Life-threatening primary postpartum hemorrhage: Treatment with emergency selective arterial embolization
Life-threatening primary postpartum hemorrhage: Treatment with emergency selective arterial embolization
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DOI：
10.1148/radiology.208.2.9680559
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发表时间：
1998-08-01
期刊：
影响因子：
19.7
通讯作者：
Rymer, R
中科院分区：
文献类型：
--
作者：
Pelage, JP;Le Dref, O;Rymer, R
目得：为了前瞻性地评估的有效性和安全性，紧急选择性动脉栓塞术在管理难治性原发性产后出血。材料和方法：27个连续看到的妇女与危及生命的原发性产后出血进行子宫栓塞。在所有病例中，由于阴道填塞和子宫收缩药物无法控制顽固性出血，因此进行了止血栓塞。栓塞前的平均血红蛋白水平为7.48 g/dL +/- 2.39（74.8 g/L +/- 23.9）（1个标准差）。结果：血管造影显示9例患者有血管外渗，5例髂内动脉分支痉挛。手术包括子宫动脉（n = 46）、阴道动脉（n = 5）或卵巢动脉（n = 2）或髂内动脉前分支（n = 8）栓塞。在所有病例中均观察到外部出血立即消失或显著减少。2例患者在第二天需要再次栓塞。未发现与栓塞相关的严重并发症，1例胎盘植入者需延期子宫切除。除两名接受子宫切除术的妇女外，所有妇女均恢复正常月经。结论：急诊动脉栓塞术是控制产后出血的一种安全有效的方法。该程序避免了高风险的手术，并允许维持生殖能力。
PURPOSE: To prospectively evaluate the efficacy and safety of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage.MATERIALS AND METHODS: Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before embolization failed to stop the bleeding.RESULTS: Angiography revealed extravasation in nine patients and spasm of the branches the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian(n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminution of external bleeding was observed in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found.ln one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women except the two who underwent hysterectomy. One woman became pregnant after embolization.CONCLUSION: Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.