Grégoire Leleup1, Audrey Fohlen2, Anthony Dohan3, Lara Bryan-Rest4, Vincent Le Pennec1, Olivier Limot4, Olivier Le Dref3, Philippe Soyer3, Jean-Pierre Pelage5. 1. Department of Diagnostic Imaging and Interventional Radiology, Centre Hospitalier Universitaire de Caen, Normandie University, Caen, France. 2. Department of Diagnostic Imaging and Interventional Radiology, Centre Hospitalier Universitaire de Caen, Normandie University, Caen, France; Imagerie et Stratégie Thérapeutique des Pathologies Cérébrales et Tumorales, Normandie University, UNICAEN, CEA, Centre National de la Recherche Scientifique, ISTCT, Caen, Caen, France. 3. Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 965, Université Paris-Diderot, Sorbonne Paris Cité, Paris, France. 4. Department of Radiology, Centre Hospitalier de Poissy, Poissy, France. 5. Department of Diagnostic Imaging and Interventional Radiology, Centre Hospitalier Universitaire de Caen, Normandie University, Caen, France; Imagerie et Stratégie Thérapeutique des Pathologies Cérébrales et Tumorales, Normandie University, UNICAEN, CEA, Centre National de la Recherche Scientifique, ISTCT, Caen, Caen, France. Electronic address: pelage-jp@chu-caen.fr.
Abstract
PURPOSE: To evaluate the feasibility and efficacy of embolization of the round ligament arteries in the management of postpartum hemorrhage. MATERIALS AND METHODS: Eleven women (mean age, 31 y) underwent round ligament artery because of persistent or recurrent hemorrhage after initial uterine or internal iliac artery embolization. RESULTS: A total of 16 round ligament arteries were embolized. The round ligament artery arose from the inferior epigastric artery in 11 cases (69%) and directly from the external iliac artery in 5 (31%). Embolization was performed with calibrated microspheres in 7 women (63%) and gelatin sponge pledgets in 4 (37%). Coils were used in addition to gelatin sponge pledgets in 3 patients. Hemostasis was achieved in 10 patients (91%), and 1 required additional conservative surgery. The mean hemoglobin level before embolization was 7.2 g/dL ± 1 and increased significantly on day 1 after embolization (10.3 g/dL ± 1.0; P < .05). No procedure-related complication was reported. The mean hospital stay was 5.6 days ± 2. Two patients had further pregnancies 13 and 14 months after embolization. CONCLUSIONS: Selective embolization of the round ligament artery is a safe and effective treatment for obstetric hemorrhage. It should be considered in cases of persistent or recurrent bleeding after initial uterine or internal iliac artery embolization.
PURPOSE: To evaluate the feasibility and efficacy of embolization of the round ligament arteries in the management of postpartum hemorrhage. MATERIALS AND METHODS: Eleven women (mean age, 31 y) underwent round ligament artery because of persistent or recurrent hemorrhage after initial uterine or internal iliac artery embolization. RESULTS: A total of 16 round ligament arteries were embolized. The round ligament artery arose from the inferior epigastric artery in 11 cases (69%) and directly from the external iliac artery in 5 (31%). Embolization was performed with calibrated microspheres in 7 women (63%) and gelatin sponge pledgets in 4 (37%). Coils were used in addition to gelatin sponge pledgets in 3 patients. Hemostasis was achieved in 10 patients (91%), and 1 required additional conservative surgery. The mean hemoglobin level before embolization was 7.2 g/dL ± 1 and increased significantly on day 1 after embolization (10.3 g/dL ± 1.0; P < .05). No procedure-related complication was reported. The mean hospital stay was 5.6 days ± 2. Two patients had further pregnancies 13 and 14 months after embolization. CONCLUSIONS: Selective embolization of the round ligament artery is a safe and effective treatment for obstetric hemorrhage. It should be considered in cases of persistent or recurrent bleeding after initial uterine or internal iliac artery embolization.