OJRad  Vol.3 No.2 , June 2013
Efficacy of Uterine Artery Embolization for Patients with Postpartum Hemorrhage
ABSTRACT

Purpose: To investigate the efficacy of uterine arterial embolization (UAE) in patients with post-partum hemorrhage (PPH). Materials and Methods: The subjects were 40 women (mean age, 33 years; age range, 21 - 42 years) who underwent UAE for PPH at two institutes from June 2001 to May 2011. The rates of clinical success (avoidance of hysterectomy) and complications were calculated. Differences in related factors between primary PPH and secondary PPH and between caesarean section and vaginal delivery were examined. The risk factors associated with hysterectomy were also examined. Results: The overall clinical success rate was 90% (93% of primary PPH, 77% of secondary PPH, and 87.5% of PPH with cesarean section), and the overall complication rate was 10%. There were significant differences in time to PPH (P < 0.0001) and in blood infusion after UAE (P = 0.0158) between subtypes of primary and secondary PPH and in blood infusion before UAE (P = 0.0052) between delivery methods. The significant factors associated with hysterectomy were cesarean section (P = 0.02), severe PPH (>1000 mL bleeding, P = 0.03), and embolization of non-uterine arteries (P = 0.02).


Cite this paper
Y. Choi, Y. Baba, S. Ikeda, Y. So, S. Hayashi and M. Nakajo, "Efficacy of Uterine Artery Embolization for Patients with Postpartum Hemorrhage," Open Journal of Radiology, Vol. 3 No. 2, 2013, pp. 51-55. doi: 10.4236/ojrad.2013.32008.
References
[1]   C. L. Roberts, J. B. Ford, C. S. Algert, J. C. Bell, J. M. Simpson and J. M. Morris, “Trends in Adverse Maternal Outcomes during Childbirth: A Population-Based Study of Severe Maternal Morbidity,” BMC Pregnancy and Childbirth, Vol. 9, No.1, 2009, p. 7. doi:10.1186/1471-2393-9-7

[2]   W. H. Zhang, S. Alexander, M. H. Bouvier-Colle and A. Macfarlane, “Incidence of Severe Pre-Eclampsia, Post partum Haemorrhage and Sepsis as a Surrogate Marker for Severe Maternal Morbidity in a European Population-Based Study: The MOMS-B Survey,” BJOG: An International Journal of Obstetrics & Gynaecology, Vol. 112, No. 1, 2005, pp. 89-96. doi:10.1111/j.1471-0528.2004.00303.x

[3]   C. G. Sosa, F. Althabe, J. M. Belizan and P. Buekens, “Risk Factors for Postpartum Hemorrhage in Vaginal De liveries in a Latin-American Population,” Obstetrics & Gynecology, Vol. 113, No. 6, 2009, pp. 1313-1319.

[4]   H. A. Mousa and Z. Alfirevic, “Major Postpartum Hemorrhage: Survey of Maternity Units in the United Kingdom,” Acta Obstetricia et Gynecologica Scandinavica, Vol. 81, No. 8, 2002, pp. 727-730. doi:10.1034/j.1600-0412.2002.810807.x

[5]   H. A. Mousa and Z. Alfirevic, “Treatment for Primary Postpartum Haemorrhage,” Cochrane Database of Systematic Reviews, No. 1, 2003, Article ID: CD 003249.

[6]   R. M. Rome, “Secondary Postpartum Haemorrhage,” BJOG: An International Journal of Obstetrics & Gynaecology, Vol. 82, No. 4, 1975, pp. 289-292. doi:10.1111/j.1471-0528.1975.tb00636.x

[7]   P. A. King, S. J. Duthie, Z. G. Dong and H. K. Ma, “Secondary Postpartum Haemorrhage,” Australian and New Zealand Journal of Obstetrics and Gynaecology, Vol. 29, No. 4, 1989, pp. 394-398. doi:10.1111/j.1479-828X.1989.tb01776.x

[8]   J. P. Pelage, O. Le Dref, P. Soyer, D. Jacob, M. Kardache, H. Dahan, D. Repiquet, D. Payen, J. B. Truc, J. J. Merland and R. Rymer, “Life-Threatening Primary Postpartum Hemorrhage: Treatment with Emergency Selective Arterial Embolization,” Radiology, Vol. 208, No. 2, 1998, pp. 359-362.

