Artery Embolization For Postpartum Hemorrhage Research Articles

Uterine necrosis following uterine artery embolization as treatment for postpartum hemorrhage: A case report and literature review.

Uterine necrosis is a rare complication of uterine artery embolization for postpartum hemorrhage and most patients end up having a hysterectomy. Here we report a case in which the patient experienced a recurrent fever 28 days after uterine artery embolization as treatment for postpartum hemorrhage and had no response to antibiotics. Magnetic resonance imaging of the pelvis revealed a mass which was approximately 12-cm in size with air bubbles in the uterus, suggesting necrosis with infection. Transvaginal clamping of the uterine mass was performed and necrotic tissue removed under laparoscopic monitoring, which successfully spared the necessity for a hysterectomy. The patient's subsequent progress was favorable. In the present study we review the high-risk factors of uterine necrosis following uterine artery embolization and summarize the key points of early diagnosis. In addition, we propose a strategy to successfully spare the necessity for a hysterectomy without the spread of infection or uterine perforation.

Association between uterine artery embolization for postpartum hemorrhage and second delivery on maternal and offspring outcomes: a nationwide cohort study.

What are the maternal and neonatal outcomes of second delivery in women who underwent uterine artery embolization (UAE) during their first delivery? Women who underwent UAE during their first delivery exhibited higher risks of placental problems, preterm births, and postpartum hemorrhage (PPH) in second delivery and the second offspring also showed increased risk of major congenital malformations, admission to the neonatal intensive care units (NICU), necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia. UAE is a minimally invasive procedure used as an alternative to hysterectomy for managing severe PPH. However, recent studies have raised concerns about potential obstetric complications, including recurrent PPH, placenta accreta spectrum (PAS), and fetal growth restriction in subsequent delivery following UAE. This was a nationwide retrospective cohort study using the Korean National Health Insurance Service (K-NHIS) database, covering 50 million individuals from 2004 to 2020. The cohort included 3616923 women with live births between 1 January 2005 and 31 December 2019 with follow-up data extending to 31 December 2020. The study included women who had their first live birth between 2005 and 2019, excluding those who underwent hysterectomy (without UAE = 3612389, UAE = 4534). Among them, we selected women who had single gestation secondary delivery (without UAE = 1694600, UAE = 1146). Propensity score matching was used to control for confounding factors, resulting in 11184 women without UAE and 1119 women with UAE for subsequent analysis. Women in the UAE group had significantly higher risks of PAS (odds ratio (OR) = 38.91, 95% CI = 18.61-81.34), placenta previa (OR = 6.98, 95% CI = 5.57-8.75), and preterm birth (OR = 2.23, 95% CI = 1.71-2.90) during their second delivery. The risk of recurrent PPH was also significantly higher (OR = 8.94, 95% CI = 7.19-11.12). Their second offspring were more likely to have major congenital malformations (OR = 1.62, 95% CI = 1.25-2.11) and adverse neonatal outcomes, including NICU admissions (OR = 1.83, 95% CI = 1.48-2.25). Long-term outcomes showed a higher risk of attention-deficit/hyperactivity disorder (hazard ratio = 1.64, 95% CI = 1.03-2.63) but were otherwise comparable to those in the without UAE group. Retrospective nature of the study may have introduced exposure and outcome misclassifications, despite the reliability of the K-NHIS database. Unmeasured confounders and selection bias due to only including live births could also have influenced the results. Women with a history of UAE require meticulous prenatal care and close monitoring during subsequent deliveries due to increased risks of complications. Counseling and referral to high-risk medical centers may improve outcomes. Further research is needed to understand the mechanisms of complications in both mothers and offspring at sequential delivery, as well as to refine UAE procedures. This study supported by Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (HC21C0123). This study was funded by S.-Y.O. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. N/A.

