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

Abstract

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.

Primary postpartum hemorrhage: outcome of uterine artery embolization

“…4 Among previous articles, there were only two reports of cases that demonstrated the need for OAE accompanied by UAE for controlling severe PPH. 10,11 Our study suggested that the necessity of OAE for patients who were supposed to have the blood from ovarian artery to uterus and this was one finding of this study.…”

The efficacy of uterine artery embolization with gelatin sponge for retained products of conception with bleeding and future pregnancy outcomes

“…The ovarian artery supplied only small part of RPOC on angiography and both uterine artery embolization was enough to stop bleeding caused by RPOC. However, ovarian arteries might be one of the causes of re-bleeding: ovarian artery supply was confirmed in 12% of PPH patients (Kim et al, 2018). Therefore, it is suggested that we should visualize both ovarian artery on initial aortography at the level of the renal arteries and selective embolization might be needed if its contribution to bleeding is confirmed (Kim et al, 2018;Maassen et al, 2009).…”

Spontaneous round ligament hematoma as an unusual cause of pelvic pain in a young female patient: MRI demonstration

“…Spontaneous round ligament hematoma is an extremely rare cause of acute pelvic pain in adult female patients [3] , [4] , [5] and, to the best of our knowledge, such a case has never been reported in the medical literature for the paediatric population.…”