J Korean Soc Radiol.  2018 Dec;79(6):315-322. 10.3348/jksr.2018.79.6.315.

Clinical and Angiographic Features of Secondary Postpartum Hemorrhage and the Outcomes of Transcatheter Arterial Embolization

• Baek SD
• Kang UR
• Ji SW
• Kim YH
• Cha JG

• KMID: 2427379
• DOI: http://doi.org/10.3348/jksr.2018.79.6.315

Abstract

PURPOSE
To analyze the clinical and angiographic features with outcome of transcatheter arterial embolization in patients with secondary postpartum hemorrhage.
MATERIALS AND METHODS
Clinical details and angiographic features with assessment of arterial embolization were reviewed in total 38 patients underwent arterial embolization at single tertiary referral center.
RESULTS
Twenty patients (53%) had Cesarean section. The major causes of bleeding were iatrogenic vascular injury, and retained placenta (55%). The patterns of vaginal bleeding were recorded as intermittent (50%), or as persistent (50%). Seven patients (18%) were hemodynamically unstable at presentation. Positive angiographic findings appeared in eighteen patients (47.3%). The frequency of pseudoaneurysm was statistically high in the Cesarean section (p < 0.001). The used embolic agents except gelfoam were N-butyl cyanoacrylate (n = 7), and microcoil (n = 7). Unilateral selective embolization (26.3%) was shown effective in superselective embolization of bleeding focus. Technical and clinical success rate were 100% and 97.4%, respectively with no complication. Sixteen resumed regular menstruation, and one pregnancy were observed in patients with available follow-up of over 6 months.
CONCLUSION
Considerable rate of hemodynamically unstable patients was observed with high rate of positive angiography findings. Given high successful rate and few complications, early angiographic assessment with embolization should be considered.

MeSH Terms

Aneurysm, False
Angiography
Cesarean Section
Cyanoacrylates
Embolization, Therapeutic
Female
Follow-Up Studies
Gelatin Sponge, Absorbable
Hemorrhage
Humans
Menstruation
Placenta, Retained
Postpartum Hemorrhage*
Postpartum Period*
Pregnancy
Tertiary Care Centers
Uterine Hemorrhage
Vascular System Injuries
Cyanoacrylates

Figure

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  Fig. 1 A 34-year-old female with secondary postpartum bleeding due to iatrogenic vascular injury after Caesarean section. A. Left internal iliac angiography shows a pseudoaneurysm (arrow) in the left uterine artery. B. On left internal iliac angiography, the pseudoaneurysm completely disappeared after embolization using N-butyl cyanoacrylate.

• 

  Fig. 2 A 37-year-old female with secondary postpartum bleeding after vaginal delivery. A. Right internal iliac angiography shows contrast extravasation (arrow) in the right vaginal artery B. Right internal iliac angiography after embolization using N-butyl cyanoacrylate shows occlusion of the right vaginal artery with complete disappearance of contrast extravasation.

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