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European Radiology
Published in: European Radiology 3/2013

01-03-2013 | Interventional

Transcatheter arterial embolisation for the management of obstetric haemorrhage associated with placental abnormality in 40 cases

Authors: Sook Min Hwang, Gyeong Sik Jeon, Man Deuk Kim, Sang Heum Kim, Jong Tae Lee, Min Jeong Choi

Published in: European Radiology | Issue 3/2013

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Abstract

Objective

To evaluate pelvic artery embolisation (PAE) in the emergency management of intractable postpartum haemorrhage (PPH) associated with placenta accreta (PA).

Methods

Forty such patients (PAE for PPH/PA) were retrospectively reviewed. Medical records were reviewed regarding the delivery and PAE procedure. Follow-up gynaecological outcomes after PAE were obtained by telephone interviews.

Results

Technical success was achieved in all women (100 %). The initial clinical success rate was 82.5 % (33/40). Three patients with PA underwent hysterectomy after PAE failed to stop the bleeding within 24 h after the embolisation. The other three patients underwent re-embolisation (two patients underwent re-embolisation on the next day and one patient had undergone re-embolisation 6 h after the first embolisation), and bleeding had stopped eventually. The clinical success rate was 92.5 %. There were four cases of immediate complications, such as, pelvic pain, nausea and urticaria. There were three late minor complications, temporary menopause, but no late major complications. After the procedure, 35 patients resumed normal menstruation, including two uncomplicated pregnancies. One patient expired owing to disseminated intravascular coagulopathy and intracerebral haemorrhage, despite successful embolisation.

Conclusion

PAE can be performed safely and effectively for patients with PPH and PA and can preserve the uterus in many patients.