[9]   J. P. Pelage, O. Le Dref, D. Jacob, P. Soyer, D. Herbreteau and R. Rymer, “Selective Arterial Embolization of the Uterine Arteries in the Management of Intractable Post-Partum Hemorrhage,” Acta Obstetricia et Gynecologica Scandinavica, Vol. 78, No. 8, 1999, pp. 698-703. doi:10.1080/j.1600-0412.1999.780807.x

[10]   J. P. Pelage, P. Soyer, D. Repiquet, D. Herbreteau, O. Le Dref, E. Houdart, D. Jacob, M. Kardache, P. Schurando, J. B. Truc and R. Rymer, “Secondary Postpartum Hemorrhage: Treatment with Selective Arterial Embolization,” Radiology, Vol. 212, No. 2, 1999, pp. 385-389.

[11]   D. M. Biko, J. F. Spanier, M. Nagamine, L. Dwyer-Joyce and D. S. Ball, “Persistent Secondary Postpartum Hemorrhage after Uterine Artery Embolization,” Journal of Vascular and Interventional Radiology, Vol. 20, No. 2, 2009, pp. 279-281. doi:10.1016/j.jvir.2008.10.016

[12]   M. E. Simons, R. C. Windrim and J. C. Kingdom, “Arterial Embolization for Primary Postpartum Hemorrhage,” Journal of Vascular and Interventional Radiology, Vol. 20, No. 8, 2009, pp. 1036-1045. doi:10.1016/j.jvir.2009.04.070

[13]   S. Ganguli, M. S. Stecker, D. Pyne, R. A. Baum and C. M. Fan, “Uterine Artery Embolization in the Treatment of Postpartum Uterine Hemorrhage,” Journal of Vascular and Interventional Radiology, Vol. 22, No. 2, 2011, pp. 169-176. doi:10.1016/j.jvir.2010.09.031

[14]   L. Sentilhes, A. Gromez, E. Clavier, B. Resch, E. Verspyck and L. Marpeau, “Predictors of Failed Pelvic Arterial Embolization for Severe Postpartum Hemorrhage,” Obstetrics & Gynecology, Vol. 113, No. 5, 2009, pp. 992-999.

[15]   J. P. Pelage, P. Soyer, O. Le Dref, H. Dahan, J. Coumbaras, M. Kardache and R. Rymer, “Uterine Arteries: Bilateral Catheterization with a Single Femoral Approach and a Single 5-F Catheter-Technical Note,” Radiology, Vol. 210, No. 2, 1999, pp. 573-575.

[16]   Geneva WHO. “World Health Report,” 2005.

[17]   F. Donnay, “Maternal Survival in Developing Countries: What Has Been Done, What Can Be Achieved in the Next Decade,” International Journal of Gynecology & Obstetrics, Vol. 70, No. 1, 2000, pp. 89-97. doi:10.1016/S0020-7292(00)00236-8

[18]   C. A. Combs, E. L. Murphy and R. K. Laros Jr., “Factors Associated with Hemorrhage in Cesarean Deliveries,” Obstetrics & Gynecology, Vol. 77, No. 1, 1991, pp. 77-82.

[19]   C. A. Combs, E. L. Murphy and R. K. Laros Jr., “Factors Associated with Postpartum Hemorrhage with Vaginal Birth,” Obstetrics & Gynecology, Vol. 77, No. 1, 1991, pp. 69-76.

[20]   M. Varner. “Postpartum Hemorrhage,” Critical Care Clinics, Vol. 7, No. 4, 1991, pp. 883-897.

[21]   P. Jouppila, “Postpartum Haemorrhage,” Current Opinion in Obstetrics and Gynecology, Vol. 7, No. 6, 1995, pp. 446-450. doi:10.1097/00001703-199512000-00008

[22]   S. Samad, P. Jonetzko, A. P. Hawkins, J. Booth, G. Thorpe-Beeston and R. Marwood, “An Unusual Cause of Delayed Postpartum Haemorrhage Following Caesarean Section,” Emergency Medicine Journal, Vol. 26, No. 8, 2009, pp. 621-622. doi:10.1136/emj.2008.066407

[23]   W. Henrich, I. Fuchs, A. Luttkus, S. Hauptmann and J. W. Dudenhausen, “Pseudoaneurysm of the Uterine Artery after Cesarean Delivery: Sonographic Diagnosis and Treatment,” Journal of Ultrasound in Medicine, Vol. 21, No. 12, 2002, pp. 1431-1434.

 
 
Top