OJOG  Vol.5 No.3 , March 2015
A New Protocol for Determining Intervention with Trans-Catheter Arterial Embolization or Surgical Hemostasis for Obstetric Hemorrhage
ABSTRACT

Objectives: The aim of this study is to introduce protocols for choosing trans-arterial embolization (TAE) or surgical hemostasis as an initial therapy for obstetric hemorrhage. Materials and Methods: From 2002 to 2011 at our hospital, the medical records of the patients who underwent TAE or surgical hemostasis for obstetric hemorrhage were reviewed to assess the following data: The causes of obstetric hemorrhage, Shock Index (SI) and obstetrical disseminated intra-vascular coagulation (DIC) score, amount of bleeding, transfusion, and operation time. Results: Twenty-five patients underwent TAE and six underwent surgical hemostasis. SI and obstetrical DIC score of the TAE group were 1.0 (0.4 - 2.2) and 6.0 (1 - 32), respectively. They were significantly lower than those of the surgical hemostasis group (SI: 1.6, obstetrical DIC score: 12.5, p < 0.05). Though the hemorrhage could be controlled sufficiently in 23 cases of the TAE group, 5 cases went into shock during TAE. The SI and obstetrical DIC score of shock group were 1.2 (1 - 2) and 10 (2 - 32), respectively. Conclusion: Though TAE is a useful therapy to control obstetric inevitable hemorrhage, special attention should be paid to the vital signs during TAE, especially in cases where SI and/or obstetrical DIC score are higher than 1.2 and 10, respectively.


Cite this paper
Myoga, M. , Yoshimura, K. and Hachisuga, T. (2015) A New Protocol for Determining Intervention with Trans-Catheter Arterial Embolization or Surgical Hemostasis for Obstetric Hemorrhage. Open Journal of Obstetrics and Gynecology, 5, 128-134. doi: 10.4236/ojog.2015.53017.
References
[1]   Deneux-Tharaux, C., Berg, C., Bouvier-Colle, M.H., Gissler, M., Harper, M., Nannini, A., Alexander, S., Wildman, K., Breart, G. and Buekens, P. (2005) Under reporting of Pregnancy-Related Mortality in the United States and Europe. Obstetrics & Gynecology, 106, 684-692.
http://dx.doi.org/10.1097/01.AOG.0000174580.24281.e6

[2]   Ledee, N., Ville, Y., Musset, D., Mercier, F., Frydman, R. and Fernandez, H. (2001) Management in Intractable Obstetric Haemorrhage: An Audit Study on 61 Cases. European Journal of Obstetrics & Gynecology and Reproductive Biology, 94, 189-196.
http://dx.doi.org/10.1016/S0301-2115(00)00349-3

[3]   Ronsmans, C. and Graham, W.J. (2006) Maternal Mortality: Who, When, Where, and Why. Lancet, 368, 1189-1200.
http://dx.doi.org/10.1016/S0140-6736(06)69380-X

[4]   Brown, B.J., Heaston, D.K., Poulson, A.M., Gabert, H.A., Mineau, D.E. and Miller Jr., F.J. (1979) Uncontrollable Post-partum Bleeding: A New Approach to Hemostasis through Angiographic Arterial Embolization. Obstetrics & Gynecology, 54, 361-365.

[5]   Park, J.K., Shin, T.B., Baek, J.C., Shin, J.K., Choi, W.J., Lee, S.A., Lee, J.H. and Paik, W.Y. (2011) Failure of Uterine Artery Embolization for Controlling Postpartum Hemorrhage. Journal of Obstetrics and Gynaecology Research, 37, 971-978.
http://dx.doi.org/10.1111/j.1447-0756.2010.01463.x

[6]   Pelage, J.P., Le Dref, O., Jacob, D., Soyer, P., Herbreteau, D. and Rymer, R. (1999) Selective Arterial Embolization of the Uterine Arteries in the Management of Intractable Post-Partum Hemorrhage. Acta Obstetricia et Gynecologica Scandinavica, 78, 698-703.
http://dx.doi.org/10.1080/j.1600-0412.1999.780807.x

