Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization

Dohan, Anthony; Soyer, Philippe; Subhani, Aqeel; Héquet, Delphine; Fargeaudou, Y.; Morel, Olivier; Boudiaf, Mourad; Gayat, Étienne; Barranger, Emmanuel; Dref, Olivier Le; Sirol, Marc

doi:10.1007/s00270-013-0668-1

Cited by 68 publications

(90 citation statements)

References 43 publications

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“…Uterine atony accounts for the majority of causes of PPH and is the most common indication for TAE [20]. However, as experience accumulates, other indications for TAE are now well-recognized, including uterine artery pseudoaneurysms [21,22], invasive placentation [23][24][25][26][27], genital tears [28,29], and other rarer causes [30][31][32].…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

Soyer

Dohan

Dautry

et al. 2015

Cardiovasc Intervent Radiol

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Postpartum hemorrhage (PPH) is a potentially life-threatening condition, which needs multidisciplinary management. Uterine atony represents up to 80 % of all causes of PPH. Transcatheter arterial embolization (TAE) has now a well-established role in the management of severe PPH. TAE allows stopping the bleeding in 90 % of women with severe PHH, obviating surgery. Pledgets of gelatin sponge as torpedoes are commonly used for safe TAE, and coils, glue, and microspheres have been primarily used in specific situations such as arterial rupture, pseudoaneurysm, and arteriovenous fistula. TAE is a minimally invasive procedure with a low rate of complications, which preserves future fertility. Knowledge of causes of PPH, potential risks, and limitations of TAE is essential for a timely decision, optimizing TAE, preventing irreversible complications, avoiding hysterectomy, and ultimately preserving fertility.

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Section: Introductionmentioning

confidence: 99%

Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

Soyer

Dohan

Dautry

et al. 2015

Cardiovasc Intervent Radiol

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“…The success rate following embolization is 97-100% [9,10]. Gelatin sponge and metallic coils are effective for the treatment of ruptured pseudoaneurysms [11]. As spontaneous resolution or separation after embolization is possible, as in the currently described cases, embolization should be the first-line treatment when the vital signs are stable.…”

Section: Discussionmentioning

confidence: 99%

Uterine Artery Pseudoaneurysm Manifesting as Delayed Postpartum Hemorrhage after Precipitous Delivery: Three Case Reports

Kim¹,

Kim²,

Kim³

et al. 2014

Gynecol Obstet Invest

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Precipitous delivery may lead to serious maternal and neonatal complications. Uterine artery pseudoaneurysm (UAP) is one of the causes of delayed postpartum hemorrhage. Here we describe 3 cases of UAP manifesting as delayed postpartum hemorrhage after precipitous delivery. The duration of the second stage of labor in cases 1, 2, and 3 was 15, 15, and 60 min, respectively. Excessive vaginal bleeding occurred 10, 9, and 31 days after delivery, respectively. Ultrasonogram and pelvic angiography revealed the UAP in each case and uterine artery embolization was performed. UAP may be a complication of precipitous delivery.

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“…Dohan et al concluded from a series of 18 patients that the gelatin sponge was superior; however, coils and glue may also be used. 1,13 In our patient, an immediate rupture with intraperitoneal migration of the material used for embolization hindered the use of resorbable gelatin, as the gelatin would not completely occlude the uterine artery. Definitive embolization by metallic coils was, thus, required.…”

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confidence: 95%

“…In the majority of cases described in the literature, FA embolization is successful without increasing the risk of complications. 1,9 We conclude that an FA can occur after non-traumatic delivery, and often represents the unknown cause of post-partum intra-abdominal hematoma, leading to a late diagnosis. FAs are rarely published in medical literature; therefore, they must be systematically born in mind, searched for attentively by US imaging or if the US does not yield acceptable results, by CT scan, particularly if prior surgical exploration did not locate the cause of bleeding.…”

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confidence: 97%

Post‐partum hemoperitoneum: Do not miss false aneurysm as a cause of bleeding

Goupil

Marcellin

Elahee

et al. 2015

J of Obstet and Gynaecol

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A 27-year-old woman underwent a first vaginal delivery at our institution. She returned four days after delivery, presenting with abdominal pain and an unexplained drop in her hemoglobin value, without external bleeding. The initial computed tomography abdominal scan revealed an isolated diffuse hemoperitoneum. A laparoscopy did not find the cause of bleeding. A second computed tomography scan, performed 15 days later, revealed hemoperitoneum associated with a false aneurysm of the right uterine artery. Treatment consisted of embolization of the uterine arteries, with clinical success. False aneurysms are a rare cause of intra-abdominal non-exteriorized bleeding in late post-partum hemorrhage.

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Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization

Cited by 68 publications

References 43 publications

Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

Uterine Artery Pseudoaneurysm Manifesting as Delayed Postpartum Hemorrhage after Precipitous Delivery: Three Case Reports

Post‐partum hemoperitoneum: Do not miss false aneurysm as a cause of bleeding

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