Efficacy and Safety of Uterine Artery Embolisation for Postpartum Haemorrhage: A Systematic Review and Meta-analysis

Efficacy and Safety of Uterine Artery Embolisation for Postpartum Haemorrhage: A Systematic Review and Meta-analysis

Effect of pelvic artery embolization for postpartum hemorrhage on subsequent pregnancies: a single-center retrospective cohort study

Objective Pelvic artery embolization (PAE) is a uterus-saving treatment for postpartum hemorrhage (PPH); however, subfertility or abnormal placentation for subsequent pregnancy has been a concern in several previous reports. This study aimed to investigate the impact of PAE on subsequent pregnancies in women with a history of PPH. Methods A retrospective cohort study was conducted on women transferred to the tertiary center for PPH and delivered for the next pregnancy at the same center later. The study group was divided into two groups based on PAE application to treat previous PPH. Results Of the 62 women included, 66% (41/62) had received PAE for the previous PPH, while 21 had not. Pregnancy outcomes for subsequent pregnancies were compared between the PAE and non-PAE groups. The PAE group had a higher estimated blood loss volume for the present delivery than the non-PAE group (600 vs. 300 mL, p = 0.008). The PAE group also demonstrated a higher incidence of placenta previa (4.8% vs. 24.4%, p = 0.080) and placenta accreta (0% vs. 14.6%, p = 0.082) than the non-PAE group, although the difference was not statistically significant. Conclusion These findings suggest that the use of PAE to treat PPH may increase the risk of bleeding, placenta previa, and placenta accreta spectrum in subsequent pregnancies.

Uterine artery embolization for postpartum hemorrhage with placenta accreta spectrum.

The reported success rate of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) differs by the cause of bleeding; in some reports, UAE shows less successful results in patients with placenta accreta spectrum (PAS). To evaluate the outcome of UAE for treating PPH associated with PAS. From September 2011 to September 2021, 227 patients (mean age = 34.67±4.06 years; age range = 19-47 years) underwent UAE for managing intractable PPH. Patients were divided into two groups: those with PAS (n = 46) and those without PAS (n = 181). Delivery details, embolization details, and procedure-related outcomes were compared between the two groups. P values <0.05 were considered statistically significant. The technical success rate was 96.9% (n = 222) and the clinical success rate was 93.8% (n = 215). There were no significant differences in outcome of UAE between the two patient groups. The technical success rate was 95.7% (n = 44) in patients with PAS and 98.3% (n = 178) in patients without PAS (P = 0.267). The clinical success rate was 91.3% (n = 42) in patients with PAS and 95.6% (n = 173) in patients without PAS (P = 0.269). There were 24 cases of immediate complications, including pelvic pain (n = 20), urticaria (n = 3), and puncture site hematoma (n = 1). No major complication was reported. UAE is a safe and effective method to control intractable PPH for patients with or without PAS.

Risk Factors Associated with Clinical Failure of Uterine Artery Embolization for Postpartum Hemorrhage

PurposeTo identify risk factors for clinical failure of uterine artery embolization (UAE) for postpartum hemorrhage (PPH), with particular attention to the uterine artery diameter. Materials and MethodsThis retrospective study included 47 patients who underwent UAE for PPH between January 1, 2010, and January 31, 2021. Technical success was defined as the completion of embolization of the arteries thought to be the cause of the bleeding. Clinical success was defined as no recurrent bleeding or need for additional therapeutic interventions. Univariate and multivariate analyses were performed to examine the risk factors associated with clinical failure of UAE. ResultsOf the 47 patients, 6 had recurrent bleeding. Of the 6 patients, 4 underwent hysterectomy, and 2 underwent repeat embolization. The clinical success rate was 87.2% (41/47), with no major adverse events such as uterine infarction or death. In univariate analysis, there were slight differences in multiparity (P = .115) and placental abruption (P = .128) and a significant difference in the findings of a narrow uterine artery on digital subtraction angiography (DSA) (P = .005). In multivariate analysis, only a narrow uterine artery on DSA was a significant factor (odds ratio, 18.5; 95% confidence interval, 2.5–134.8; P = .004). ConclusionsA narrow uterine artery on DSA was a risk factor for clinically unsuccessful UAE for PPH. It may be prudent to conclude the procedure only after it is ensured that vasospasm has been relieved.

