An analysis of the efficacy of uterine artery embolization in obstetrical hemorrhage
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20233291Keywords:
Obstetric hemorrhage, Postpartum hemorrhage, Postabortal hemorrhage, Uterine artery embolizationAbstract
Background: Obstetrical hemorrhage is the single most important cause of maternal morbidity and mortality. The study is conducted at a tertiary-care hospital to assess the efficacy of uterine artery embolization as a treatment for obstetrical uterine hemorrhage. It examines various aspects such as the outcome of the procedure, need of blood and blood products, need of secondary procedures post intervention and the possibility of future pregnancies.
Methods: It was a retrospective observational study conducted with sample size of 20 patients with obstetrical hemorrhage at the Department of Obstetrics and Gynecology of Bhagwan Mahaveer Jain Hospital, Bengaluru in India between January 2011 to July 2019.
Results: Records of 20 patients with obstetrical hemorrhage were assessed. The study indicates that 11 patients experienced postpartum hemorrhage (PPH), 5 postabortal bleeding & 4 bleeding due to scar ectopic. Out of 20 patients, hemodynamic stability was achieved in 17 cases (85%), hysterectomy was needed in 2 cases (10%) and 1 (5%) patient died after the procedure. Of total 20 cases, 18 (90%) required secondary procedures post-intervention like dilatation and evacuation 6 cases (33.3% of total cases), vaginal suturing and packing 10 cases (55.5% of total cases) and supportive measures like PPH and Disseminated intravascular coagulation (DIC) management in 2 cases (11.1% of total cases). Blood transfusion was given in 15 cases (75%) after the procedure. Future pregnancy was attained in 8 cases (47%) after considering the history of the patients, loss of follow-up, possibility of complications, family planning and hysterectomy performed.
Conclusions: Uterine artery embolization is a very effective method to control obstetric hemorrhage with high success and low complication rate and hysterectomy can be avoided to preserve fertility.
References
American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 183: Postpartum Hemorrhage. Obstetrics and Gynecol. 2017;130(4):e168-86.
Women’s health. Available at: https://www.acog.org/womens-health/faqs/uterine-artery-embolization. Accessed on 14th January 2023.
Anderson JM, Etches D. Prevention and management of postpartum hemorrhage. Am Fam Physician. 2007;15(6):875-82.
Muñoz M, Stensballe J, Ducloy-Bouthors AS, Bonnet MP, De Robertis E, Fornet I, et al. Patient blood management in obstetrics: prevention and treatment of postpartum hemorrhage. A NATA consensus statement. Blood Transfusion. 2019;17(2):112-36.
Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician. 2017;95(7):442-9.
Miller DT, Roque DM, Santin AD. Use of Monsel solution to treat obstetrical hemorrhage: a review and comparison to other topical hemostatic agents. Am J Obstet Gynecol. 2015;212(6):725-35.
Juneja SK, Tandon P, Mohan B, Kaushal S. A change in the management of intractable obstetrical hemorrhage over 15 years in a tertiary care center. Int J Appl Basic Med Res. 2014;4(Suppl 1):S17-9.
Hong TM, Tseng HS, Lee RC, Wang JH, Chang CY. Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage. Clin Radiol. 2004;59(1):96-101.
Steinauer JE, Diedrich JT, Wilson MW, Darney PD, Vargas JE, Drey EA. Uterine artery embolization in postabortion hemorrhage. Obstet Gynecol. 2008;111(4):881-9.
Hong Y, Guo Q, Pu Y, Lu D, Hu M. Outcome of high-intensity focused ultrasound and uterine artery embolization in the treatment and management of cesarean scar pregnancy: A retrospective study. Medicine (Baltimore). 2017;96(30):e7687.
Jung HN, Shin SW, Choi SJ, Cho SK, Park KB, Park HS et al. Uterine artery embolization for emergent management of postpartum hemorrhage associated with placenta accreta. Acta Radiologica. 2011;52(6):638-42.
Hansch E, Chitkara U, McAlpine J, El-Sayed Y, Dake MD, Razavi MK. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience. Am J Obste Gynecol. 1999;180(6):1454-60.
Zhang Y. Clinical efficacy analysis of selective uterine artery embolization in the treatment of obstetrical hemorrhage. Minerva Med. 2022;113(5):894-5.
Delotte J, Novellas S, Koh C, Bongain A, Chevallier P. Obstetrical prognosis and pregnancy outcome following pelvic arterial embolisation for post-partum hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2009;145(2):129-32.
Agrawal S, Thakur R, Sonker S. Study of uterine artery embolization: a newer modality in secondary PPH. Int J Reprod Contracept Obstet Gynecol. 2018;7(2):452-5.
Choi YH, Baba Y, Ikeda S, et al. Efficacy of uterine artery embolization for patients with postpartum hemorrhage. Open J Radiol. 2013;3:5.
Salomon LJ, deTayrac R, Castaigne-Meary V, Audibert F, Musset D, Ciorascu R, et al. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod. 2003;18(4):849-52.
Gaia G, Chabrot P, Cassagnes L, Calcagno A, Gallot D, Botchorishvili R, et al. Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study. Eur Radiol. 2009;19(2):481-7.
