Postpartum haemorrhage due to genital tract injury after vaginal delivery: safety and efficacy of transcatheter arterial embolisation

Lee, Sang Min; Shin, Ji Hoon; Shim, Jong Joon; Yoon, Ki Woong; Cho, Young Jong; Kim, Jong Woo; Ko, Heung Kyu

doi:10.1007/s00330-018-5490-3

Cited by 23 publications

(33 citation statements)

References 31 publications

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“…Among these patients, TAE procedures in which the embolization of IMA was included, were identified in eight patients. Four of these patients were included in the context of TAE for PPH caused by genital tract injury, 5 however, as detailed information was not provided, there were, therefore, also included in this report.…”

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confidence: 99%

Inferior mesenteric artery embolization for persistent postpartum hemorrhage after sufficient bilateral iliac arteries embolization: safety and efficacy in eight patients

Chen

Chu

Shin

et al. 2019

The British Journal of Radiology

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Objective: To assess the safety and efficacy of transcatheter arterial embolization (TAE) of the inferior mesenteric artery (IMA) for the management of post-partum hemorrhage (PPH). Methods: A retrospective analysis was performed regarding eight patients (mean age, 34.4 y; age range, 31 – 40 y) who underwent TAE of the IMA for PPH between March 2001 and September 2018. Obstetric records, including maternal characteristics, clinical manifestations, complications, and clinical outcomes, as well as TAE details were obtained. Results: All eight patients had primary PPH and the vaginal delivery mode. CT scans of two patients showed active bleeding from the lower uterus or hematoma and with the origin of contrast extravasation abutting the adjacent rectum. In seven patients, an aortogram or IMA arteriogram following persistent vaginal bleeding after sufficient embolization of the bleeding focus from the bilateral iliac arteries, found the bleeding focus of the IMA, while in one patient, the IMA bleeding focus was found at the second session 4 h after the first session. TAE of the IMA was technically successful in all eight patients and cessation of bleeding without repeated TAE or additional hemostatic surgery was achieved in all patients after TAE of the IMA. There were neither procedure-related complications nor bowel ischemia during follow-up. Conclusion: TAE of the IMA for PPH was safe and effective with successful hemostasis. Bleeding from the IMA should be suspected when there is persistent vaginal bleeding after sufficient embolization of bleeders from the bilateral iliac arteries. Advances in knowledge: Bleeding from the IMA should be suspected when there is persistent vaginal bleeding after sufficient embolization of bleeders from the bilateral iliac arteries.

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confidence: 99%

Inferior mesenteric artery embolization for persistent postpartum hemorrhage after sufficient bilateral iliac arteries embolization: safety and efficacy in eight patients

Chen

Chu

Shin

et al. 2019

The British Journal of Radiology

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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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“…Characteristics considered to be potential confounders for the association between use of intrauterine balloon tamponade or use of uterine artery embolization, or characteristics considered to be risk factors for the occurrence of the primary outcome measure alone, were included as covariates in the propensity score model. 17 Characteristics included as covariates that were available at the moment the clinician decided to use intrauterine balloon tamponade or perform uterine artery embolization were: maternal age, gestational age, parity (nulliparity or multiparity), preeclampsia, multiple pregnancy, prior cesarean birth, mode of birth (vaginal birth or cesarean section), cause of hemorrhage (categorized as uterine atony, retained placenta, abnormally invasive placenta and other causes [composite of placenta previa, placental abruption and uterine rupture due to small numbers]), the presence of coagulopathy (defined as a fibrinogen level ≤2 g/L during bleeding), symptoms of shock (defined as at least one measurement of a systolic blood pressure ≤90 mm Hg and/or heart rate ≥120 beats per minute during bleeding), volume of blood loss at time were selected a priori based on the literature 4,5,7,12,13,[18][19][20][21][22][23] and clinical reasoning. Missing variables were imputed using median and logically derived imputation (see Appendix S2 for the rationale behind the imputation method applied per missing variable).…”

Section: Statistical Analysesmentioning

confidence: 99%

Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score‐matched cohort study

Ramler

Henriquez

Akker

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The aim of this study was to compare the outcomes of women who were initially managed by intrauterine balloon tamponade or uterine artery embolization because of persistent postpartum hemorrhage demanding an immediate intervention to control bleeding. Material and methods Propensity score‐matched cohort study including women who had intrauterine balloon tamponade or uterine artery embolization as initial management strategy to control persistent postpartum hemorrhage, that is, refractory to first‐line therapy combined with at least one uterotonic agent. The primary outcome measure was a composite of peripartum hysterectomy and/or maternal mortality. Secondary outcomes measures were total volume of blood loss and total number of packed red blood cells transfused. Results Our 1:1 propensity score‐matched cohort comprised of 50 women who had intrauterine balloon tamponade and 50 women who underwent uterine artery embolization at a blood loss between 1000 and 7000 mL. There was no statistically significant difference in the hysterectomy risk between the two groups (n = 6 in each group, odds ratio [OR] 1.00, 95% confidence interval [CI] .30‐3.34), in total volume of blood loss (median 4500 mL, interquartile range [IQR] 3600‐5400) for balloon vs 4000 mL (IQR 3250‐5000) for embolization, P = 0.382) or in total units of packed red blood cells transfused (median 7 (IQR 5‐10) for balloon vs 6 [IQR 4‐9] for embolization, P = 0.319). Fifteen women (30%) who were initially managed by an intrauterine balloon still underwent uterine artery embolization, of whom one had an embolization‐related thrombo‐embolic event. Maternal mortality occurred in neither of the intervention groups. Conclusions No difference in the risk of peripartum hysterectomy and/or maternal death was observed between women who had intrauterine balloon tamponade and women who underwent uterine artery embolization as an initial management for persistent postpartum hemorrhage. Although this study was underpowered to demonstrate equivalence, our study design provides a framework for future research in which intrauterine balloon tamponade may prove to be a suitable intervention of first choice in the management of persistent postpartum hemorrhage.

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Postpartum haemorrhage due to genital tract injury after vaginal delivery: safety and efficacy of transcatheter arterial embolisation

Cited by 23 publications

References 31 publications

Inferior mesenteric artery embolization for persistent postpartum hemorrhage after sufficient bilateral iliac arteries embolization: safety and efficacy in eight patients

Inferior mesenteric artery embolization for persistent postpartum hemorrhage after sufficient bilateral iliac arteries embolization: safety and efficacy in eight patients

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

Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score‐matched cohort study

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