Abstract
ObjectiveThe liquid embolic agent n-butyl cyanoacrylate (NBCA) is a tissue adhesive used as an immediate and permanent embolic agent when mixed with oil-based contrast medium. In this study, the preservation of fertility with TAE using NBCA for massive haemorrhage during pregnancy or the peripartum period and the utility of this therapy were investigated.MethodsCases from January 2005 to October 2010 in which TAE was performed for massive haemorrhage in pregnant women, particularly during the peripartum period, were investigated.ResultsTAE was performed in 27 pregnant women. The embolic agent used was GS only in five cases, NBCA only in 19 cases, and additional embolization with NBCA when the effect with GS was insufficient in three cases, one each of abruptio placentae, cervical pregnancy, and uterine atony.A comparison of mean blood loss when each embolic agent was used for haemostasis showed a significant difference between cases in which GS only was used and cases in which NBCA only was used. In a comparison of mean transfusion volume, a significant difference was seen between cases in which both GS and NBCA were used and cases in which NBCA only was used. In a postoperative follow-up survey, menses resumed in eight patients, including four patients who later became pregnant and three who delivered.ConclusionsTAE with NBCA, which has an embolic effect unrelated to clotting dysfunction for massive haemorrhage during the peripartum period, is a minimally invasive and very effective treatment method for patients with severe DIC.
Highlights
Perinatal bleeding is a leading cause of death in pregnant and parturient women
gelatine sponges (GS) is generally used as an embolic agent in transcatheter arterial embolization (TAE), but in this investigation, n-butyl cyanoacrylate (NBCA) was used with the following indications: (1) haemostasis was insufficient with GS; (2) there was severe disseminated intravascular coagulation (DIC) during the peripartum period; (3) obvious extravasation was seen with contrast CT or angiography
There were three with abruptio placentae, two each with caesarean scar pregnancy, placenta accreta, and vaginal laceration, and one each with cervical pregnancy, placenta praevia, pregnancy complicated with myomas, and amniotic fluid embolism
Summary
Perinatal bleeding is a leading cause of death in pregnant and parturient women. Atonic haemorrhage, birth canal laceration, uterine rupture, and placental defects (e.g., placenta praevia, placenta accreta). In cases of sudden intrapartum bleeding, attempts are first made to stop the bleeding with massage of the uterine fundus, administration of uterotonic agents, and suture of the laceration site. If there is excessive blood loss over a short time, haemorrhagic shock or disseminated intravascular coagulation (DIC) may occur, and massive transfusion volumes become necessary. Favourable haemostatic effects have been achieved with transcatheter arterial embolization (TAE)
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