Predictive factors for failure of pelvic arterial embolization for postpartum hemorrhage

Poujade, O; Zappa, Magaly; Letendre, Irène; Ceccaldi, P F; Vilgrain, Valérie; Luton, Dominique

doi:10.1016/j.ijgo.2011.11.025

Cited by 59 publications

(36 citation statements)

References 25 publications

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“…Although other studies have described other potential predictors of PAE failure, including the amount of blood transfused and haemoglobin level, (18,19) these factors were not statistically significant in our study. These earlier studies were also limited by the larger number of predictive factors and the lack of multivariate analysis.…”

Section: Discussioncontrasting

confidence: 93%

Predictors of the success and failure of emergency pelvic artery embolisation for primary postpartum haemorrhage: a 12-year review

Lai

Shum

Chu

et al. 2017

smedj

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INTRODUCTIONThis study aimed to identify predictors of the outcome and clinical efficacy of emergency pelvic artery embolisation (PAE) for primary postpartum haemorrhage (PPH) and to assess the post-embolisation fertility of PAE patients in a regional hospital setting. METHODSA 12-year retrospective study of patients undergoing emergency PAE was conducted at a regional acute general hospital. Clinical and procedural parameters, clinical outcomes and post-embolisation pregnancy success rates were analysed.RESULTS There were 47,221 deliveries at the hospital during the study period, of which 33 patients required urgent PAE for primary PPH. The technical success rate of embolisation was 97.0% (n = 32). Clinically adequate haemostasis was achieved by a single embolisation procedure in 24 (72.7%) patients; the remaining eight eventually required surgery to achieve cessation of bleeding. Among the parameters studied, multivariate logistic regression analysis showed that preembolisation platelet count (p = 0.036) and maternal age (p = 0.019) were the only significant independent predictors of embolisation failure. Only two patients successfully conceived after PAE, although one of them had an ectopic pregnancy.CONCLUSION Emergency PAE is an effective measure to arrest life-threatening bleeding in patients with primary PPH. As low pre-embolisation platelet count and advanced maternal age are associated with higher odds of embolisation failure, careful post-embolisation monitoring may be required for such patients. Embolisation also allows subsequent pregnancy. However, further studies are required to assess the outcomes of post-embolisation pregnancies.

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Section: Discussioncontrasting

confidence: 93%

Predictors of the success and failure of emergency pelvic artery embolisation for primary postpartum haemorrhage: a 12-year review

Lai

Shum

Chu

et al. 2017

smedj

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“…Criteria of failed TAE include disseminated intravascular coagulation [18,19,75,76], major transfusion (i.e., transfusion [5 or 10 red blood cell packs), blood loss [1.5L [18,19,40], severe arterial vasoconstriction at the time of TAE [56], and invasive placenta, which has a failure rate of approximately 20 % [24,25,67]. It has been suggested that repeat TAE may be more frequently needed in women with active extravasation at initial angiography [60].…”

Section: General Results and Causes Of Failurementioning

confidence: 99%

“…This form should be used in women with retained placenta to induce thrombosis of intervillous spaces [24,66]. The use of slurry of gelatin sponge should be avoided in other situations because of reported cases of uterine necrosis with this specific material [60,67,68], although some authors have reported safe and effective TAE with slurry [65].…”

Section: Temporary and Permanent Occluding Agentsmentioning

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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“…(1.32), compared with 1.79 (0.9) in the unsuccessful group [38]. Although low fibrinogen is more commonly associated with specific aetiologies of bleeding, in the earlier stages of PPH from any cause it has similar predictive values.…”

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confidence: 84%

Haemostatic management of obstetric haemorrhage

2014

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SummaryThe haemostatic management of major obstetric haemorrhage remains challenging, and current published guidance relies heavily on experience from the non-pregnant population and expert opinion. In recent years, an interest in the implications of relative hypofibrinogenaemia, point-of-care monitoring of coagulation abnormalities, and the potential to give goal-directed therapy to correct coagulopathies, have created the possibility of significantly challenging and changing guidance. There is evidence that the haemostatic impairment in the pregnant population is different from trauma-induced bleeding, and the type and rate of onset of coagulopathies differ depending on the underlying cause. This review examines areas such as possible intervention points, describes evidence for overtransfusion of fresh frozen plasma in some situations and challenges conventional thinking on formulaic management. It also examines the rationale for other therapeutic options, including fibrinogen concentrate and tranexamic acid.

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Predictive factors for failure of pelvic arterial embolization for postpartum hemorrhage

Abstract: Predictive factors significantly associated with failed pelvic arterial embolization were the presence of placenta accreta, biologic factors, and transfusional factors. Delay due to inter-hospital transfer did not affect the outcome of embolization.

Cited by 59 publications

References 25 publications

Predictors of the success and failure of emergency pelvic artery embolisation for primary postpartum haemorrhage: a 12-year review

Predictors of the success and failure of emergency pelvic artery embolisation for primary postpartum haemorrhage: a 12-year review

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

Haemostatic management of obstetric haemorrhage

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