[7]   Pelage, J.P., Le Dref, O., Mateo, J., Soyer, P., Jacob, D., Kardache, M., Dahan, H., Repiquet, D., Payen, D., Truc, J.B., Merland, J.J. and Rymer, R. (1998) Life-Threatening Primary Postpartum Hemorrhage: Treatment with Emergency Selective Arterial Embolization. Radiology, 208, 359-362.
http://dx.doi.org/10.1148/radiology.208.2.9680559

[8]   Soncini, E., Pelicelli, A., Larini, P., Marcato, C., Monaco, D. and Grignaffini, A. (2007) Uterine Artery Embolization in the Treatment and Prevention of Postpartum Hemorrhage. International Journal of Gynecology & Obstetrics, 96, 181-185.
http://dx.doi.org/10.1016/j.ijgo.2006.12.010

[9]   Vegas, G., Illescas, T., Munoz, M. and Perez-Pinar, A. (2006) Selective Pelvic Arterial Embolization in the Management of Obstetric Hemorrhage. European Journal of Obstetrics & Gynecology and Reproductive Biology, 127, 68-72.
http://dx.doi.org/10.1016/j.ejogrb.2005.09.008

[10]   Yong, S.P. and Cheung, K.B. (2006) Management of Primary Postpartum Haemorrhage with Arterial Embolisation in Hong Kong Public Hospitals. Hong Kong Medical Journal, 12, 437-441.

[11]   Tsang, M.L., Wong, W.C., Kun, K.Y., Tai, C.M., Ng, T.K., Lau, K.Y. and Wong, T.P. (2004) Arterial Embolisation in Intractable Primary Post-Partum Haemorrhage: Case Series. Hong Kong Medical Journal, 10, 301-306.

[12]   Kobayashi, T., Terao, T., Maki, M. and Ikenoue, T. (2001) Diagnosis and Management of Acute Obstetrical DIC. Seminars in Thrombosis and Hemostasis, 27, 161-167.
http://dx.doi.org/10.1055/s-2001-14076

[13]   Sentilhes, L., Gromez, A., Clavier, E., Resch, B., Verspyck, E. and Marpeau, L. (2009) Predictors of Failed Pelvic Arterial Embolization for Severe Postpartum Hemorrhage. Obstetrics Gynecology, 113, 992-999.
http://dx.doi.org/10.1097/AOG.0b013e3181a114f7

[14]   Bros, S., Chabrot, P., Kastler, A., Ouchchane, L., Cassagnes, L., Gallot, D. and Boyer, L. (2012) Recurrent Bleeding within 24 Hours after Uterine Artery Embolization for Severe Postpartum Hemorrhage: Are There Predictive Factors? CardioVascular and Interventional Radiology, 35, 508-514.
http://dx.doi.org/10.1007/s00270-011-0181-3

[15]   Maassen, M.S., Lambers, M.D., Tutein Nolthenius, R.P., van der Valk, P.H. and Elgersma, O.E. (2009) Complications and Failure of Uterine Artery Embolisation for Intractable Postpartum Haemorrhage. BJOG: An International Journal of Obstetrics and Gynaecology, 116, 55-61.
http://dx.doi.org/10.1111/j.1471-0528.2008.01939.x

[16]   Cottier, J.P., Fignon, A., Tranquart, F. and Herbreteau, D. (2002) Uterine Necrosis after Arterial Embolization for Post-partum Hemorrhage. Obstetrics Gynecology, 100, 1074-1077.

[17]   Hardeman, S., Decroisette, E., Marin, B., Vincelot, A., Aubard, Y., Pouquet, M. and Maubon, A. (2010) Fertility after Embolization of the Uterine Arteries to Treat Obstetrical Hemorrhage: A Review of 53 Cases. Fertility and Sterility, 94, 2574-2579.
http://dx.doi.org/10.1016/j.fertnstert.2010.02.052

 
 
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