Effectiveness of Selective Transcatheter Arterial Embolization in Delayed Postpartum Hemorrhage

Abstract

Background: Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide. Delayed PPH has received less attention compared to early PPH because the incidence rate of delayed PPH is relatively lower than that of early PPH. Objectives: The aim of this study was to evaluate the clinical manifestations, angiographic findings, and effectiveness of selective transcatheter arterial embolization (TAE) for delayed PPH. Patients and Methods: Selective TAE was performed on 37 women (mean age: 32.1 years, range: 24-40) with delayed PPH between March 2006 and October 2016. Delayed PPH was defined as continuous hemorrhage from the female genital tract 24 hours to 6 weeks after delivery. Medical records were retrospectively reviewed for patient characteristics, the time interval between delivery and TAE, angiographic findings, embolized artery, embolic materials, technical and clinical success rate, and complications. Results: Delayed bleeding developed at a median 11.6 days (range: 2-34 days) after cesarean section (n = 19) and vaginal delivery (n = 18). On angiography, diffuse hypervascularity was detected in 24 patients, pseudoaneurysm in 11, active extravasation in 1, and arteriovenous malformation in 1. Arteries subjected to TAE included bilateral uterine arteries (UAs) (n = 29), bilateral UAs and unilateral ovarian artery (OA) (n = 4), bilateral UAs and bilateral OAs (n = 1), bilateral UAs and cervicovaginal branch (n = 1), unilateral OA (n = 1), and internal pudendal artery (n = 1). Embolic materials were Gelfoam (n = 30), Gelfoam and coil (n = 3), polyvinyl alcohol (PVA) (n = 2), and PVA and coil (n = 2). There were no procedure-related major complications. Technical success was obtained in all patients (100%), and clinical success was obtained in 34 patients (91.9%) Conclusion: Selective TAE in patients with delayed PPH is a useful treatment with high technical and clinical success.

Usefulness of transcatheter arterial embolization for eighty-three patients with secondary postpartum hemorrhage: Focusing on difference in angiographic findings

“…This study includes a relatively large number of patients and resulted with the clinical success rate of 96.4% (80/83). It clearly shows that TAE was effective for treating secondary PPH which consistently followed the results from other previous studies[ 10 - 12 ]. As aforementioned from the results of this study, there was one major complication related to the embolization.…”

“…In the present study, the angiographic findings of this study are as follows; contrast extravasation ( n = 37, 80.4%), pseudoaneurysm ( n = 8, 17.4%), contrast extravasation with pseudoaneurysm ( n = 1, 2.2%), and indirect bleeding was shown for spastic uterine artery ( n = 2, 5.4%) and hyperemia ( n = 35, 94.6%). The active arterial bleeding sign was 55.4%, which was higher in frequency than 32.4%-48% as from other studies happened to secondary PPH patients[ 10 - 12 ] and it happened more frequently than a larger study in primary PPH patients[ 8 ]. Active bleeding sign was significantly related to multiparity among maternal characteristics.…”

“…Limited studies[ 10 - 12 ] have shown that TAE for secondary PPH is effective and safe. This study aimed to investigate on the usefulness of TAE and whether there were any differences according to angiographic findings in a relatively large number of patients with secondary PPH.…”

“…Since studies on the efficacy and the safety for patients undergoing secondary PPH are limited[ 10 - 12 ], the purpose of this study is to evaluate the effectiveness and the safety of TAE for patients with secondary PPH as well as to identify the differences between the two groups according to the presence and the absence of their active bleeding signs on angiography.…”