A New Protocol for Determining Intervention with Trans-Catheter Arterial Embolization or Surgical Hemostasis for Obstetric Hemorrhage

Mai Myoga,Toru Hachisuga,Kazuaki Yoshimura

doi:10.4236/ojog.2015.53017

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.

Highlights

Obstetric hemorrhage is one of the major causes of maternal morbidity and mortality [1]-[3] and its management represents a critical concern to obstetricians
We focused on the causes of obstetric hemorrhage and post-embolization complications
“Others” in the trans-catheter embolization (TAE) group include false aneurysm and hydatidiform mole coexisting with a fetus

Summary

Introduction

Obstetric hemorrhage is one of the major causes of maternal morbidity and mortality [1]-[3] and its management represents a critical concern to obstetricians. There are many treatments to control obstetric hemorrhage, i.e., uterine fundal massage, uterine bimanual compression, uterotonic agents, intra-uterine balloon tamponade, uterine packing, and placental tissue removal. If these conservative treatments are not effective, invasive interventions are required. The usages of TAE are wide ranging, which includes postpartum hemorrhage (such as uterine atony), placenta accreta, puerperal hematoma, early pregnancy bleeding, placental polyp, and cervical pregnancy. As an initial therapy, there is no standard protocol for choosing TAE or surgical hemostasis to control obstetric hemorrhage. The purpose of this study is to, by reviewing the past cases in our hospital, introduce protocols for choosing TAE or surgical hemostasis as an initial therapy for obstetric hemorrhage

Objectives

Methods

Results

Conclusion