Uterine Artery Embolization for Primary Postpartum Hemorrhage

Brown, Matthew; Hong, Michael; Lindquist, J.

doi:10.1016/j.tvir.2021.100727

Cited by 22 publications

(16 citation statements)

References 13 publications

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“…Bleeding control rates are higher, approaching 98%, with technical success rates of 100%. Proven clinical factors influencing the outcome include DIC, extravasation on angiogram, and hemodynamic instability (31,32). Although there are no extensive randomized studies, and the evidence level is limited, arterial embolization may be recognized as a safe and effective procedure (33).…”

Section: Discussionmentioning

confidence: 99%

Cesarean section complicated with presumed massive pulmonary embolism and cardiac arrest treated with rescue thrombolytic therapy—two case reports

Krawczyk¹,

Huras²,

Jaworowski³

et al. 2023

Ann Palliat Med

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Background: Massive pulmonary embolus (PE), resulting in cardiac arrest during pregnancy and postpartum, is a rare but potentially catastrophic event. The most severe manifestation of massive PE is cardiovascular instability, including cardiogenic shock and cardiac arrest requiring intensive care unit (ICU) admissions. Up to 23% of high-risk PE pregnant and postpartum patients experience cardiac arrest.Case Description: Case 1, a 34-year-old obese patient, with a twin pregnancy, had cesarean sections in the 24th week of pregnancy due to premature abruption of the placenta. Immediately after the birth, she experienced a sudden cardiac arrest. Treatment was initiated in line with ALS, heparine and alteplase was administered due to suspected massive pulmonary embolism. After 20 minutes from ROSC, the uterine atony and severe hemorrhage occurred, and a postpartum hysterectomy was performed. The mother and two daughters are alive in 2021. Case 2, a 24-year-old obese patient had a cesarean section due to abruption of the placenta in the 28th week of pregnancy. Twelve hours after cesarean delivery, the patient's condition suddenly deteriorated. The patient reported dyspnea, chest pain, and presented cyanosis. The blood pressure was 66/30 mmHg, heart rate 130/min, tachypnea with a respiratory rate of 30/min, saturation 80% on air.High flow oxygen via face mask with reservoir (FiO 2 0.85) and ephedrine 2×10 mg i.v. were administered.Due to suspected pulmonary embolism, a bolus of 5,000 IU of heparin was administered iv. Despite the implemented measures, cardiac arrest was confirmed with the initial rhythm of PEA (sinus tachycardia 120/min). Treatment consistent with ALS was initiated. Due to the high probability of pulmonary embolism, a bolus of alteplase was administrated. ROSC was obtained 7 minutes later. Because of obstetric hemorrhage hysterectomy was performed. The mother and the baby are alive in 2022. Conclusions:In light of current evidence, presented data suggest that early and aggressive recombinant thrombolytic use in case of cardiac arrest and suspected PE in obstetric patients may be life-saving, effective treatment with a good neurological outcome. Major bleeding complications should be anticipated when administering this therapy.

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Section: Discussionmentioning

confidence: 99%

Cesarean section complicated with presumed massive pulmonary embolism and cardiac arrest treated with rescue thrombolytic therapy—two case reports

Krawczyk¹,

Huras²,

Jaworowski³

et al. 2023

Ann Palliat Med

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“…Postpartum hemorrhage (PPH) is an important cause of morbidity and mortality worldwide with more than 1 lakh death per annum. 55 It is defined as blood loss of more than 1000 mL of blood associated with features of volume loss such as hypotension and tachycardia. It can be primary, which occurs within the first 24 hours due to uterine atony, trauma to the genital tract, retained placental tissues or coagulopathic disorders or secondary (occurring 24 hours to 12 weeks) due to retained placental tissue, infection, coagulopathy, uterine artery pseudoaneurysm ( Fig.…”

