Abstract
PurposeTo evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery.MethodsWe evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups.ResultsThe combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003).ConclusionS-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.
Highlights
Postpartum hemorrhage (PPH) remains the leading cause of maternal death worldwide [1, 2]
The purpose of this study was to evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery
Patients who underwent TAE for intractable PPH due to GTT after vaginal delivery, in which hemostasis was difficult to achieve by suturing, at our institution between January 2008 and December 2020 were included in the study
Summary
Postpartum hemorrhage (PPH) remains the leading cause of maternal death worldwide [1, 2]. PPH is defined by the American College of Obstetrics and Gynecology as cumulative blood loss greater than 1000 mL with signs and symptoms of hypovolemia within 24 h of the birth process, Bilateral uterine artery embolization (UAE) is an established treatment for uterine causes of intractable PPH, including uterine atony, retained tissue, or placenta accreta [5,6,7]. Emergency Radiology bilateral UAE but rather transcatheter arterial embolization (TAE) of the bleeding point. Several studies have demonstrated the high effectiveness of TAE for intractable PPH due to GTT [8,9,10]. Other reports do not strictly distinguish between bleeding due to uterine atony and PPH due to GTT; these conditions are often confused
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