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Massive Postpartum Hemorrhage Treated with Transcatheter Arterial Embolization: Technical aspects and long-term effects on fertility and menstrual cycle
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. (Nyman)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. (Obstetrisk forskning/Axelsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. (Magnusson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. (Nyman)
2007 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 48, no 6, 635-642 p.Article in journal (Refereed) Published
Abstract [en]

Background: Transcatheter arterial embolization (TAE) is considered a safe, life-saving procedure in postpartum hemorrhage (PPH), but its long-term effect on menstruation and fertility is unclear. Purpose: To investigate technical aspects and the evaluation of complications, focused on menstrual cycle and fertility, using TAE in patients with PPH. Material and Methods: A retrospective study including 20 patients (seven with vaginal and 13 with cesarean delivery) with severe PPH treated with bilateral TAE of the uterine artery was carried out. All patients were asked to answer a questionnaire regarding their post-embolization history. In six patients, the radiation dose was measured. Results: All 20 cases underwent bilateral TAE of the uterine artery. Gelfoam was used as the embolic agent. However, after cesarean delivery in six patients who had clear contrast medium extravasation and/or pseudoaneurysm-like lesion, metallic coils had to be used in order to achieve hemostasis. No major short- or long-term complications were registered. Normal menses resumed in all patients. Four patients had a total of five full-term and two preterm pregnancies, and all delivered healthy infants by cesarean section with no recurrence of PPH. The mean radiation dose to the ovaries was 586 mGy (range 204-729 mGy). Conclusion: TAE in patients with PPH is safe and has no major short- or long-term side effects. A patient managed with TAE can expect return of normal menses and preservation of future fertility and successful pregnancies. PPH after cesarean section might need to be embolized with metallic coils in addition to Gelfoam in order to achieve secure hemostasis.

Place, publisher, year, edition, pages
2007. Vol. 48, no 6, 635-642 p.
Keyword [en]
Embolization, fertility, menstrual cycle, obstetric hemorrhage
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-96285DOI: 10.1080/02841850701370683ISI: 000247870200008PubMedID: 17611871OAI: oai:DiVA.org:uu-96285DiVA: diva2:170806
Available from: 2007-12-12 Created: 2007-12-12 Last updated: 2012-03-07Bibliographically approved
In thesis
1. Transcatheter Arterial Embolization in the Management of Life Threatening Bleeding Applied in Upper Gastrointestinal and Post Partum Bleedings.
Open this publication in new window or tab >>Transcatheter Arterial Embolization in the Management of Life Threatening Bleeding Applied in Upper Gastrointestinal and Post Partum Bleedings.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Transcatheter Arterial Embolization (TAE) is a method in which a catheter is inserted into an artery under fluoroscopy guidance. By using material that creates a thrombus, inserted through the catheter, the artery can be occluded and the bleeding stopped.

Endoscopy is the treatment of choice in upper gastrointestinal (GI) bleeding, but 10% to 30% of patients rebleed and needs other treatment options. Post Partum Hemorrhage (PPH) may evolve rapidly and can become life threatening. Obstetrical treatment will manage most cases, but in some cases emergency surgery is needed and in the worst case hysterectomy.

The primary aim of this thesis was to evaluate the clinical usefulness, improve the TAE technique and compare the outcome of TAE with surgery used as “salvage therapy” in patients with upper GI bleeding. Evaluate TAE technique and the long-term effect on the menstrual cycle and fertility in severe PPH.

To evaluate the clinical usefulness 13 patients were treated with TAE after endoscopic treatment failure and 5 were treated for recurrent hemorrhage after emergency surgery.

The clinical outcome and mortality rate of 40 patients treated with TAE was compared with 51 patients treated with surgery of upper GI bleedings.

In 13 patients the ulcer was marked with placement of a metallic clip at endoscopy to be able to locate the exact site of the bleeding ulcer during the TAE procedure.

A retrospective study of 20 patients with severe PPH treated with bilateral TAE of the uterine artery was performed.

TAE was found to be effective and an alternative to emergency surgery for control of massive upper GI bleeding. The 30-day mortality was lower in the TAE group (3%) compared to the surgical group (14%).

By marking the bleeding ulcer at endoscopy using a metallic clip the site of bleeding could be identified on angiography without extravasation of contrast media.

No major impact on fertility or menstruation cycle was found in patients treated with TAE in PPH. TAE in PPH is safe and have no major long-term side effect. By using TAE in PPH hysterectomy can be avoided.

Place, publisher, year, edition, pages
Uppsala: Institutionen för onkologi, radiologi och klinisk immunologi, 2007. 44 p.
Keyword
Radiology, Post partum hemorrhage, Upper peptic ulcer bleeding, Transcatheter arterial embolization, Endoscopic treatment, Endoscopic marking, Metallic clip, Radiologisk forskning
Identifiers
urn:nbn:se:uu:diva-8248 (URN)978-91-506-1961-4 (ISBN)
Public defence
2008-02-01, Enghoffsalen, Akademiska sjukhuset, Ing 50, 09:15
Opponent
Supervisors
Available from: 2007-12-12 Created: 2007-12-12Bibliographically approved

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Eriksson, Lars-GunnarLutvica-Mulic, AjlanaJangland, LarsNyman, Rickard

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