Pelvic Artery Embolization for Treatment of Postpartum Hemorrhage

Lindquist, J.; Vogelzang, Robert L.

doi:10.1055/s-0038-1636520

Cited by 27 publications

(9 citation statements)

References 88 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Only 3 of them were less than gestational age. 53 These numerical values indicated that PAE has no direct effect on the placental blood supply and fetal growth. The formation of collateral circulation develops very quickly after PAE.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

The Emergent Pelvic Artery Embolization in the Management of Postpartum Hemorrhage: A Systematic Review and Meta-analysis

Zhang

Chen

Zhang³

et al. 2021

Obstetrical &Amp; Gynecological Survey

View full text Add to dashboard Cite

Importance Postpartum hemorrhage (PPH) is an emergent obstetric complication and the leading cause of maternal mortality. Pelvic arterial embolization (PAE) is an effective treatment for intractable PPH. However, a unique protocol has not been accepted in obstetrical practice. Objective To evaluate its efficiency, safety, complications, and outcomes, we conducted a systematic review and meta-analysis of PAE for PPH in the literature. Evidence Acquisition The Medline, the database of abstract of reviews, the index to allied health literature, and the Chinese database Sino-Med were searched on March 31, 2020, for studies on PAE for PPH. The data for PAE indication, agents, arteries, success rate, complications, and outcomes were extracted and syncretized for meta-analysis. Results From 1075 identified articles, 113 abstracts or full articles were retrieved and 43 studies were finally identified as meeting the including criteria. The results demonstrated that the indications for PAE were as follows: uterine atony, placental abnormality, delivery tract injury, disseminated intravascular coagulation, arteriovenous malformation, and vaginal hematoma. The embolization agents mostly in order were gelatin sponge particles, polyvinyl alcohol particles, Gelfoam, N -butyl cyanoacrylate, microcoil, and glue; for arteries, they were mostly uterine artery and internal iliac artery. The clinical success rate was 90.5%, whereas the technical success rate was 99.3%. The most common complications of PAE were postembolization syndrome and menstrual abnormality. Conclusions and Relevance The emergent PAE is a safe and effective method with high success rate in life-threatening PPH management. Gelatin sponge granules measuring 500 to 1000 μm in diameter have safe results. Pelvic arterial embolization may affect the recovery of menses and increase PPH in the subsequent pregnancy, but there was no noted correlation with fetal growth restriction. Target Audience Obstetricians and gynecologist, family physicians Learning Objectives After participating in this activity, physicians should be better able to explain the causes of PPH; identify which arteries should be chosen for embolization; and describe the advantages of PAE for PPH management.

show abstract

Section: Discussionmentioning

confidence: 98%

“…The current literature suggests using a diameter of 500 to 1000 μm gelatin sponge granules for embolization in PPH. 16 , 53 Other embolic agents are used less often. Hemostasis of NBCA is based on the mechanism of rapid polymerization and hardening in an ionic fluid without abundant clotting factor.…”

Section: Discussionmentioning

confidence: 99%

The Emergent Pelvic Artery Embolization in the Management of Postpartum Hemorrhage: A Systematic Review and Meta-analysis

Zhang

Chen

Zhang³

et al. 2021

Obstetrical &Amp; Gynecological Survey

View full text Add to dashboard Cite

show abstract

“…This technique has been validated by some other authors, too [13, 16, 17]. In cases with unsuccessful attempts of intraoperative bleeding control, intraoperative or postoperative embolization may be the procedure of choice [18].…”

Section: Discussionmentioning

confidence: 99%

Management and Morbidity of Major Pelvic Hemorrhage in Complex Abdominopelvic Surgery

Aytac,

Sökmen,

Öztürk

et al. 2023

Eur Surg Res

View full text Add to dashboard Cite

Introduction: Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management and factors associated with morbidity in patients experiencing major pelvic hemorrhage during complex abdomino-pelvic surgery. Methods: Patients who had major intraoperative pelvic hemorrhage during complex abdomino-pelvic surgery at 11 tertiary referral centers between 1997-2017 were included. Patient characteristics, management strategies to control bleeding, short and long term postoperative outcomes were evaluated retrospectively. Results: There were 120 patients with a mean age of 56.6± 2.4 years and a mean BMI of 28.3 ± 1 kg/m2. While 104 (95%) of the patients were operated for malignancy, 16(5%) of the patients had surgery for a benign disease. The most common bleeding site was the presacral venous plexus 90(75%). Major pelvic hemorrhage was managed simultaneously in 114(95 %) patients. Electrocauterization 27(23%), pelvic packing 26(22%), suturing 7(6%), thumbtacks application 7(6%), muscle welding 4(4%), use of energy devices 2(2%) and topical hemostatic agents 2(2%) were the management tools. Combined techniques were used in 43(36%) patients. Short-term morbidity and mortality rates were 48(40%) and 2(2%), respectively. High preoperative CRP levels(p=0.04), history of preoperative radiotherapy (p=0.04), longer bleeding time (p=0.006) and increased blood transfusion (p=0.005) were the factors associated with postoperative morbidity. Discussion/Conclusion: Postoperative morbidity related to major pelvic hemorrhage can be reduced by optimizing the risk factors. Prehabilitation prior to surgery to moderate inflammatory status and prompt action with proper technique to control major pelvic hemorrhage can prevent excessive blood loss in complex abdomino-pelvic surgery.

