Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate.

Abstract

To identify predictive factors for embolic material conversion to N-butyl cyanoacrylate (NBCA) for the treatment of primary postpartum hemorrhage (PPH) after failed transcatheter arterial embolization (TAE) using gelatin sponge (GS). Institutional review board approval was obtained. We retrospectively studied 62 consecutive women with primary PPH who underwent TAE between January 2006 and March 2015. Five of them were excluded for the following: cardiopulmonary arrest at arrival (n =1), uterine inversion (n =1), and hysterectomy after TAE (n =3). Remaining 57 women (age range, 21-43years; mean, 32.6years) comprised study population. TAE was initially performed using GS in all cases and then converted to NBCA after two embolizations using GS with persistent hemodynamic instability or vaginal bleeding. The patients' background, uterine height, vital signs, laboratory tests, disseminated intravascular coagulation score, and details of procedure were reviewed. Univariate and multivariate analyses were performed to determine factors related to embolic material conversion. Technical success rate was 100%. Fourteen patients (25%) needed embolic material conversion to NBCA. Univariate analysis showed that uterine height, systolic blood pressure (sBP), and hemoglobin level were significantly related to embolic material conversion to NBCA (P=0.029, 0.030, and 0.042). Logistic regression analysis showed that uterine height (odds ratio, 1.37; P=0.025) and sBP (odds ratio, 0.96; P=0.003) were associated with embolic material conversion to NBCA. Uterine height and sBP can be predictive factors for embolic material conversion to NBCA for the treatment of PPH. Level 4, Case Control Study.