To evaluate the efficacy and safety of pelvic arterial embolization (PAE) in women with intractable primary postpartum hemorrhage (PPH).Clinical data of 36 cases were analyzed retrospectively in which women underwent PAE for intractable primary PPH in Peking Union Medical College Hospital between Jan 2006 and Jan 2015. The success rate of PAE were measured and possible predictive risk factors associated with treatment failure were analyzed. The complications secondary to PAE were also recorded.(1) The etiology of PPH. Among the 36 cases, 21 patients delivered viginally (Group VD) and 15 received cesarean section (Group CS). The most frequent cause of PPH was uterine atony (72%, 26/36). The less common causes were placental problems (28%, 10/36), genital tract trauma (6%, 2/36) and coagulation defects (3%, 1/36) in turn. Three patients (8%, 3/36) had combined causes. (2) Interventions before PAE. Uterotonic medications were used in all patients. 31 patients received carboprost methylate suppositorites, 27 received carbetocin and 31 received carboprost tromethamine. Besides, 20 patients received one or more surgical interventions before PAE. PAE was performed when these interventions failed. (3) Characteristics of PAE. Altogether 78 arteries were embolized in 36 cases. Embolization of bilateral uterine arteries was performed in 31 cases, right internal iliac artery and bilateral inferior epigastric arteries were embolized in one case. Right internal pudendal artery, bilateral uterine arteries and bilateral internal iliac arteries were embolized in one case. And bilateral uterine arteries, bilateral internal iliac arteries were embolized in one case. In the other 2 cases, bilateral internal iliac arteries were embolized. (4) Efficacy of PAE. The overall technical success rate of PAE was 100%(36/36), while the clinical success rate was 94%(34/36). All patients survived. (5) Complications of PAE. 15 patients were transferred to ICU after PAE for 1 to 7 days. Except self-limited fever, no puncture site hematoma, buttock necrosis or vessel rupture was observed. The effect on menstrual cycle and fertility were followed in 25 patients. 17 (68%, 17/25) reported resumption of normal menses and 8 (32%, 8/25) reported amenorrhea. Three pregnancies after PAE were observed.PAE is a safe and effective treatment for intractable primary PPH which can prevent hysterectomy and preserve fertility of patients.
Objective: This study investigated bilateral uterine artery chemo -embolization (BUACE) combined with dilation and curettage (D&C) in caesarean scar pregnancy (CSP). Methods: Nineteen women with CSP were referred for interventional radiology. In 13 patients, BUACE was performed before D&C, following a diagnosis of CSP. A further six patients received BUACE for massive vaginal bleeding after D&C for inevitable miscarriage; the diagnosis of CSP was subsequently confirmed ultrasonographically. BUACE of the uterine arteries was performed using gelfoam particles following intra-arterial infusion of 100 mg/m 2 methotrexate. Results: BUACE was technically successful and immediate haemostasis was achieved in all patients. Blood loss was significantly greater during D&C undertaken before BUACE compared with D&C after BUACE, but this bleeding was controlled by BUACE. No patient required further surgical intervention and there were no severe complications. The gestational sac and placenta could no longer be detected ultrasonographically and the menstrual cycle returned to normal 2 - 3 months after treatment in all patients. Conclusions: BUACE followed by D&C seems to be a safe and effective treatment for CSP and should be considered as a treatment of choice.
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