Section: Uae For Fibroidsmentioning

confidence: 99%

Section: Uae In Postpartum Bleedmentioning

confidence: 99%

“…Absorbable gel foam as embolizing material is preferred as it stops bleeding and allows recanalization within 2 to 4 weeks, thereby preventing ischemia. 55 Liquid embolics such as N-butyl cyanoacrylate are used only when the total permanent occlusion of the vessel is required in recurrent or refractory PPH or in large pseudoaneurysms. 58 In cases where the bleeding site is not identified, empirical embolization of bilateral uterine arteries or anterior division of the internal iliac artery can be attempted.…”

Section: Uae In Postpartum Bleedmentioning

confidence: 99%

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Evidences in Uterine Artery Embolization: A Radiologist's Primer

Bellala

Valakkada

Ayyappan

et al. 2022

Journal of Clinical Interventional Radiology ISVIR

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Uterine artery embolization is an established minimally invasive therapy for symptomatic fibroids. It has also been used for other diseases of the uterus, including adenomyosis, uterine arteriovenous malformation, ectopic pregnancy, abnormal invasive placenta, and postpartum hemorrhage. In this review, we provide an updated and comprehensive review of uterine artery embolization based on the evidence published. We review the indications, the role of MRI, technical aspects, and complications of the procedure. The issues with a future pregnancy, risk of infertility, and fetal radiation are discussed as well.

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“…Uterine leiomyomas, the most common benign tumour of premenopausal women, can cause extensive symptoms such as menorrhagia, dysmenorrhoea, dyspareunia, urinary frequency, and urinary urgency [ 2 ]. Although traditionally managed by total abdominal or laparoscopic hysterectomy, the advent of UAE has allowed for a minimally invasive treatment modality that also spares the uterus [ 2 , 3 ]. UAE not only preserves fertility but also minimizes patient recovery time and the rate of surgical complications.…”

Section: Introductionmentioning

confidence: 99%

Transradial versus transfemoral arterial access in the uterine artery embolization of fibroids

Ghosh¹,

Agnihotri²,

Gupta³

et al. 2022

Pol J Radiol

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Purpose:Transradial arterial access has become more popular in body interventional procedures but has not been ubiquitously adapted. This retrospective study assesses the efficacy of this approach in uterine artery embolization. Aim of the study was to compare transradial to transfemoral arterial access in patients undergoing uterine artery embolization for the treatment of fibroids. Material and methods:A total of 172 patients underwent uterine artery embolization procedures at our institute from October 2014 to June 2020. Of these, 76 patients had their operations performed via transfemoral access while 96 underwent transradial access. The peak radiation dose, fluoroscopy time, procedure time, total contrast volume, and equipment cost for each procedure were all reviewed to evaluate for statistical differences between the 2 groups.Results: All cases were technically successful without major complications. The average peak skin dose was 2281 mGy, with no statistical difference between the transradial or transfemoral cohorts. Average fluoroscopy time was 25 minutes, also with no statistical difference between the subsets. Mean procedure time was 100 min, and mean contrast volume usage was 138 mL with no statistical differences. Similarly, the average equipment cost was $2204, with no significant differences found between transradial and transfemoral access. Conclusions:With respect to many pertinent radiation parameters, transradial access was evaluated as being an equally efficacious alternative to transfemoral access in uterine artery embolization procedures. The results of this study suggest that transradial access should be considered more often, whenever viable, as an option in the uterine artery embolization treatment of fibroids.

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Uterine Artery Embolization for Primary Postpartum Hemorrhage

Cited by 22 publications

References 13 publications

Cesarean section complicated with presumed massive pulmonary embolism and cardiac arrest treated with rescue thrombolytic therapy—two case reports

Cesarean section complicated with presumed massive pulmonary embolism and cardiac arrest treated with rescue thrombolytic therapy—two case reports

Evidences in Uterine Artery Embolization: A Radiologist's Primer

Transradial versus transfemoral arterial access in the uterine artery embolization of fibroids

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