Life-threatening primary postpartum hemorrhage: Treatment with emergency selective arterial embolization

被引:198
作者
Pelage, JP
Le Dref, O
Mateo, J
Soyer, P
Jacob, D
Kardache, M
Dahan, H
Repiquet, D
Payen, D
Truc, JB
Merland, JJ
Rymer, R
机构
[1] Hop Lariboisiere, Dept Body & Vasc Imaging, AP HP, F-75475 Paris 10, France
[2] Hop Lariboisiere, Dept Obstet & Gynecol, AP HP, F-75475 Paris, France
[3] Hop Lariboisiere, Dept Anesthesiol & Crit Care, AP HP, F-75475 Paris 10, France
关键词
arteries; therapeutic blockade; uterine; pregnancy; complications; uterus; hemorrhage;
D O I
10.1148/radiology.208.2.9680559
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
PURPOSE: To prospectively evaluate the efficacy and safety of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage. MATERIALS AND METHODS: Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before embolization failed to stop the bleeding. RESULTS: Angiography revealed extravasation in nine patients and spasm of the branches the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian(n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminution of external bleeding was observed in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found.ln one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women except the two who underwent hysterectomy. One woman became pregnant after embolization. CONCLUSION: Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.
引用
收藏
页码:359 / 362
页数:4
相关论文
共 31 条
  • [1] PROPHYLACTIC AND EMERGENT ARTERIAL CATHETERIZATION FOR SELECTIVE EMBOLIZATION IN OBSTETRIC HEMORRHAGE
    ALVAREZ, M
    LOCKWOOD, CJ
    GHIDINI, A
    DOTTINO, P
    MITTY, HA
    BERKOWITZ, RL
    [J]. AMERICAN JOURNAL OF PERINATOLOGY, 1992, 9 (5-6) : 441 - 444
  • [2] Biehl DR., 1987, ANESTHESIA OBSTET, V2, P385
  • [3] BRAF Z F, 1977, Urology, V9, P670, DOI 10.1016/0090-4295(77)90319-3
  • [4] BROWN BJ, 1979, OBSTET GYNECOL, V54, P361
  • [5] BURCHELL R C, 1968, Journal of Obstetrics and Gynaecology of the British Commonwealth, V75, P642
  • [6] COLLATERAL ARTERIAL CIRCULATION IN PELVIS - AN ANGIOGRAPHIC STUDY
    CHAIT, A
    MOLTZ, A
    NELSON, JH
    [J]. AMERICAN JOURNAL OF ROENTGENOLOGY RADIUM THERAPY AND NUCLEAR MEDICINE, 1968, 102 (02): : 392 - &
  • [7] PELVIC ARTERIAL EMBOLIZATION FOLLOWING HYSTERECTOMY AND BILATERAL INTERNAL ILIAC ARTERY LIGATION FOR INTRACTABLE PRIMARY POST-PARTUM HEMORRHAGE
    COLLINS, CD
    JACKSON, JE
    [J]. CLINICAL RADIOLOGY, 1995, 50 (10) : 710 - 714
  • [8] COMBS CA, 1991, OBSTET GYNECOL, V77, P77
  • [9] COMBS CA, 1991, OBSTET GYNECOL, V77, P69
  • [10] Duvauferrier R, 1984, J Radiol, V65, P285