Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

Koganemaru, Masamichi; Nonoshita, Masaaki; Iwamoto, Ryoji; Kuhara, Asako; Nabeta, Masakazu; Kusumoto, Masashi; Kugiyama, Tomoko; Kozuma, Yutaka; Nagata, Shuji; Abe, Toshi

doi:10.1007/s00270-016-1309-2

Cited by 10 publications

(11 citation statements)

References 13 publications

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“…Based on the retrospective review of the angiographic finding, the consensus was that additional uterine arterial embolization was unnecessary even in this patient. According to previous reports of PPH from birth canal injury, bleeding could be successfully controlled by super-selective target arterial embolization without uterine artery embolization (18,19). Therefore, it would be desirable to make more efforts to find causative non-uterine arteries when the PPH is not due to uterine atony.…”

Section: Discussionmentioning

confidence: 99%

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Postpartum hemorrhage from non-uterine arteries: clinical importance of their detection and the results of selective embolization

Kim

et al. 2017

Acta Radiol

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Background Identification of the source of postpartum hemorrhage (PPH) is important for embolization because PPH frequently originates from non-uterine arteries. Purpose To evaluate the clinical importance of identifying the non-uterine arteries causing the PPH and the results of their selective embolization. Material and Methods This retrospective study enrolled 59 patients who underwent embolization for PPH from June 2009 to July 2016. Angiographic findings and medical records were reviewed to determine whether non-uterine arteries contributed to PPH. Arteries showing extravasation or hypertrophy accompanying uterine hypervascular staining were regarded as sources of the PPH. The results of their embolization were analyzed. Results Of 59 patients, 19 (32.2%) underwent embolization of non-uterine arteries. These arteries were ovarian (n = 7), vaginal (n = 5), round ligament (n = 5), inferior epigastric (n = 3), cervical (n = 2), internal pudendal (n = 2), vesical (n = 1), and rectal (n = 1) arteries. The embolic materials used included n-butyl cyanoacrylate (n = 9), gelatin sponge particles (n = 8), gelatin sponge particles with microcoils (n = 1), and polyvinyl alcohol particles (n = 1). In 13 patients, bilateral uterine arterial embolization was performed. Re-embolization was performed in two patients with persistent bleeding. Hemostasis was achieved in 17 (89.5%) patients. Two patients underwent immediate hysterectomy due to persistent bleeding. One patient experienced a major complication due to pelvic organ ischemia. One patient underwent delayed hysterectomy for uterine infarction four months later. Conclusion Non-uterine arteries are major sources of PPH. Detection and selective embolization are important for successful hemostasis.

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Section: Discussionmentioning

confidence: 99%

“…Considering the complex pelvic arterial anatomy and the potential vascular anastomotic network around the uterus, non-uterine pelvic arteries are also possible sources of PPH (6). Moreover, non-uterine arteries are major sources of PPH in certain clinical situations such as cases of birth canal laceration (18,19).…”

Section: Discussionmentioning

confidence: 99%

Postpartum hemorrhage from non-uterine arteries: clinical importance of their detection and the results of selective embolization

Kim

et al. 2017

Acta Radiol

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“…The use of permanent embolic materials in many cases of S-TAE may also be related, although embolic materials were not related to the failure of bleeding control in the previous report [8]. We used NBCA for about half of the patients in this study, which is more frequent than previously reported [8][9][10]. Several studies have reported that TAE using NBCA was effective to prevent recanalization, particularly in cases of pseudoaneurysm or active bleeding with extravasation [15,16].…”

Section: Discussionmentioning

confidence: 69%

“…However, intractable PPH due to GTT, where hemostasis by sutures is difficult to achieve, does not require bilateral UAE but rather transcatheter arterial embolization (TAE) of the bleeding point. Several studies have demonstrated the high effectiveness of TAE for intractable PPH due to GTT [8][9][10]. However, some reports have suggested that the blood vessels that cause bleeding due to GTT are diverse, and there is a risk of re-bleeding from anastomotic branches [11,12].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery

et al. 2021

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Purpose To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery. Methods We evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups. Results The combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003). Conclusion S-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.

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“…AEM has been reported as a reliable therapeutic option for PPH, especially for cases of PGHA in which hemostasis cannot be achieved by CM or SURG (Hsu and Wan 1998;Pelage et al 1998;Villella et al 2001;Banovac et al 2007;Baruch et al 2015;Soyer et al 2015;Koganemaru et al 2016; Committee on Practice Bulletins-Obstetrics 2017; Lee et al 2018). Moreover, the efficacy of AEM as the initial treatment for PGHA has recently been reported (Distefano et al 2013;Takagi et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Establishing a Treatment Algorithm for Puerperal Genital Hematoma Based on the Clinical Findings

Soeda

Kyozuka

Kato

et al. 2019

Tohoku J. Exp. Med.

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Postpartum hemorrhage within 24 hours after delivery remains the leading cause of maternal mortality worldwide. Puerperal genital hematoma (PGHA) is a rare complication of postpartum hemorrhage, and PGHA can be life-threatening if hemostasis is not properly achieved. However, a reliable management algorithm for PGHA based on the clinical findings has not been developed. The objectives were to evaluate the management strategies for PGHA and identify the clinical findings that help select the treatment for PGHA. The medical records of women who were treated for PGHA in our department were reviewed, and data regarding the clinical findings and the treatment strategy for PGHA were analyzed. Thirty-four women who underwent treatment for PGHA were identified and divided into three groups according to the final procedure that achieved hemostasis: conservative management (CM) (n = 9), surgical management (SURG) (n = 15), and arterial embolization management (AEM) (n = 10). Regarding the clinical findings on initial evaluation, the shock index was significantly higher in the AEM group than in the CM or SURG group; and initial platelet count and fibrinogen level were significantly lower in the AEM group than in the CM group. There was no significant difference in any computed tomography (CT) finding among the three groups. In conclusion, this study clearly shows the difference in clinical findings among treatment strategies for PGHA. We suggest that the clinical findings of shock index, platelet count, and fibrinogen level together with CT findings are helpful and valuable for selecting the treatment strategy for PGHA.

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Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

Cited by 10 publications

References 13 publications

Postpartum hemorrhage from non-uterine arteries: clinical importance of their detection and the results of selective embolization

Postpartum hemorrhage from non-uterine arteries: clinical importance of their detection and the results of selective embolization

Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery

Establishing a Treatment Algorithm for Puerperal Genital Hematoma Based on the Clinical Findings

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