Obstetrical and Fertility Outcomes Following Transcatheter Pelvic Arterial Embolization for Postpartum Hemorrhage: A Cohort Follow-Up Study.

Objectives: Management of severe postpartum hemorrhage (PPH) includes transcatheter pelvic arterial embolization (TAE). Data regarding subsequent fertility and obstetrical outcomes is limited, as most fertility outcomes derive from TAE in uterine fibroma. The purpose of our study was to evaluate the long-term outcomes of patients undergoing TAE, particularly concerning subsequent fertility and following pregnancies. Material and methods: We included 28 patients who underwent TAE for PPH at our institution between 2009 and 2018 in a retrospective cohort study. Data were assessed by reviewing patients’ charts and by contacting the patients. Results: Ten patients had prophylactic balloon occlusion before cesarean section because of anticipated PPH, with planned hysterectomy by placenta increta/percreta. All these patients were excluded from the analysis regarding fertility. 16 (73%) patients reported having regular menstruation after TAE. In total, 11 women had no desire for subsequent pregnancy. Seven of the remaining 11 patients (63.6%) had a total of 13 spontaneous pregnancies, nine of these resulted in miscarriages. Four patients delivered a live baby (36.4%). Two of these (50%) had recurrent PPH and treatment was conservative. Of the patients with infertility (n = 4, 36.4%), two (18.1%) underwent assisted infertility treatment without success. Conclusion: Our study suggests that the fertility of patients undergoing TAE due to PPH is limited. In women who conceive, the risk for first trimester miscarriage as well as recurrent PPH seems to be increased. If this is a consequence of the underlying cause of PPH or the TAE remains unknown. Larger follow-up cohorts are needed. In the meantime, patients who desire pregnancy after TAE should be counseled accordingly.

Unsuccessful Transcatheter Arterial Embolization for Postpartum Hemorrhage: A Case Report

&lt;p&gt;Postpartum haemorrhage (PPH) is the most common cause of death from childbirth and is commonly treated with transcatheter arterial embolisation (TAE). However, TAE failure could occur in the form of intractable PPH with uncontrolled bleeding. Here we report the case of a 36-year-old female who developed PPH post-delivery and was treated with TAE. The bilateral internal iliac and uterine arteries were first catheterised, after which embolisation of the bilateral uterine and internal iliac arteries was performed with Gelfoam particles, and the blood flow of the vessels was markedly reduced after the embolisation. However, the patient&amp;rsquo;s blood pressure remained low (about 60/40 mmHg) after TAE, necessitating a subtotal hysterectomy. In this report, related studies on the risk factors and treatments for PPH and the risk factors for the clinical failure of TAE are discussed.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

A Case of Preeclampsia with Uterine Necrosis after Uterine Artery Embolization for Postpartum Hemorrhage

Uterine necrosis is a rare complication in uterine artery embolization (UAE) for postpartum hemorrhage (PPH). Preeclampsia (PE) is a condition characterized with systemic endothelial damage and intravascular volume depletion. Whether a patient with PE is at high risk for uterine necrosis after UAE for PPH has been unknown. A 30-year-old primipara woman was diagnosed with PE based on hypertension and proteinuria during delivery. UAE was performed for PPH after forceps delivery. After UAE, the patient presented with pleural effusion and massive ascites as well as persistent fever unresponsive to antibiotics. Ultrasonography and contrast-enhanced magnetic resonance imaging (MRI) led to the diagnosis of uterine necrosis, for which we performed total laparoscopic hysterectomy. It should be kept in mind that patients with PE associated with massive ascites may be at high risk for uterine necrosis after UAE due to decreased uterine perfusion. Therefore, it is important to pay attention to persistent symptoms such as fever and abdominal pain after UAE to diagnose uterine necrosis.

Abstract No. 514 Uterine artery embolization for post-partum hemorrhage: a health system retrospective review over 7 years

Post-partum hemorrhage is a leading cause of pregnancy-related mortality. Uterine arterial embolization (UAE) by interventional radiologists can aid in hemostasis, but reproductive outcomes is not well known. We describe hemorrhage etiology, embolization technique, and reproductive outcomes of patients with post-partum hemorrhage who underwent UAE within 24 hours of delivery at a large healthcare system over the past 7 years.

