Arterial catheterization and embolization for management of emergent or anticipated massive obstetrical hemorrhage

Abstract

Arterial catheterization and embolization is an effective, safe method for treating intractable obstetrical hemorrhage and might eliminate the need for hysterectomy and maintain reproductive ability.

Surgical management of placenta accreta: to leave or remove the placenta?

“…Both selective pelvic vessel embolisation and balloon occlusion catheters have been described in a number of reports. [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Which patients derive the greatest benefit from these technologies and when to use these procedures remains an area of active debate.…”

“…Pelvic artery embolisation is the most frequently performed radiologic procedure for obstetric haemorrhage. [30][31][32][33][34][35][36][37][38] Catheters are placed, under fluoroscopic guidance, into the internal iliac artery. If needed, haemostatic substances can then be administered via the catheters.…”

“…Additionally, and as discussed below, embolisation is often a component of treatment in women with placenta accreta who are managed conservatively, with the placenta left in situ. [30][31][32][33][34][35][36]38 One analysis of 30 women with placenta accreta who underwent embolisation catheter placement reported performing embolisation in 77% of patients, and noted that only 8% required hysterectomy. The mean estimated blood loss in this report was 2000 ml.…”

The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage

“…In 1979, selective transcatheter pelvic arterial embolization (TAE) as a new treatment modality for PPH was reported for the first time [1]. Many investigators [3,6,10,12,14,22] have reported the efficacy of TAE as the alternative to surgical treatments for intrac table PPH. A systematic review [4] mentioned that the clinical success rate of TAE was up to 90.7%. However, there has been a little information about factors for ineffectiveness or clinical failure of the TAE procedure.…”

Postpartum Hemorrhage

“…21 In a similar study of 28 patients with intractable PPH, one patient was unsuccessfully embolized (due to perforation of the internal iliac artery). The one case requiring hysterectomy was secondary to unsuccessful embolization.…”