Villella J, Garry D, Levine G, Glanz S, Figueroa R, Maulik D
Departments of Obstetrics and Gynecology and of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA.
J Reprod Med. 2001 Jan;46(1):65-7.
Puerperal hematomas can become a life-threatening obstetric emergency. Their incidence is 1 or 2/1,000 deliveries. When mainstay methods of suture and packing fail, arterial embolization becomes an excellent alternative to definitive treatment, laparotomy.
A 32-year-old woman, para 2-0-2-2, developed extreme rectal and vulvar pain one hour postpartum. A 12 x 10-cm vulvovaginal hematoma was identified, drained, sutured and packed. Bleeding continued, blood products were administered, and selective angiographic embolization of the pudendal and inferior gluteal arteries was successfully performed. A 31-year-old woman, para 1-0-1-1, developed a left vaginal hematoma immediately postpartum. She failed vaginal packing and underwent angiographic arterial embolization successfully. The patient was discharged on the fourth postpartum day. At six weeks postpartum, neither patient had evidence of hematoma formation.
In the setting of a puerperal hematoma refractory to conventional first-line therapy, arterial embolization provides a rational, effective alternative for achieving hemostasis with minimal morbidity.
产褥期血肿可成为危及生命的产科急症。其发病率为每1000例分娩中有1至2例。当缝合和填塞等主要方法失败时，动脉栓塞成为剖腹手术这一确定性治疗的极佳替代方案。
一名32岁经产妇，孕2产2，产后1小时出现极度直肠和外阴疼痛。发现一个12×10厘米的外阴阴道血肿，进行了引流、缝合和填塞。出血仍持续，给予血液制品，并成功对阴部动脉和臀下动脉进行了选择性血管造影栓塞。一名31岁经产妇，孕1产1，产后立即出现左侧阴道血肿。她的阴道填塞失败，成功接受了血管造影动脉栓塞。患者于产后第四天出院。产后六周，两名患者均无血肿形成的迹象。
在传统一线治疗难治的产褥期血肿情况下，动脉栓塞为实现止血且发病率最低提供了一种合理、有效的替代方法。
