Uterine artery embolization versus hysterectomy in the treatment of refractory postpartum hemorrhage: a systematic review and meta-analysis

Liu, ZhiRong; Wang, Yaxuan; Yan, Jingxin; Li, Juan; Liu, Xinlian; Zhang, Lushun; Li, Cheng

doi:10.1080/14767058.2018.1497599

Cited by 23 publications

(15 citation statements)

References 41 publications

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“…However, its efficacy remains unclear in patients with unstable hemodynamics and coagulopathies, which are typical features of DIC [ 19 , 21 , 22 , 29 ]. The clinical success rate of TAE in hemostasis was reported to be approximately 90% [ 13 , 15 , 26 , 27 , 28 ], which is comparable to our results. In this study, we investigated the utility of TAE in patients with or without DIC according to the three diagnostic criteria for DIC.…”

Section: Discussionsupporting

confidence: 91%

“…Obstetric PPH is characterized by the development of intractable DIC in a short period of time [ 21 , 29 ]. It has been reported that unstable hemodynamics and coagulopathies in DIC could lead to a failure of TAE for PPH and an increase in complications resulting from TAE [ 12 , 18 , 26 , 27 , 30 , 31 , 32 ]. In previous reports of large-scale surveys, the success rate of TAE for PPH in patients with DIC has been reported to be approximately 62.5–75.8%, which is lower than that in patients without DIC [ 13 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

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The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience

Ochiai

Nakatsuka

Abe

et al. 2021

JCM

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Indications for the use of transarterial embolization (TAE) for postpartum hemorrhage (PPH) have been established. However, the efficacy of TAE for PPH complicated by disseminated intravascular coagulation (DIC) remains controversial. In this study, we investigated the efficacy of TAE for PPH complicated by DIC. A database review was conducted to identify patients who were treated with TAE for PPH at our hospital. TAE was performed in 41 patients during the study period. Effective hemostasis was achieved in all cases, but additional procedures, such as re-embolization or hysterectomy, were required in five patients (12.2%). The typical causes of PPH included uterine atony (18 cases), placenta previa (15 cases), amniotic fluid embolism (DIC-type) (11 cases), and placenta accreta spectrum (10 cases). The mean blood loss was 3836 mL. The mean obstetrical DIC and the International Society on Thrombosis and Hemostasis DIC scores were 7.9 and 2.6, respectively. The efficacy of hemostasis was comparable between patients with and without DIC. However, the complete success rate of TAE was lower in patients with DIC as the condition worsened than that in non-DIC patients. Overall, TAE is effective as a minimally invasive treatment for PPH complicated by DIC.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience

Ochiai

Nakatsuka

Abe

et al. 2021

JCM

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“…UAE is considered appropriate in the treatment of PPH because it reduces bleeding, avoids hysterectomy, and preserves fertility with high success rates and tolerable side effects. 8,36,37 However, the procedure entails risks such as PAS in the subsequent pregnancy. Although there is little evidence, uterine compression sutures and uterine balloon tamponade (UBT) seem not to be associated with a higher risk of PAS in the subsequent pregnancy when compared with UAE.…”

Section: Discussionmentioning

confidence: 99%

<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

Jitsumori¹,

Endo²,

Hara³

et al. 2020

IJWH

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Background: Uterine artery embolization (UAE) is used to treat severe postpartum hemorrhage (PPH). According to a few studies, UAE for PPH was associated with preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) in subsequent pregnancies. These previous studies, however, lacked controls, and to the best of our knowledge, no systematic literature reviews have been conducted thus far. We report the results of our retrospective case-control study of pregnancies after UAE at a single center and include a literature review to evaluate the risk of PAS in pregnancies after UAE. Methods: We retrospectively reviewed data from deliveries at our hospital between January 2012 and October 2017. We divided the delivery data into cases with previous UAEs performed for PPH (the post-UAE group) and those without UAEs (the non-UAE group, which included women without previous PPH). We defined PAS as cases in which hysterectomy was performed and pathological examination confirmed the diagnosis. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). Results: We used data from 3155 patients in this study, of whom 16 patients had undergone UAE (post-UAE group) and 3139 had not (non-UAE group). We found no differences between the groups in terms of frequency of preterm births (12.5% versus 14.2%, respectively; OR, 0.863; 95% CI, 0.218 to 3.414; P = 0.84) or FGR (6.2% versus 10.0%, respectively; OR, 0.602; 95% CI, 0.104 to 3.584; P = 0.61). However, cases of PAS were significantly more common in the post-UAE group (37.5%) than in the non-UAE group (1.2%; OR, 50.303; 95% CI, 17.38 to 145.592; P < 0.01). Conclusion: Our results suggest that previous UAE is a significant risk factor for PAS.

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“…Combination therapy is considered to be effective with less complications 4. UAE has been proved to be a safe and viable intervention to control hemorrhaging and preserve the uterus in the treatment of uterine fibroids, uterine arteriovenous fistula, or postpartum hemorrhage,5–7 but for the treatment of CSP, UAE usually need to be combined with D&C or other therapies. Tumenjargal et al suggested that UAE combined with D&C can be efficient and safe for CSP management, and it should be considered as one of the treatment options which enable preservation of fertility after treatment 8.…”

Section: Introductionmentioning

confidence: 99%

Analysis on clinical effects of dilation and curettage guided by ultrasonography versus hysteroscopy after uterine artery embolization in the treatment of cesarean scar pregnancy

Qiu¹,

Fu²,

Xu³

et al. 2019

TCRM

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PurposeThe purpose of this study was to investigate the efficiency, complications, and subsequent fertility outcomes of two methods in treating patients with cesarean scar pregnancy (CSP) after receiving uterine artery embolization (UAE) treatment.Patients and methodsA total of 62 CSP patients who visited our hospital and underwent UAE from January 2013 to January 2018 were retrospectively analyzed. Patients were either treated by dilation and curettage (D&C) guided by ultrasonography or hysteroscopy. The differences of related clinical indicators, clinical efficacy, complications, and subsequent fertility outcomes between the two groups were analyzed.ResultsThe rates of therapeutic success of the ultrasonography group and hysteroscopy group were 84.6% and 95.7%, respectively, the difference was not statistically significant (P=0.243). However, the intraoperative blood loss, duration of hospitalization, and overall complications were significantly lower in hysteroscopy group compared with D&C guided by ultrasonography group (P<0.05 for all). Meanwhile, hysteroscopy had the advantage of discovering potential diverticulum in the lower segment of anterior wall of uterus (P<0.001).ConclusionD&C guided by ultrasonography or hysteroscopy for the treatment of CSP after UAE resulted in similarly good clinical outcomes. Compared with treatment of D&C guided by ultrasonography, hysteroscopy had less complications and had the advantages of discovering diverticulum. It can be used as an effective way for the treatment of CSP.

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Uterine artery embolization versus hysterectomy in the treatment of refractory postpartum hemorrhage: a systematic review and meta-analysis

Cited by 23 publications

References 41 publications

The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience

The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience

<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

Analysis on clinical effects of dilation and curettage guided by ultrasonography versus hysteroscopy after uterine artery embolization in the treatment of cesarean scar pregnancy

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