The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience.

Daigo Ochiai,Masahiro Jinzaki,Satoru Ikenoue,Masanori Inoue,Yushi Abe,Yoshifumi Kasuga,Seishi Nakatsuka,Mamoru Tanaka

doi:10.3390/jcm10184082

Daigo Ochiai, Masahiro Jinzaki + Show 6 more

Open Access

https://doi.org/10.3390/jcm10184082

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Journal: Journal of Clinical Medicine	Publication Date: Sep 9, 2021
Citations: 1	License type: CC BY 4.0

Affiliation: Keio University

Abstract

Indications for the use of transarterial embolization (TAE) for postpartum hemorrhage (PPH) have been established. However, the efficacy of TAE for PPH complicated by disseminated intravascular coagulation (DIC) remains controversial. In this study, we investigated the efficacy of TAE for PPH complicated by DIC. A database review was conducted to identify patients who were treated with TAE for PPH at our hospital. TAE was performed in 41 patients during the study period. Effective hemostasis was achieved in all cases, but additional procedures, such as re-embolization or hysterectomy, were required in five patients (12.2%). The typical causes of PPH included uterine atony (18 cases), placenta previa (15 cases), amniotic fluid embolism (DIC-type) (11 cases), and placenta accreta spectrum (10 cases). The mean blood loss was 3836 mL. The mean obstetrical DIC and the International Society on Thrombosis and Hemostasis DIC scores were 7.9 and 2.6, respectively. The efficacy of hemostasis was comparable between patients with and without DIC. However, the complete success rate of TAE was lower in patients with DIC as the condition worsened than that in non-DIC patients. Overall, TAE is effective as a minimally invasive treatment for PPH complicated by DIC.

Highlights

Postpartum hemorrhage (PPH), a pregnancy complication that may occur during or after delivery, is one of the most common causes of maternal morbidity and mortality [1,2].PPH is initially treated with rehydration, blood transfusion, and oxytocin administration, followed by local procedures such as uterine balloon tamponade within the uterine cavity.if bleeding continues, surgical procedures or transarterial embolization (TAE) may be required for management.TAE, including uterine artery embolization, has been attracting attention in the field of interventional radiology as a treatment option for PPH
We found that TAE was a useful strategy for managing PPH regardless of the presence or absence of disseminated intravascular coagulation (DIC)
Hemostatic improvement was achieved in all patients, and the overall complete success rate was 87.8% upon treatment with TAE

Summary

Introduction

Postpartum hemorrhage (PPH), a pregnancy complication that may occur during or after delivery, is one of the most common causes of maternal morbidity and mortality [1,2]. If bleeding continues, surgical procedures (e.g., hysterectomy and internal iliac artery ligation) or transarterial embolization (TAE) may be required for management. TAE, including uterine artery embolization, has been attracting attention in the field of interventional radiology as a treatment option for PPH. TAE reportedly results in shorter hospital stays, requires a smaller blood transfusion volume, and may preserve fertility compared with hysterectomy [3,4,5]. According to the Royal College of Obstetricians and Gynecologists and the Japanese Society of Interventional Radiology guidelines, TAE should be considered in the treatment of PPH [9,10].

Materials and Methods

Patient Characteristics

The Characteristics of Patients with or without Obstetrical and ISTH DIC

The Obstetric Outcomes in Patients with or without Obstetrical and ISTH DIC

Discussion