• Br J Radiol · Jul 2018

    Primary postpartum hemorrhage: outcome of uterine artery embolization.

    • Makoto Aoki, Hiroyuki Tokue, Masaya Miyazaki, Kei Shibuya, Satoshi Hirasawa, and Kiyohiro Oshima.
    • 1 Department of Emergency Medicine, Gunma University Graduate School of Medicine , Maebashi, Gunma , Japan.
    • Br J Radiol. 2018 Jul 1; 91 (1087): 20180132.

    ObjectiveTo assess the efficacy of uterine artery embolization (UAE) for the management of primary postpartum hemorrhage (PPH) and to determine the factors associated with clinical outcomes especially in relation to the ovarian artery.MethodsA retrospective analysis of 33 patients who underwent UAE for primary PPH was performed. Clinical data were used regarding maternal characteristics, cause of bleeding, mode of delivery, bleeding onset after delivery, risk factors for PPH, presence of coagulopathy, details regarding the UAE procedure, and types of ovarian artery flow. We defined two types of ovarian artery flow by initial aortography before UAE (Type A: ovarian artery flow arose directly from the aorta to the uterine artery; Type B: ovarian artery flow that did not obviously arise from the aorta). Clinical success was defined as cessation of bleeding after UAE without the need for hysterectomy. Univariate analysis was performed to determine factors related to clinical outcomes.ResultsThe major indication of UAE was uterine atony (82%; 27/33). Extravasation of contrast medium was observed in 15 (45%) patients. The clinical success rate was 85% (28/33). In five patients, embolization failed, and these patients were managed by hysterectomy. Univariate analysis showed that retained placental tissue (p < 0.001), type of ovarian artery (p < 0.001) and the existence of extravasation of contrast medium (p = 0.049) were related to the clinical success rate.ConclusionThe clinical success rate was 85% (28/33), and some PPH patients were thought to need ovarian artery embolization in addition to UAE. Advances in knowledge: Initial aortography before UAE may be useful to predict the failure of UAE and the need of ovarian artery embolization. Obvious ovarian arterial blood flow to the uterus by aortography could be a warning sign.

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