Anatomic variations of the Uterine Artery. Review of the literature and their clinical significance.

Uterine arteries are the main vessels supplying blood to the uterus. Mainly, they originate from the anterior trunk of the internal iliac artery. Uterine arteries play an important role in pregnancy as well as transcatheter arterial embolization for postpartum hemorrhage and uterine fibroid management. This is a review of the English literature in the PubMed database of the anatomic variety on the origin of uterine arteries and their clinical significance. Eleven studies describe the origin of the uterine arteries and their variations in the literature. In six studies, the uterine artery emerged from internal iliac artery in the majority of the cases, either as a separate branch, or as a bifurcation with the inferior gluteal artery, or trifurcation with superior and inferior gluteal artery. In two studies, the inferior gluteal artery manifested as the main source of the uterine artery, whereas in three studies, the umbilical artery posed as its main origin. Internal iliac artery is described as the most common vascular origin of uterine artery. However, this review highlights that the main vessels of origin for uterine arteries are internal iliac, umbilical and inferior gluteal artery. Nevertheless, classification and further research for this peculiar anatomic structure is fundamental in the future.

Uterine Necrosis after Uterine Artery Embolization for Postpartum Hemorrhage

Uterine Necrosis after Uterine Artery Embolization for Postpartum Hemorrhage

Uterine necrosis following selective embolization for postpartum hemorrhage: report of four cases and review of literature

Uterine necrosis is one of the rare complications that may follow uterine arterial embolization for postpartum hemorrhage (PPH), and its incidence remains unknown. The authors report four cases of uterine necrosis in Korea. The mean time interval between uterine artery embolization (UAE) and diagnosis of uterine necrosis was 72 days. Patients’ main symptoms were abdominal pain, fever, profuse vaginal discharge, and vaginal bleeding. Decisions related to management depended on the condition of the patient and the patient’s desire regarding conservation of the uterus. Based on these cases, the authors suggest helpful decisions for the therapeutic guidelines for uterine necrosis after UAE.

The prediction of abnormally invasive placenta in subsequent pregnancies after uterine artery embolization for postpartum hemorrhage

The prediction of abnormally invasive placenta in subsequent pregnancies after uterine artery embolization for postpartum hemorrhage

Outcome of re-pregnancy in women with uterine artery embolization for postpartum hemorrhage

To evaluate the outcome of re-pregnancy in women with uterine artery embolization(UAE)for postpartum hemorrhage(PPH). Clinical data of 117 pregnant women with previous PPH admitted in Ningbo Women and Children's Hospital from January 2010 to January 2016 were retrospectively analyzed. Among them 40 cases were treated with UAE (UAE group) and 77 cases were not treated with UAE (control group). The outcomes of re-pregnancy were followed up and compared between two groups. There were significant differences in the incidence of induced abortion in early pregnancy and cesarean scars pregnancy (CSP) between the two groups (P<0.05 or P<0.01). In the UAE group, the incidence of PPH, placental accretion and hysterectomy rate was significantly higher than that of control group (P<0.05 or P<0.01). Multivariate analysis showed that UAE was independent risk factor for CSP, placenta accretion, PPH and hystere-ctomy (P<0.05 or P<0.01). The overall fertility and re-pregnant outcomes in women with previous UAE for PPH are favorable. However, the risk of CSP, placenta accretion and associated recurrence of PPH and hysterectomy is higher in women receiving UAE during subsequent pregnancy.

