Abstract
Purpose
We evaluated the efficacy and predictors of clinical outcome after transcatheter arterial embolization (TAE) for treatment of postpartum hemorrhage with disseminated intravascular coagulation (DIC).
Materials and Methods
Of 127 patients who underwent TAE for postpartum hemorrhage, 46 progressed to DIC (group 1), 81 showed normal range hematological parameters (group 2). We retrospectively evaluated etiology, embolization methods and the efficacy of TAE for intergroup comparison Pearson Chi-Square test and logistic regression model.
Results
Overall TAE failed to control bleeding in 9 patients in spite of technical success. Lower bleeding control rate was found in group 2 (82.6%) relative to group 1 (98.8%, p = 0.001). And embolization methods were not statistically different between two groups no statistically significant predictors associated with failed hemostasis except the amount of transfusion in group 1.
Figures and Tables
References
1. Gilbert L, Porter W, Brown VA. Postpartum haemorrhage--a continuing problem. Br J Obstet Gynaecol. 1987; 94:67–71.
2. Vegas G, Illescas T, Muñoz M, Pérez-Piñar A. Selective pelvic arterial embolization in the management of obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2006; 127:68–72.
3. Badawy SZ, Etman A, Singh M, Murphy K, Mayelli T, Philadelphia M. Uterine artery embolization: the role in obstetrics and gynecology. Clin Imaging. 2001; 25:288–295.
4. Pelage JP, Le Dref O, Mateo J, Soyer P, Jacob D, Kardache M, et al. Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology. 1998; 208:359–362.
5. Deux JF, Bazot M, Le Blanche AF, Tassart M, Khalil A, Berkane N, et al. Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage? AJR Am J Roentgenol. 2001; 177:145–149.
6. Lee SY, Ko GY, Song HY, Gwon DI, Sung KB, Yoon HK. Postpartum bleeding: efficacy of endovascular management. J Korean Radiol Soc. 2003; 48:459–465.
7. Boulleret C, Chahid T, Gallot D, Mofid R, Tran Hai D, Ravel A, et al. Hypogastric arterial selective and superselective embolization for severe postpartum hemorrhage: a retrospective review of 36 cases. Cardiovasc Intervent Radiol. 2004; 27:344–348.
8. Lee JS, Shepherd SM. Endovascular treatment of postpartum hemorrhage. Clin Obstet Gynecol. 2010; 53:209–218.
9. Wi JY, Kim HC, Chung JW, Jun JK, Jae HJ, Park JH. Importance of angiographic visualization of round ligament arteries in women evaluated for intractable vaginal bleeding after uterine artery embolization. J Vasc Interv Radiol. 2009; 20:1031–1035.
10. Bros S, Chabrot P, Kastler A, Ouchchane L, Cassagnes L, Gallot D, et al. Recurrent bleeding within 24 hours after uterine artery embolization for severe postpartum hemorrhage: are there predictive factors? Cardiovasc Intervent Radiol. 2011; [Epub ahead of print].
11. Maassen MS, Lambers MD, Tutein Nolthenius RP, van der Valk PH, Elgersma OE. Complications and failure of uterine artery embolisation for intractable postpartum haemorrhage. BJOG. 2009; 116:55–61.
12. Descargues G, Douvrin F, Degré S, Lemoine JP, Marpeau L, Clavier E. Abnormal placentation and selective embolization of the uterine arteries. Eur J Obstet Gynecol Reprod Biol. 2001; 99:47–52.
13. Gayat E, Resche-Rigon M, Morel O, Rossignol M, Mantz J, Nicolas-Robin A, et al. Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med. 2011; 37:1816–1825.
14. Padmanabhan A, Schwartz J, Spitalnik SL. Transfusion therapy in postpartum hemorrhage. Semin Perinatol. 2009; 33:124–127.
15. Loffroy R, Guiu B, D'Athis P, Mezzetta L, Gagnaire A, Jouve JL, et al. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009; 7:515–523.
16. Aina R, Oliva VL, Therasse E, Perreault P, Bui BT, Dufresne MP, et al. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol. 2001; 12:195–200.
17. Soyer P, Morel O, Fargeaudou Y, Sirol M, Staub F, Boudiaf M, et al. Value of pelvic embolization in the management of severe postpartum hemorrhage due to placenta accreta, increta or percreta. Eur J Radiol. 2011; 80:729–735.