Effectiveness of selective transcatheter arterial embolization in delayed postpartum hemorrhage

Se Hwan Kwon, Yeo Jin Kim, Jehong Yoon, Joo Hyeong Oh, Myung Gyu Song, Tae-Seok Seo

Research output: Contribution to journalArticle

Abstract

Background: Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide. Delayed PPH has received less attention compared to early PPH because the incidence rate of delayed PPH is relatively lower than that of early PPH. Objectives: The aim of this study was to evaluate the clinical manifestations, angiographic findings, and effectiveness of selective transcatheter arterial embolization (TAE) for delayed PPH. Patients and Methods: Selective TAE was performed on 37 women (mean age: 32.1 years, range: 24 - 40) with delayed PPH between March 2006 and October 2016. Delayed PPH was defined as continuous hemorrhage from the female genital tract 24 hours to 6 weeks after delivery. Medical records were retrospectively reviewed for patient characteristics, the time interval between delivery and TAE, angiographic findings, embolized artery, embolic materials, technical and clinical success rate, and complications. Results: Delayed bleeding developed at a median 11.6 days (range: 2 - 34 days) after cesarean section (n = 19) and vaginal delivery (n = 18). On angiography, diffuse hypervascularity was detected in 24 patients, pseudoaneurysm in 11, active extravasation in 1, and arteriovenous malformation in 1. Arteries subjected to TAE included bilateral uterine arteries (UAs) (n = 29), bilateral UAs and unilateral ovarian artery (OA) (n = 4), bilateral UAs and bilateral OAs (n = 1), bilateral UAs and cervicovaginal branch (n = 1), unilateral OA (n = 1), and internal pudendal artery (n = 1). Embolic materials were Gelfoam (n = 30), Gelfoam and coil (n = 3), polyvinyl alcohol (PVA) (n = 2), and PVA and coil (n = 2). There were no procedure-related major complications. Technical success was obtained in all patients (100%), and clinical success was obtained in 34 patients (91.9%) Conclusion: Selective TAE in patients with delayed PPH is a useful treatment with high technical and clinical success.

Original languageEnglish
Article numbere77175
JournalIranian Journal of Radiology
Volume16
Issue number2
DOIs
Publication statusPublished - 2019 Apr 1

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Postpartum Hemorrhage
Uterine Artery
Arteries
Absorbable Gelatin Sponge
Polyvinyl Alcohol
Hemorrhage
Maternal Mortality
Arteriovenous Malformations
False Aneurysm
Cesarean Section
Medical Records
Angiography
Morbidity

Keywords

  • Angiography
  • Interventional radiology
  • Postpartum hemorrhage
  • Transcatheter embolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Effectiveness of selective transcatheter arterial embolization in delayed postpartum hemorrhage. / Kwon, Se Hwan; Kim, Yeo Jin; Yoon, Jehong; Oh, Joo Hyeong; Song, Myung Gyu; Seo, Tae-Seok.

In: Iranian Journal of Radiology, Vol. 16, No. 2, e77175, 01.04.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide. Delayed PPH has received less attention compared to early PPH because the incidence rate of delayed PPH is relatively lower than that of early PPH. Objectives: The aim of this study was to evaluate the clinical manifestations, angiographic findings, and effectiveness of selective transcatheter arterial embolization (TAE) for delayed PPH. Patients and Methods: Selective TAE was performed on 37 women (mean age: 32.1 years, range: 24 - 40) with delayed PPH between March 2006 and October 2016. Delayed PPH was defined as continuous hemorrhage from the female genital tract 24 hours to 6 weeks after delivery. Medical records were retrospectively reviewed for patient characteristics, the time interval between delivery and TAE, angiographic findings, embolized artery, embolic materials, technical and clinical success rate, and complications. Results: Delayed bleeding developed at a median 11.6 days (range: 2 - 34 days) after cesarean section (n = 19) and vaginal delivery (n = 18). On angiography, diffuse hypervascularity was detected in 24 patients, pseudoaneurysm in 11, active extravasation in 1, and arteriovenous malformation in 1. Arteries subjected to TAE included bilateral uterine arteries (UAs) (n = 29), bilateral UAs and unilateral ovarian artery (OA) (n = 4), bilateral UAs and bilateral OAs (n = 1), bilateral UAs and cervicovaginal branch (n = 1), unilateral OA (n = 1), and internal pudendal artery (n = 1). Embolic materials were Gelfoam (n = 30), Gelfoam and coil (n = 3), polyvinyl alcohol (PVA) (n = 2), and PVA and coil (n = 2). There were no procedure-related major complications. Technical success was obtained in all patients (100{\%}), and clinical success was obtained in 34 patients (91.9{\%}) Conclusion: Selective TAE in patients with delayed PPH is a useful treatment with high technical and clinical success.",
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AU - Kim, Yeo Jin

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AU - Song, Myung Gyu

AU - Seo, Tae-Seok

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AB - Background: Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide. Delayed PPH has received less attention compared to early PPH because the incidence rate of delayed PPH is relatively lower than that of early PPH. Objectives: The aim of this study was to evaluate the clinical manifestations, angiographic findings, and effectiveness of selective transcatheter arterial embolization (TAE) for delayed PPH. Patients and Methods: Selective TAE was performed on 37 women (mean age: 32.1 years, range: 24 - 40) with delayed PPH between March 2006 and October 2016. Delayed PPH was defined as continuous hemorrhage from the female genital tract 24 hours to 6 weeks after delivery. Medical records were retrospectively reviewed for patient characteristics, the time interval between delivery and TAE, angiographic findings, embolized artery, embolic materials, technical and clinical success rate, and complications. Results: Delayed bleeding developed at a median 11.6 days (range: 2 - 34 days) after cesarean section (n = 19) and vaginal delivery (n = 18). On angiography, diffuse hypervascularity was detected in 24 patients, pseudoaneurysm in 11, active extravasation in 1, and arteriovenous malformation in 1. Arteries subjected to TAE included bilateral uterine arteries (UAs) (n = 29), bilateral UAs and unilateral ovarian artery (OA) (n = 4), bilateral UAs and bilateral OAs (n = 1), bilateral UAs and cervicovaginal branch (n = 1), unilateral OA (n = 1), and internal pudendal artery (n = 1). Embolic materials were Gelfoam (n = 30), Gelfoam and coil (n = 3), polyvinyl alcohol (PVA) (n = 2), and PVA and coil (n = 2). There were no procedure-related major complications. Technical success was obtained in all patients (100%), and clinical success was obtained in 34 patients (91.9%) Conclusion: Selective TAE in patients with delayed PPH is a useful treatment with high technical and clinical success.

KW - Angiography

KW - Interventional radiology

KW - Postpartum hemorrhage

KW - Transcatheter embolization

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