Total Laparoscopic Hysterectomy for Uterine Infarction Following Uterine Artery Embolization for Postpartum Hemorrhage

Total Laparoscopic Hysterectomy for Uterine Infarction Following Uterine Artery Embolization for Postpartum Hemorrhage

The Relationship Between Gelatin Sponge Preparation Methods and the Incidence of Intrauterine Synechia Following Uterine Artery Embolization for Postpartum Hemorrhage

To evaluate the relationship between gelatin sponge preparation methods and the incidence of intrauterine synechia following uterine artery embolization (UAE) for postpartum hemorrhage (PPH). In a retrospective monocentric study, we used data from 20 consecutive UAE procedures (19 patients) for PPH, performed in 2007-2016, in which gelatin sponge had been used. The gelatin sponge was processed either into a slurry by pumping it back and forth about 10 times through two syringes connected to a three-way stopcock or into pledgets using a scalpel and small scissors to obtain pieces approximately 2 × 2 × 2mm in size. Patient information was obtained from medical records, and the data were compared between patients treated with the slurry (n = 7) or pledgets (n = 13) forms. Due to the lack of follow-up data and hysterectomy after UAE, the sample size was 6 and 12 because 1 patient with 2 procedures was excluded. The rate of intrauterine synechia was significantly higher in the slurry group (5/6, 83.3%) than that in the pledgets group (0/12, 0%; P < 0.001). In contrast, there were no significant differences in population characteristics, such as the incidence of placenta accreta, non-placental diseases, and severity of shock (DIC score, shock index, or blood loss) between the groups. Although non-randomization and small sample size were the two main limitations, our observations suggest that UAE using gelatin sponge slurry may be associated with a high incidence of intrauterine synechia compared to UAE using pledgets.

Puerperal Uterine Necrosis and Pyometrium After Uterine Artery Embolization [27L

INTRODUCTION: Uterine necrosis is a rare complication following uterine artery embolization. METHODS: We report a case of uterine necrosis in a 32 year old primigravida patient who underwent uterine artery embolization for postpartum hemorrhage. RESULTS: This patient presented in labor at term and had a spontaneous vaginal delivery. Her labor was complicated by chorioamnionitis, which was treated appropriately. Her history was remarkable for a 6.9 × 5.4 × 6.8 cm posterior submucosal fibroid. Postpartum course was significant for hemorrhage secondary to atony and retained placenta, which was manually extracted. Bakri balloon placement was attempted, but unsuccessful due to obstruction from the fibroid. She subsequently underwent an uncomplicated uterine artery embolization, and was discharged on postpartum day 3. She re-presented on postpartum day 10 for fevers to 103°F, and was admitted for presumed endometritis. Appropriate antibiotics were started, however she continued having recurrent fevers through hospital day 9. Computed tomography scan revealed gas and fluid within the uterine cavity, and endometrial biopsy showed heavy growth of E. coli. She underwent an abdominal hysterectomy, and was found to have a 20 weeks sized uterus with a 6 cm submucosal fibroid with blood-tinged purulent contents. Histology was consistent with pyometrium and uterine necrosis. CONCLUSION: Uterine necrosis is a rare, but serious complication of uterine artery embolization when used for postpartum hemorrhage. Recognizing risk factors and understanding rare complications can help providers better counsel patients and prevent delays in care when patients re-present with fevers refractory to conventional treatment.

Classification of uterine artery angiographic images: a predictive factor of failure in uterine artery embolization for postpartum hemorrhage.

To justify a classification system for angiographic images of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) and identify new risk factors associated with failed embolization. A retrospective analysis of 63 consecutive patients who underwent UAE for severe PPH was performed. Uterine artery angiography (UA) before embolization was classified into two types: type 1 was defined as complete staining and type 2 was defined as partial staining of the uterine arteries. The clinical outcome, UA classification, and other possible factors previously reported were evaluated. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes. Sixty-three patients were enrolled (type 1, 22; type 2, 41). The clinical success rates of the primary UAE session were 90.9% (20/22) for type 1 and 61.0% (25/41) for type 2 (p = 0.018). Univariate and multivariate analyses demonstrated that the only UA classification was significantly associated with primary UAE failure (p = 0.033). The UA classification is an independent predictive factor of the clinical success rate of the primary UAE session for PPH; thus, it is an intuitive and optimal predictor for interventional radiologists to decide whether additional therapy is necessary.

Pyomyoma after Uterine Artery Embolization for Postpartum Hemorrhage Misdiagnosed as Uterine Necrosis

Pyomyoma after Uterine Artery Embolization for Postpartum Hemorrhage Misdiagnosed as Uterine Necrosis