Alberto Rebonato1, Stefano Mosca2, Matthias Fischer2, Sandro Gerli3, Gianluigi Orgera4, Luigina Graziosi3, Daniele Maiettini3, Gian Carlo Di Renzo3, Giorgio Epicoco5, Miltiadis Krokidis6, Michele Rossi7, Michele Scialpi3. 1. Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, Perugia, 06132, Italy. rebonatoalberto@gmail.com. 2. Radiology Unit, Santa Maria della Misericordia University Hospital, Sant'Andrea delle Fratte, Perugia, 06132, Italy. 3. Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, Perugia, 06132, Italy. 4. St. Andrea Hospital, Radiology Department, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Via di Grottarossa, 1035-39, 00189, Rome, Italy. 5. Obsterics and Ginecology Unit, Santa Maria della Misericordia University Hospital, Sant'Andrea delle Fratte, Perugia, 06132, Italy. 6. Department of Radiology, "Guy's and St Thomas' NHS Foundation Trust", 1st Floor Lambeth Wing, St Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK. 7. Radiology Department, St. Andrea Hospital, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy.
Abstract
OBJECTIVES: To retrospectively evaluate safety and efficacy of pelvic artery embolisation (PAE) in post-partum haemorrhage (PPH) in abnormal placental implantation (API) deliveries. METHODS: From January 2009 to November 2013, 12 patients with API and intractable intraoperative PPH underwent PAE after caesarean delivery to control a haemorrhage (in four of these cases after hysterectomy). Arterial access was obtained prior to the delivery; PAE was performed in the obstetrics operating room by an interventional radiologist that was present with an interventional radiology (IR) team during the delivery. RESULTS: PAE was successful in preventing bleeding and avoid hysterectomy in four cases (group A). Uterine atony and disseminated intravascular coagulation caused failure of PAE requiring hysterectomy in four patients (group B). PAE prevented bleeding post-hysterectomy in the remaining four cases (group C). Technical success (cessation of contrast extravasation on angiography or occlusion of the selected artery) was 100 %. Maternal and foetal mortality and morbidity were 0 %. CONCLUSIONS: PAE is a minimal invasive technique that may help to prevent hysterectomy and control PPH in API pregnancies without complications. Embolisation should be performed on an emergency basis. For such cases, an IR team on standby in the obstetrics theatre may be useful to prevent hysterectomy, blood loss and limit morbidity. KEY POINTS: • Endovascular treatment is a validated technique in post-partum haemorrhage. • Abnormal placental implantation is a risk factor for post-partum haemorrhage. • We propose an interventional radiologist standby in the delivery room.
OBJECTIVES: To retrospectively evaluate safety and efficacy of pelvic artery embolisation (PAE) in post-partum haemorrhage (PPH) in abnormal placental implantation (API) deliveries. METHODS: From January 2009 to November 2013, 12 patients with API and intractable intraoperative PPH underwent PAE after caesarean delivery to control a haemorrhage (in four of these cases after hysterectomy). Arterial access was obtained prior to the delivery; PAE was performed in the obstetrics operating room by an interventional radiologist that was present with an interventional radiology (IR) team during the delivery. RESULTS:PAE was successful in preventing bleeding and avoid hysterectomy in four cases (group A). Uterine atony and disseminated intravascular coagulation caused failure of PAE requiring hysterectomy in four patients (group B). PAE prevented bleeding post-hysterectomy in the remaining four cases (group C). Technical success (cessation of contrast extravasation on angiography or occlusion of the selected artery) was 100 %. Maternal and foetal mortality and morbidity were 0 %. CONCLUSIONS:PAE is a minimal invasive technique that may help to prevent hysterectomy and control PPH in API pregnancies without complications. Embolisation should be performed on an emergency basis. For such cases, an IR team on standby in the obstetrics theatre may be useful to prevent hysterectomy, blood loss and limit morbidity. KEY POINTS: • Endovascular treatment is a validated technique in post-partum haemorrhage. • Abnormal placental implantation is a risk factor for post-partum haemorrhage. • We propose an interventional radiologist standby in the delivery room.
Authors: Trévor La Folie; Vincent Vidal; Mayssoun Mehanna; Marianne Capelle; Alexis Jaquier; Guy Moulin; Jean Michel Bartoli Journal: J Obstet Gynaecol Res Date: 2007-10 Impact factor: 1.730