Postpartum hemorrhage - what the interventional radiologist should know

Abstract

Postpartum hemorrhage is a leading cause of maternal morbidity and mortality around the world and can be caused by multiple etiologies. Distinguishing between the various etiologies that lead to PPH and identifying high risk features are crucial to implementing effective clinical management. In this review, the diagnostic imaging features and management principles of some of the most important causes of postpartum hemorrhage are discussed, with an emphasis on the pearls and pitfalls when minimally invasive treatment via interventional radiologic techniques are employed.

Uterine Arteriovenous Malformation: Diagnostic and Therapeutic Challenges

“…The differential diagnosis of uterine arteriovenous malformations is mainly made by ultrasound: colour and pulsed Doppler [ 10 ]. The visualisation of endometrial thickening with an anechoic and vascular intramiometrial structure is very useful in the diagnosis and can help to exclude other causes of dysfunctional uterine bleeding such as retained placental debris, uterine sarcoma, pelvic varices, or gestational trophoblastic disease [ 11 , 12 , 13 ].…”

“…As this technique usually produces high levels of radiation, digital subtraction angiography [ 19 ] can be performed with less exposure to ionising radiation and less contrast than conventional studies, with the possibility of obtaining three-dimensional reconstructions of the vessels studied. Nowadays, although angiography is the gold standard, it is reserved for therapeutic embolisation to delay or avoid surgery, while ultrasound is preferred as a diagnostic technique [ 1 , 10 ].…”

Factores de riesgos que inciden en la hemorragia postparto.

“…• La coagulopatía durante el embarazo es un proceso que implica un delicado equilibrio entre la coagulación y la anticoagulación, y que suele alterarse fácilmente durante el puerperio, dando lugar a hemorragias o trombosis intermitentes. Se estima que, del total de casos, menos del 1% de HPP están relacionados con trastornos de la coagulación (32). La prevención efectiva y rápida del desarrollo de la coagulopatía durante el parto y controlar la pérdida de sangre pueden ayudar a evitar complicaciones graves, como la incontinencia urinaria (30).…”

“…También se incluyen factores de riesgo durante el parto, como el uso excesivo de la oxitocina, parto apresurado y maniobras Factores de riesgos que inciden en la hemorragia postparto obstétricas no recomendadas, así como problemas asociados con la salud materna, como deshidratación y agotamiento, y complicaciones como la corioamnionitis. Además, los anestésicos hipotónicos y una atención deficiente por parte del profesional de salud también pueden contribuir a las complicaciones durante el embarazo y el parto (31)(32)(33).…”