Place of embolization of the uterine arteries in the management of post-partum haemorrhage: a study of 12 cases

Prenatal Diagnosis of Morbidly Adherent Placenta with 2D Ultrasonography, 3D Color Power Doppler and Magnetic Resonance Imaging

“…Antenatal suspicion of placenta percreta made possible the appropriate preoperative and perioperative management, which has also been described by Tourne et al 13 In our case, uterine artery catheters were inserted preoperatively as prophylactic measure but embolization was not performed while other cases as Taipale et al performed embolization of the uterine arteries after cesarean delivery and before hysterectomy to minimize bleeding, which is recommended in the management of severe postpartum bleeding. 13 The repeated ultrasound for our patient at 34 weeks with the aid of 3D ultrasound showed more details about placental invasion.The tentative proposed 3D US criteria for advanced invasive placentation of suspected bladder involvement are as follows: (1) a loss of the echolucent space between the bladder and the placenta in coronal and axial scans; (2) invasion of the bladder by the infiltrating placenta with irregularity and disruption of the normal bladder wall architecture and/or a focal exophytic placental mass projecting into the bladder in coronal and axial scans; and (3) aberrant blood vessels in the spatial vascular network in the region of interest extending into the bladder by rotational angiography.…”

“…13 The repeated ultrasound for our patient at 34 weeks with the aid of 3D ultrasound showed more details about placental invasion.The tentative proposed 3D US criteria for advanced invasive placentation of suspected bladder involvement are as follows: (1) a loss of the echolucent space between the bladder and the placenta in coronal and axial scans; (2) invasion of the bladder by the infiltrating placenta with irregularity and disruption of the normal bladder wall architecture and/or a focal exophytic placental mass projecting into the bladder in coronal and axial scans; and (3) aberrant blood vessels in the spatial vascular network in the region of interest extending into the bladder by rotational angiography.…”

Fertility after embolization of the uterine arteries to treat obstetrical hemorrhage: a review of 53 cases

“…The relative risk of pregnancy occurring in the nonembolized group compared with the exposed group is 1.47, and the rates of pregnancy obtained in each group were not statistically different (P¼. 30), suggesting that the embolization did not dramatically harm subsequent fertility. However, because we did observe a trend toward fewer pregnancies in the exposed group, with a larger population and a longer follow-up period a significant difference could have been revealed; in fact, the power of our analysis to detect a 1.47 relative risk was quite small (44%).…”

Secondary postpartum hemorrhage due to a pseudoaneurysm rupture at the fundal area of the uterus: a case treated with selective uterine arterial embolization

“…If a bleeding pseudoaneurysm is diagnosed, vaginal or uterine packing may be introduced, but this is frequently unsuccessful. Selective arterial embolization of the uterine arteries is an option in hemodynamically stable patients and is the treatment of choice (4,5). Abdominal computed tomography with angiogram would be considered in the patients with secondary postpartum hemorrhages without retained placental tissue, to diagnose vessel hemorrhages such as pseudoaneurysms and arteriovenous malformations, and neoplasm in a hemodynamically stable state.…”