Top

CardioVascular and Interventional Radiology

Published in:

01-02-2013 | Clinical Investigation

Postpartum Hemorrhage Treated with Gelfoam Slurry Embolization Using the Superselective Technique: Immediate Results and 1-Month MRI Follow-up

Authors: Olivier Pellerin, Anne-Sophie Bats, Massimiliano Di Primio, Ana Palomera-Ricco, Gabrielle Pinot de Villechenon, Laure Fournier, Jean-Yves Pagny, Bernard Beyssen, Bertrand Louail, Fabrice Lécuru, Marc Sapoval

Published in: CardioVascular and Interventional Radiology | Issue 1/2013

Abstract

Purpose

To evaluate the efficacy and safety of superselective embolization of the uterine arteries in a postpartum hemorrhage.

Materials and Methods

Between November 2004 and January 2011, a total of 44 consecutive women (median ± standard deviation age 34 ± 3 years, range 23–41 years) were referred to our institution for postpartum intractable hemorrhage management. All patients were embolized with a microcatheter that was placed deep into the uterine arteries upstream of the cervical arteries. The embolic agent was a mixture of contrast medium and 5 × 5 × 5 cm pieces of gelfoam (Gelita-Spon) modified into a gelatin emulsion as follows: rapid mixing through a three-way stopcock with two 2.5-ml syringes. A 1-ml syringe was used for injection. One month after embolization, all patients underwent magnetic resonance imaging and clinical examination.

Results

Technical and clinical success was obtained in all cases. Thirty-five patients experienced bleeding related to poor retraction of the uterus, 7 patients because of a tear of the cervix and 2 because of a vaginal hematoma. Pre- and postembolization red blood cell transfusions were (mean ± standard deviation [SD]) 6 ± 1.2 (range 3–8) U and 2 ± 0.7 (range 2–4) U, respectively. One-month magnetic resonance imaging follow-up revealed no sign of ischemic myometrium or necrosis, and no instances of uterine rupture and no pelvic vein thrombosis. Incidental findings included two small intramyometrial hematic collections. All uterine arteries were patent via magnetic resonance angiography. Seventeen patients had concomitant fibroids, all of which appeared hypovascular.

Conclusion

This technique permits good, safe clinical results with no marked damage to the uterine arteries or the uterus itself.

Khan KS, Wojdyla D, Say L et al (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367(9516):1066–1074PubMedCrossRef

Centers for Disease Control and Prevention (1999) Healthier mothers and babies, 1900–1999. JAMA 282:1807–1810CrossRef

Devine PC (2009) Obstetric hemorrhage. Semin Perinatol 33:76–81PubMedCrossRef

Elbourne DR, Prendiville WJ, Carroli G et al (2001) Prophylactic use of oxytocin in the third stage of labour. Cochrane Database Syst Rev (4):CD001808

Jouppila P (1995) Postpartum haemorrhage. Curr Opin Obstet Gynecol 7:446–450PubMedCrossRef

Varner M (1991) Postpartum hemorrhage. Crit Care Clin 7:883–897PubMed

Heaston DK, Mineau DE, Brown BJ, Miller FJ Jr (1979) Transcatheter arterial embolization for control of persistent massive puerperal hemorrhage after bilateral surgical hypogastric artery ligation. AJR Am J Roentgenol 133:152–154PubMed

Brown BJ, Heaston DK, Poulson AM et al (1979) Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol 54:361–365PubMed

Mousa HA, Alfirevic Z (2009) Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 1:CD003249

10.

Pelage JP, Le Dref O, Jacob D et al (1999) Selective arterial embolization of the uterine arteries in the management of intractable post-partum hemorrhage. Acta Obstet Gynecol Scand 78:698–703PubMedCrossRef

11.

Bros S, Chabrot P, Kastler A, Ouchchane L, Cassagnes L, Gallot D, Boyer L (2011) Recurrent bleeding within 24 hours after uterine artery embolization for severe postpartum hemorrhage: are there predictive factors? Cardiovasc Intervent Radiol

12.

Pelage JP, Soyer P, Repiquet D et al (1999) Secondary postpartum hemorrhage: treatment with selective arterial embolization. Radiology 212:385–389PubMed

13.

Pelage JP, Le Dref O, Mateo J et al (1998) Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology 208:359–362PubMed

14.

Sentilhes L, Gromez A, Clavier E et al (2009) Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Obstet Gynecol 113:992–999PubMed

15.

Noonan JB, Coakley FV, Qayyum A et al (2003) MR imaging of retained products of conception. AJR Am J Roentgenol 181:435–439PubMed

16.

Dicle O, Kucukler C, Pirnar T et al (1997) Magnetic resonance imaging evaluation of incision healing after cesarean sections. Eur Radiol 7:31–34PubMedCrossRef

17.

Louail B, Sapoval M, Bonneau M et al (2006) A new porcine sponge material for temporary embolization: an experimental short-term pilot study in swine. Cardiovasc Intervent Radiol 29:826–831PubMedCrossRef

18.

Ganguli S, Stecker MS, Pyne D et al (2011) Uterine artery embolization in the treatment of postpartum uterine hemorrhage. J Vasc Interv Radiol 22:169–176PubMedCrossRef

19.

Courbiere B, Jauffret C, Provansal M et al (2008) Failure of conservative management in postpartum haemorrhage: uterine necrosis and hysterectomy after angiographic selective embolization with gelfoam. Eur J Obstet Gynecol Reprod Biol 140:291–293PubMedCrossRef

20.

Coulange L, Butori N, Loffroy R et al (2009) Uterine necrosis following selective embolization for postpartum hemorrhage using absorbable material. Acta Obstet Gynecol Scand 88:238–240PubMedCrossRef

21.

Kirby JM, Kachura JR, Rajan DK et al (2009) Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol 20:1036–1045PubMedCrossRef

22.

Sone M, Arai Y, Shimizu T et al (2010) Phase I/II multiinstitutional study of uterine artery embolization with gelatin sponge for symptomatic uterine leiomyomata: Japan Interventional Radiology in Oncology Study Group study. J Vasc Interv Radiol 21:1665–1671PubMedCrossRef

Title: Postpartum Hemorrhage Treated with Gelfoam Slurry Embolization Using the Superselective Technique: Immediate Results and 1-Month MRI Follow-up
Authors: Olivier Pellerin
Anne-Sophie Bats
Massimiliano Di Primio
Ana Palomera-Ricco
Gabrielle Pinot de Villechenon
Laure Fournier
Jean-Yves Pagny
Bernard Beyssen
Bertrand Louail
Fabrice Lécuru
Marc Sapoval
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 1/2013
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-012-0355-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Postpartum Hemorrhage Treated with Gelfoam Slurry Embolization Using the Superselective Technique: Immediate Results and 1-Month MRI Follow-up

Abstract

Purpose

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2013

Life-threatening Cerebral Edema Caused by Acute Occlusion of a Superior Vena Cava Stent

Toxicity of Doxorubicin on Pig Liver After Chemoembolization with Doxorubicin-loaded Microspheres: A Pilot DNA-microarrays and Histology Study

US-Guided Femoral and Sciatic Nerve Blocks for Analgesia During Endovenous Laser Ablation

Aberrant Ovarian Collateral Originating from External Iliac Artery During Uterine Artery Embolization

Neointimal Hyperplasia after Silverhawk Atherectomy versus Percutaneous Transluminal Angioplasty (PTA) in Femoropopliteal Stent Reobstructions: A Controlled, Randomized Pilot Trial

Protective Embolization of the Gastroduodenal Artery with a One-HydroCoil Technique in Radioembolization Procedures