Pelage J P, Soyer P, Repiquet D, Herbreteau D, Le Dref O, Houdart E, Jacob D, Kardache M, Schurando P, Truc J B, Rymer R
Department of Vascular Imaging, Hôpital Lariboisière, Paris, France.
Radiology. 1999 Aug;212(2):385-9. doi: 10.1148/radiology.212.2.r99jl05385.
To evaluate the efficacy and safety of selective arterial embolization of the uterine arteries in the management of intractable delayed postpartum hemorrhage.
Fourteen consecutive women with secondary postpartum hemorrhage were treated with selective embolization of the uterine arteries. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with the administration of uterotonic drugs or with uterine curettage.
The causes of bleeding included genital tract tears in four women and endometritis in eight women; the endometritis was associated with proved, retained portions of placenta in four women. In two women, no evident cause of bleeding was found before angiography. Angiography revealed extravasation in three women. A false aneurysm of the uterine artery was found in two women. In one patient, an arteriovenous fistula was observed. Immediate resolution of external bleeding was observed in all women. No complication related to embolization was found. Normal menstruation resumed in all women.
Selective arterial embolization of the uterine arteries is a safe and effective means of controlling secondary postpartum hemorrhage.
评估子宫动脉选择性动脉栓塞术治疗难治性产后延迟出血的有效性和安全性。
连续14例继发性产后出血的妇女接受了子宫动脉选择性栓塞治疗。在所有病例中，由于使用宫缩剂或刮宫术无法控制的难治性出血而进行了止血栓塞。
出血原因包括4例生殖道撕裂和8例子宫内膜炎；4例子宫内膜炎与证实的胎盘残留部分有关。2例妇女在血管造影前未发现明显的出血原因。血管造影显示3例妇女有造影剂外渗。2例妇女发现子宫动脉假性动脉瘤。1例患者观察到动静脉瘘。所有妇女均立即停止了外部出血。未发现与栓塞相关的并发症。所有妇女均恢复了正常月经。
子宫动脉选择性动脉栓塞术是控制继发性产后出血安全有效的方法。
