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European Radiology
Published in: European Radiology 6/2016

01-06-2016 | Vascular-Interventional

Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries

Authors: Alberto Rebonato, Stefano Mosca, Matthias Fischer, Sandro Gerli, Gianluigi Orgera, Luigina Graziosi, Daniele Maiettini, Gian Carlo Di Renzo, Giorgio Epicoco, Miltiadis Krokidis, Michele Rossi, Michele Scialpi

Published in: European Radiology | Issue 6/2016

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Abstract

Objectives

To retrospectively evaluate safety and efficacy of pelvic artery embolisation (PAE) in post-partum haemorrhage (PPH) in abnormal placental implantation (API) deliveries.

Methods

From January 2009 to November 2013, 12 patients with API and intractable intraoperative PPH underwent PAE after caesarean delivery to control a haemorrhage (in four of these cases after hysterectomy). Arterial access was obtained prior to the delivery; PAE was performed in the obstetrics operating room by an interventional radiologist that was present with an interventional radiology (IR) team during the delivery.

Results

PAE was successful in preventing bleeding and avoid hysterectomy in four cases (group A). Uterine atony and disseminated intravascular coagulation caused failure of PAE requiring hysterectomy in four patients (group B). PAE prevented bleeding post-hysterectomy in the remaining four cases (group C). Technical success (cessation of contrast extravasation on angiography or occlusion of the selected artery) was 100 %. Maternal and foetal mortality and morbidity were 0 %.

Conclusions

PAE is a minimal invasive technique that may help to prevent hysterectomy and control PPH in API pregnancies without complications. Embolisation should be performed on an emergency basis. For such cases, an IR team on standby in the obstetrics theatre may be useful to prevent hysterectomy, blood loss and limit morbidity.

Key Points

• Endovascular treatment is a validated technique in post-partum haemorrhage.
• Abnormal placental implantation is a risk factor for post-partum haemorrhage.
• We propose an interventional radiologist standby in the delivery room.
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Metadata
Title
Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries
Authors
Alberto Rebonato
Stefano Mosca
Matthias Fischer
Sandro Gerli
Gianluigi Orgera
Luigina Graziosi
Daniele Maiettini
Gian Carlo Di Renzo
Giorgio Epicoco
Miltiadis Krokidis
Michele Rossi
Michele Scialpi
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-4001-z

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