnosis of suspected postpartum complications. The aim of this article is to review the normal and abnormal post vaginal delivery MDCT aspects in order to help the clinical management by preventing misdiagnoses and tailoring the best medical treatments.
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Affiliation(s)
- Benedetta Gui
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Miriam Corvino
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Pier Paolo Grimaldi
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Russo
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Margo Di Marco
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Lia Valentini
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Brigida Carducci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Antonio Lanzone
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Riccardo Manfredi
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
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13
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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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14
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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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15
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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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16
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Aldo Solari A, Caterina Solari G, Alex Wash F, Marcos Guerrero G, Omar Enríquez G. Hemorragia del postparto. Principales etiologías, su prevención, diagnóstico y tratamiento. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70649-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Takeda A, Koike W, Imoto S, Nakamura H. Author's response to "Avoiding radiation in management of post-partum hemorrhage: CT angiography is not a good idea". Eur J Obstet Gynecol Reprod Biol 2014; 180:195-6. [PMID: 24853820 DOI: 10.1016/j.ejogrb.2014.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 04/22/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
| | - Wataru Koike
- Department of Diagnostic Radiology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Imoto
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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18
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Takeda A, Koike W, Imoto S, Nakamura H. Three-dimensional computerized tomographic angiography for diagnosis and management of intractable postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol 2014; 176:104-11. [PMID: 24630300 DOI: 10.1016/j.ejogrb.2014.02.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/31/2014] [Accepted: 02/13/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report our experience on the value of dynamic three-dimensional computerized tomographic (CT) angiography for immediate diagnosis and management of intractable postpartum hemorrhage (PPH). STUDY DESIGN Retrospective study of all cases of PPH examined by three-dimensional CT angiography between January 2007 and August 2013 in a single center. In each case, emergency dynamic CT was taken at the early arterial, late arterial and venous phases to identify the extravasated contrast agent that represents active hemorrhage. Images for three-dimensional CT angiography were reconstituted from multiplanar CT images. Based on these findings, management procedures were individually determined and those outcomes were compared with angiographic, surgical and clinical findings. RESULTS Twenty-nine cases with primary PPH and 19 cases with secondary PPH were examined. In primary PPH, extravasation in the early arterial phase was noted in 12 cases. Those included vulvovaginal hematoma (n=4), invasive placenta (n=2), retained placenta (n=2), uterine atony (n=1), retroperitoneal hematoma (n=1), retrovesical hematoma (n=1) and rectus sheath hematoma after cesarean section (n=1). Of these, ten cases were treated by transcatheter arterial embolization (TAE) of the offending vessels with or without additional therapies. In secondary PPH, extravasation was identified in 14 cases. Those included invasive placenta (n=8), uterine artery pseudoaneurysm (n=3), uterine arteriovenous fistula (n=2), and subinvolution of placenta bed (n=1), which were treated by TAE of the offending vessels with or without additional therapies. Successful hemostasis with fertility preservation was achieved in all cases. Complications were not identified except for a case of placenta increta that developed secondary amenorrhea after TAE of both uterine arteries. In subsequent gestation after TAE of both uterine arteries, normal vaginal delivery (n=4), uncomplicated cesarean delivery (n=3), cesarean delivery followed by recurrent arteriovenous fistula (n=1) and spontaneous miscarriage followed by recurrent invasive placenta (n=1) were identified. CONCLUSIONS This case series emphasizes that three-dimensional CT angiography has significant diagnostic value when the appropriate procedure for management of PPH was immediately determined to avoid potential maternal morbidity and mortality.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
| | - Wataru Koike
- Department of Diagnostic Radiology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Imoto
- Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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Kawamura Y, Kondoh E, Hamanishi J, Kawasaki K, Fujita K, Ueda A, Kawamura A, Mogami H, Konishi I. Treatment decision-making for post-partum hemorrhage using dynamic contrast-enhanced computed tomography. J Obstet Gynaecol Res 2013; 40:67-74. [PMID: 23937115 DOI: 10.1111/jog.12123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Abstract
AIM Post-partum hemorrhage (PPH) is the leading cause of maternal mortality. Identification of the precise bleeding site is generally important to control hemorrhage, but such an approach has not been fully established in the context of PPH. We postulated that visualization of bleeding sites could aid treatment decisions in the management of PPH. METHODS We conducted a prospective review of 26 patients who underwent dynamic computed tomography (CT) for PPH. RESULTS A total of 17 cases presented with uterine bleeding, eight with vaginal hematomas, and one with hemoperitoneum. Overall, dynamic CT identified contrast media extravasation in the arterial phase in 12 of 26 (46.2%) cases: the upper (n = 4) and the lower uterine segment including the cervix (n = 2), subfascial space (n = 1) and vagina (n = 5). Identification of precise arterial bleeding sites using CT provided informative guidance about where to place balloons for intractable uterine bleeding, and how to manage hemoperitoneum and vaginal hematomas. In addition, dynamic CT revealed the existence of a subtype of uterine atony, which is characterized by focal active arterial bleeding in the upper uterine segment. Furthermore, negative contrast extravasation extracted cases of PPH that were well controlled without the need for surgical or radiological intervention. No patient required emergency hysterectomy to control PPH. CONCLUSION Dynamic CT has potential clinical utility in treatment decision-making for PPH.
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Affiliation(s)
- Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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20
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Sierra A, Burrel M, Sebastia C, Radosevic A, Barrufet M, Albela S, Buñesch L, Domingo MA, Salvador R, Real I. Utility of Multidetector CT in Severe Postpartum Hemorrhage. Radiographics 2012; 32:1463-81. [DOI: 10.1148/rg.325115113] [Citation(s) in RCA: 39] [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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Pinto A, Niola R, Brunese L, Pinto F, Losco M, Romano L. Postpartum hemorrhage: what every radiologist needs to know. Curr Probl Diagn Radiol 2012; 41:102-10. [PMID: 22459890 DOI: 10.1067/j.cpradiol.2011.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Postpartum hemorrhage is among the most common causes of maternal morbidity and mortality. Postpartum hemorrhage is defined as a blood loss of greater than 500 mL or any amount that, if not replaced, could cause shock or death in the mother. The most common cause of postpartum hemorrhage is uterine atony. This occurs when the normal myometrium fails to contract after delivery of the placenta. The initial treatment involves the administration of intravenous oxytocin and uterine massage. If the initial maneuvers fail to stop the postpartum hemorrhage, other techniques, such as uterine packing, suture techniques, uterine or hypogastric artery ligation, can be considered. In the last 30 years, a new angiographic approach for treatment of postpartum hemorrhage has emerged. Pelvic arterial embolization, after emerging as a treatment option to control and prevent pregnancy-related hemorrhage, has been established to be safe and effective. The goal of treatment for all causes of postpartum hemorrhage is cessation of bleeding in a timely fashion, before the onset of consumptive coagulopathy and end organ damage.
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Affiliation(s)
- Antonio Pinto
- Department of Diagnostic Imaging, Section of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy.
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22
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Hemorragia post-parto: embolización terapéutica. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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