Key Points

• Pelvic artery embolisation (PAE) is an important therapeutic option for postpartum haemorrhage.
• It seems safe and effective for PPH with placenta accreta (PA).
• PAE preserves the uterus and does not impair subsequent menstruation.
• PAE has few major complications.
Literature
1.
Combs CA, Murphy EL, Laros RK Jr (1991) Factors associated with hemorrhage in cesarean deliveries. Obstet Gynecol 77:77–82PubMed
2.
Combs CA, Murphy EL, Laros RK Jr (1991) Factors associated with obstetric hemorrhage with vaginal birth. Obstet Gynecol 77:69–76PubMed
3.
Lund CJ, Donavan JC (1967) Blood volume during pregnancy. Significance of plasma and red cell volumes. Am J Obstet Gynecol 98:394–403PubMed
4.
Roberts WE (1995) Emergent obstetric management of obstetric hemorrhage. Obstet Gynecol Clin North Am 22:283–302PubMed
5.
Eriksson L-G, Mulic-Lutvica A, Jangland L et al (2007) Massive obstetric hemorrhage treated with transcatheter arterial embolization: technical aspects and long-term effects on fertility and menstrual cycle. Acta Radiol 48:635–642PubMedCrossRef
6.
Mazouni C, Gorincour G, Juhan V et al (2008) Placenta accreta: a review of current advances in prenatal diagnosis. Placenta 28:599–603CrossRef
7.
Elsayes KM, Trout AT, Friedkin AM et al (2009) Imaging of the placenta: a multimodality pictorial, review. RadioGraphics 29:1371–1391PubMedCrossRef
8.
9.
American College of Obstetricians and Gynecologists (2006) ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 108:1039–1047CrossRef
10.
Hansch E, Chitkara U, McAlpine J et al (1999) Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience. Am J Obstet Gynecol 180:1454–1460PubMedCrossRef
11.
Mitty HA, Sterling KM, Alvarez M et al (1993) Obstetric hemorrhage: prophylactic and emergency arterial catheterization and embolotherapy. Radiology 188:183–187PubMed
12.
Diop AN, Chabrot P, Bertrand A et al (2010) Placenta accreta: management with uterine artery embolization in 17 cases. J Vasc Interv Radiol 21:644–648PubMedCrossRef
13.
Trévor La Folie T, Vidal V, Mehanna M et al (2007) Results of endovascular treatment in cases of abnormal placentation with post-partum hemorrhage. J Obstet Gynaecol Res 33:624–630PubMedCrossRef
14.
Sofiah S, Med M, Late Y, Fung C et al (2009) Placenta accreta: clinical risk factors, accuracy of antenatal diagnosis and effect on pregnancy outcome. Med J Malaysia 64:298–302PubMed
15.
Jung HN, Shin SW, Choi SJ et al (2011) Uterine artery embolization for emergent management of obstetric hemorrhage associated with placenta accreta. Acta Radiol 52:638–642PubMedCrossRef
16.
Deux JF, Bazot M, Le Blanche AF et al (2001) Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with obstetric hemorrhage? Am J Roentgenol 177:145–149
17.
Drooz AT, Lewis CA, Allen TE et al (2003) Quality improvement guidelines for percutaneous transcatheter embolization. J Vasc Interv Radiol 14:S237–S242PubMed
18.
19.
Doumouchtsis SK, Papageorghiou A, Arulkumaran S (2007) Systematic review of conservative management of postpartum haemorrhage; what to do when medical treatment fails. Obstet Gynecol Surv 62:540–547PubMedCrossRef
20.
Hunter LA (2010) Exploring the role of uterine artery embolization in the management of obstetric hemorrhage. J Perinat Neonatal Nurs 24:207–214PubMed
21.
Pelage JP, Le Dref O, Mateo J et al (1998) Life-threatening primary obstetric hemorrhage: Treatment with emergency selective arterial embolization. Radiology 208:359–362PubMed
22.
Merland JJ, Houdart E, Herbreteau D et al (1996) Place of emergency arterial embolisation in obstetric haemorrhage about 16 personal cases. Eur J Obstet Gynecol Reprod Biol 65:141–143PubMedCrossRef
23.
Cravello L, Petrakian M, Roger V (2008) Placenta accreta: étiologies. Réalités en Gynécologie-Obstétrique 129:24
24.
Clouqueur E, Rubod C, Paquin A et al (2008) Placenta accreta: diagnosis and management in a French type-3 maternity hospital. J Gynecol Obstet Biol Reprod (Paris) 37:499–504CrossRef
25.
Wu S, Kocherginsky M, Hibbard JU (2005) Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 192:1458–1461PubMedCrossRef
26.
Silver RM, Landon MB, Rouse DJ et al (2006) Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107:1226–1232PubMedCrossRef
27.
Choi SJ, Song SE, Jung KL et al (2008) Antepartum risk factors associated with peripartum cesarean hysterectomy in women with placenta previa. Am J Perinatol 25:37–41PubMedCrossRef
28.
29.
Siskin GP, Englander M, Stainken BF et al (2000) Embolic agents used for uterine fibroid embolization. AJR Am J Roentgenol 175:767–773PubMed
30.
Quisling RG, Mickle JP, Ballinger WB et al (1984) Histopathologic analysis of intraarterial polyvinyl alcohol microemboli in rat cerebral cortex. AJNR Am J Neuroradiol 5:101–104PubMed
31.
Chung SK, Kim JK, Yoon W et al (2003) Bronchial artery and non-bronchial systemic artery embolization for the treatment in patients with hemoptysis: analysis of efficacy of Gelfoam single use. J Korean Radiol Soc 49:15–22
32.
Ganguli S, Faintuch S, Salazar GM et al (2008) Postembolization syndrome: changes in white blood cell counts immediately after uterine artery embolization. J Vasc Interv Radiol 19:443–445PubMedCrossRef
33.
Castells A, Bruix J, Ayuso C et al (1995) Transarterial embolization for hepatocellular carcinoma. Antibiotic prophylaxis and clinical meaning of postembolization fever. J Hepatol 22:410–415PubMedCrossRef
34.
Hascalik S, Celik O, Sarac K et al (2004) Transient ovarian failure: a rare complication of uterine fibroid embolization. Acta Obstet Gynecol Scand 83:682–685PubMed
35.
Descargues G, Mauger Tinlot F, Douvrin F et al (2004) Menses, fertility and pregnancy after arterial embolization for the control of postpartum haemorrhage. Hum Reprod 19:339–343PubMedCrossRef
36.
Casele HL, Laifer SA (1997) Successful pregnancy after bilateral hypogastric artery ligation. A case report. J Reprod Med 42:306–308PubMed
37.
Pelage JP, Le Dref O, Soyer P et al (1999) Prise en charge des hémorragies graves du post-partum par embolisation artérielle sélective. J Gynecol Obstet Biol Reprod 28:55–61
38.
Dunson DB, Baird DD, Colombo B (2004) Increased infertility with age in men and women. Obstet Gynecol 103:51–56PubMedCrossRef
Metadata
Title
Transcatheter arterial embolisation for the management of obstetric haemorrhage associated with placental abnormality in 40 cases
Authors
Sook Min Hwang
Gyeong Sik Jeon
Man Deuk Kim
Sang Heum Kim
Jong Tae Lee
Min Jeong Choi
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
European Radiology / Issue 3/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2612-1

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