Hansch E, Chitkara U, McAlpine J, El-Sayed Y, Dake M D, Razavi M K
Department of Gynecology and Obstetrics and the Department of Interventional Radiology, Stanford University Medical Center, California, USA.
Am J Obstet Gynecol. 1999 Jun;180(6 Pt 1):1454-60. doi: 10.1016/s0002-9378(99)70036-0.
Obstetric hemorrhage is a significant cause of maternal morbidity and death. Postpartum hemorrhage that cannot be controlled by local measures has traditionally been managed by bilateral uterine artery or hypogastric artery ligation. These techniques have a high failure rate, often resulting in hysterectomy. In contrast, endovascular embolization techniques have a success rate of >90%. An additional benefit of the latter procedure is that fertility is maintained. We report our experience at Stanford University Medical Center in which this technique was used in 6 cases within the past 5 years.
Six women between the ages of 18 and 41 years underwent placement of arterial catheters for emergency (n = 3) or prophylactic (n = 3) control of postpartum bleeding. Specific diagnoses included cervical pregnancy (n = 1), uterine atony (n = 3), and placenta previa and accreta (n = 2).
Control of severe or anticipated postpartum hemorrhage was obtained with transcatheter embolization in 4 patients. A fifth patient had balloon occlusion of the uterine artery performed prophylactically, but embolization was not necessary. In a sixth case, bleeding could not be controlled in time, and hysterectomy was performed. The only complication observed with this technique was postpartum fever in 1 patient, which was treated with antibiotics and resolved within 7 days.
Uterine artery embolization is a superior first-line alternative to surgery for control of obstetric hemorrhage. Use of transcatheter occlusion balloons before embolization allows timely control of bleeding and permits complete embolization of the uterine arteries and hemostasis. Given the improved ultrasonography techniques, diagnosis of some potential high-risk conditions for postpartum hemorrhage, such as placenta previa or accreta, can be made prenatally. The patient can then be prepared with prophylactic placement of arterial catheters, and rapid occlusion of these vessels can be achieved if necessary.
产科出血是孕产妇发病和死亡的重要原因。传统上，局部措施无法控制的产后出血通过双侧子宫动脉或腹下动脉结扎来处理。这些技术失败率高，常导致子宫切除术。相比之下，血管内栓塞技术成功率>90%。后一种方法的另一个好处是可维持生育能力。我们报告了斯坦福大学医学中心过去5年内在6例患者中使用该技术的经验。
6名年龄在18至41岁之间的女性接受了动脉导管置入术，用于紧急（n = 3）或预防性（n = 3）控制产后出血。具体诊断包括宫颈妊娠（n = 1）、宫缩乏力（n = 3）和前置胎盘并植入（n = 2）。
4例患者通过经导管栓塞实现了对严重或预期产后出血的控制。第5例患者预防性地进行了子宫动脉球囊闭塞，但无需栓塞。在第6例中，出血未能及时控制，进行了子宫切除术。该技术观察到的唯一并发症是1例患者出现产后发热，经抗生素治疗后7天内消退。
子宫动脉栓塞是控制产科出血优于手术的一线替代方法。在栓塞前使用经导管闭塞球囊可及时控制出血，并能实现子宫动脉的完全栓塞和止血。鉴于超声检查技术的改进，一些产后出血潜在高危情况，如前置胎盘或植入，可在产前诊断。然后可为患者预防性放置动脉导管，必要时可快速闭塞这些血管。
