Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization.

Pelage, Jean-Pierre; Dref, Olivier Le; Matéo, Joaquim; Soyer, Philippe; Jacob, Denis; Kardache, M; Dahan, H.; Repiquet, D; Payen, Didier; Truc, Jean-Bernard; Merland, J J; Rymer, Roland

doi:10.1148/radiology.208.2.9680559

Cited by 237 publications

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“…Of the 13 vaginal deliveries, uterine atony was responsible for the recurrence of PPH in four pregnancies, requiring local procedures (manual removal of placenta, exploration of genital tract, uterine massage) and prostaglandins to stop haemorrhage in three (cases 1,11,14) and embolisation in one (case 3). In the six caesarean deliveries, recurrence of PPH occurred in two, both caused by placenta accreta (cases 17 and 18).…”

Section: Outcome Of Full-term Pregnanciesmentioning

confidence: 99%

“…8 Primary long-term studies suggest that uterine-sparing surgical procedures do not appear to impair subsequent fertility and pregnancy outcomes. [7][8][9][10] Previous studies of women undergoing embolisation have suggested that it does not impair subsequent fertility, [11][12][13][14][15][16][17][18][19][20][21][22][23][24] but the cohort, methodology and follow-up rate of these small case series are limited. 25 Moreover, in the majority of case series, no information is available regarding women with presumed preserved fertility and desire for pregnancy who do not become pregnant.…”

Section: Introductionmentioning

confidence: 99%

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Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Sentilhes

Gromez

Clavier

et al. 2009

BJOG

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Objectives To determine and compare the fertility and pregnancy outcomes following embolisation with or without uterine-sparing surgery for postpartum haemorrhage, and to attempt to identify specific risk factors associated with an increased likelihood of intrauterine synechia.Design Retrospective study.Setting University-affiliated tertiary referral centre.Population All consecutive women who had an embolisation with or without uterine-sparing surgery (vessel ligation and/or uterine compression) for postpartum haemorrhage between 1994 and 2007 were included.Methods Data were retrieved from medical files and telephone interviews.Main outcome measure(s) Fertility and pregnancy outcomes, synechia.Results Data were available for 68 of the 85 women (80%) included in the study. Among the 15 women who complained of amenorrhoea or decreased flow of menstruation, synechia was found in all those who decided to undergo an ambulatory hysteroscopy (n = 8). Seventeen women had 26 pregnancies with 19 term deliveries, one ectopic pregnancy, two abortions and four miscarriages. The clinical courses of the 19 complete gestations were uneventful, but postpartum haemorrhage recurred in six women (31.6%) (caused by placenta accreta in two women). Fertility and pregnancy outcomes did not differ between women who had undergone embolisation versus both embolisation and a uterine-sparing surgical procedure. The occurrence of synechia was significantly associated with a higher rate of placenta accreta/ percreta (P < 0.001) and postpartum fever above 38.5°C (P = 0.04).Conclusions Embolisation, whether or not associated with a uterine-sparing surgical procedure, for postpartum haemorrhage does not appear to compromise a woman's subsequent fertility and obstetric outcome. Nevertheless, these women should be considered at high risk for postpartum haemorrhage during future deliveries.

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Section: Outcome Of Full-term Pregnanciesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Sentilhes

Gromez

Clavier

et al. 2009

BJOG

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“…To stop bleeding, nonsurgical compression (e.g., bimanual compression and balloon tamponade) and surgical compression (e.g., B-lynch suture) have been widely used. Surgical arterial ligation using step-wise devascularization has also been used; however, interventional radiology techniques have been recognized as alternatives to surgery in the past 2 decades [2,4].…”

mentioning

confidence: 99%

Interventional radiology for critical hemorrhage in obstetrics: Japanese Society of Interventional Radiology (JSIR) procedural guidelines

et al. 2015

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“…[10][11][12] Occasionally, failures are rescued by a repeated embolization. [10][11][12] Bleeding after hysterectomy has also been rescued by embolization. 11 There are many advantages to embolization therapy.…”

Section: Conclusion : Une Embolisation De L'artère Utérine Doit êTre mentioning

confidence: 99%

“…[10][11][12] Bleeding after hysterectomy has also been rescued by embolization. 11 There are many advantages to embolization therapy. It appears to be more effective than surgical ligation of vessels and preserves fertility.…”

Section: Conclusion : Une Embolisation De L'artère Utérine Doit êTre mentioning

confidence: 99%

Two cases of hemorrhage secondary to amniotic fluid embolus managed with uterine artery embolization

Goldszmidt

Davies

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To describe the anesthetic management of two cases of amniotic fluid embolus (AFE) and disseminated intravascular coagulation (DIC) who underwent bilateral uterine artery embolization to control their postpartum hemorrhage.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : We report the clinical course and management of two women who suffered sudden cardiorespiratory events during labour. The first patient had a cardiac arrest whereas the second developed respiratory failure and altered neurological status. They were diagnosed as having had an AFE. Both of these events were accompanied by severe postpartum hemorrhage and DIC. They suffered prolonged bleeding and received massive transfusions. Successful management of hemorrhage was optimized by uterine artery embolization, thus avoiding ongoing problems with bleeding and possible hysterectomy. The role of uterine artery embolization is described, along with its advantages and anesthetic considerations.C Co on nc cl lu us si io on n: : Women with severe postpartum hemorrhage, with or without DIC, should be considered for uterine artery embolization. Objectif Conclusion : Une embolisation de l'artère utérine doit être envisagée chez des femmes qui subissent de sévères hémorragies postpartum, avec ou sans CIVD.MNIOTIC fluid embolus (AFE) is one of the most devastating complications of pregnancy. It can be neither predicted nor prevented and therefore remains one of the most feared entities among those caring for pregnant patients. Similar to other embolic phenomena, the clinical presentation and manifestations are quite variable. 1 The development of a consumptive coagulopathy, with or without clinically significant bleeding, appears to be inevitable in most, if not all, patients with AFE. 2 Despite appropriate management of the coagulopathy, the associated morbidity and mortality remain high. 1 The following report describes two patients with the clinical diagnosis of AFE in whom the successful management of the bleeding and coagulopathy were facilitated by uterine artery embolization.

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Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization.

Abstract: Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.

Cited by 237 publications

References 0 publications

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Interventional radiology for critical hemorrhage in obstetrics: Japanese Society of Interventional Radiology (JSIR) procedural guidelines

Two cases of hemorrhage secondary to amniotic fluid embolus managed with uterine artery embolization

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