show abstract

“…Predictive factors associated with an unsuccessful UAE in PPH encompass DIC, blood transfusion of 5—10 units, blood loss > 1.5L, pronounced arterial vasoconstriction during embolization procedure and unilateral UAE [ 25 ].…”

Section: Primary and Secondary Postpartum Hemorraghementioning

confidence: 99%

“…UAE in PPH is predominantly carried out employing non-permanent embolic materials such as resorbable gelatine sponge (GS) [ 20 , 31 ]. GS expedite swift hemostasis by inducing mechanical obstruction and promoting thrombus formation within the vessel lumen which recanalizes in approximately 3 to 6 weeks [ 25 ]. The preparation of GS for embolization involved the creation of small torpedoes or a semi-liquid form from 1-2 mm pledgets (“slurry”).…”

Section: Primary and Secondary Postpartum Hemorraghementioning

confidence: 99%

Primary and secondary postpartum haemorrhage: a review for a rationale endovascular approach

Alonso-Burgos,

Díaz-Lorenzo,

Muñoz-Saá

et al. 2024

CVIR Endovasc

View full text Add to dashboard Cite

Postpartum haemorrhage (PPH) is a significant cause of maternal mortality globally, necessitating prompt and efficient management. This review provides a comprehensive exploration of endovascular treatment dimensions for both primary and secondary PPH, with a focus on uterine atony, trauma, placenta accreta spectrum (PAS), and retained products of conception (RPOC). Primary PPH, occurring within 24 h, often results from uterine atony in 70% of causes, but also from trauma, or PAS. Uterine atony involves inadequate myometrial contraction, addressed through uterine massage, oxytocin, and, if needed, mechanical modalities like balloon tamponade. Trauma-related PPH may stem from perineal injuries or pseudoaneurysm rupture, while PAS involves abnormal placental adherence. PAS demands early detection due to associated life-threatening bleeding during delivery. Secondary PPH, occurring within 24 h to 6 weeks postpartum, frequently arises from RPOC. Medical management may include uterine contraction drugs and hemostatic agents, but invasive procedures like dilation and curettage (D&C) or hysteroscopic resection may be required.Imaging assessments, particularly through ultrasound (US), play a crucial role in the diagnosis and treatment planning of postpartum haemorrhage (PPH), except for uterine atony, where imaging techniques prove to be of limited utility in its management. Computed tomography play an important role in evaluation of trauma related PPH cases and MRI is essential in diagnosing and treatment planning of PAS and RPOC.Uterine artery embolization (UAE) has become a standard intervention for refractory PPH, offering a rapid, effective, and safe alternative to surgery with a success rate exceeding 85% (Rand T. et al. CVIR Endovasc 3:1-12, 2020). The technical approach involves non-selective uterine artery embolization with resorbable gelatine sponge (GS) in semi-liquid or torpedo presentation as the most extended embolic or calibrated microspheres. Selective embolization is warranted in cases with identifiable bleeding points or RPOC with AVM-like angiographic patterns and liquid embolics could be a good option in this scenario. UAE in PAS requires a tailored approach, considering the degree of placental invasion. A thorough understanding of female pelvis vascular anatomy and collateral pathways is essential for accurate and safe UAE.In conclusion, integrating interventional radiology techniques into clinical guidelines for primary and secondary PPH management and co-working during labour is crucial. Graphical Abstract

show abstract

Pelvic Artery Embolization for Treatment of Postpartum Hemorrhage

Cited by 27 publications

References 88 publications

The Emergent Pelvic Artery Embolization in the Management of Postpartum Hemorrhage: A Systematic Review and Meta-analysis

The Emergent Pelvic Artery Embolization in the Management of Postpartum Hemorrhage: A Systematic Review and Meta-analysis

Management and Morbidity of Major Pelvic Hemorrhage in Complex Abdominopelvic Surgery

Primary and secondary postpartum haemorrhage: a review for a rationale endovascular approach

Contact Info

Product

Resources

About