Alvarez M, Lockwood C J, Ghidini A, Dottino P, Mitty H A, Berkowitz R L
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, New York.
Am J Perinatol. 1992 Sep-Nov;9(5-6):441-4. doi: 10.1055/s-2007-999284.
Treatment of obstetric hemorrhage by the selective embolization of damaged pelvic vessels under fluoroscopy holds promise as an alternative to surgical intervention. Unfortunately, the effectiveness of selective embolization is often compromised by its use in emergent settings following the failure of primary operative approaches. Therefore we compared the efficacy of prophylactic versus emergent catheter placement for selective embolization in nine patients with or at risk for obstetric hemorrhage. In four patients with acute obstetric hemorrhage catheterization and embolization was carried out following the failure of initial medical and surgical approaches. In five patients determined to be at risk for intrapartum hemorrhage based on sonographic findings, catheters were inserted into the hypogastric vessels prior to elective cesarean delivery. Three of these five patients subsequently required selective embolization. In comparison to patients undergoing selective embolization following prophylactic catheter placement, patients in the emergent group all had a coagulopathy at the time of embolization, sustained substantially greater blood loss, and had an increased rate of postpartum complications. Finally, there was a significant reduction in total embolization time and therefore in radiation exposure in patients undergoing prophylactic catheter placement prior to selective embolization. These data support the conclusion that in patients determined to be at risk for intrapartum or postpartum hemorrhage the prophylactic placement of catheters allows for selective embolization in a hemodynamically intact patient with stable coagulation indices, theoretically reducing the risk of maternal morbidity and possibly mortality.
在荧光镜引导下对受损盆腔血管进行选择性栓塞治疗产科出血有望成为手术干预的替代方法。不幸的是，选择性栓塞的有效性常常因在初次手术方法失败后的紧急情况下使用而受到影响。因此，我们比较了9例有产科出血或有产科出血风险的患者预防性与紧急放置导管进行选择性栓塞的疗效。4例急性产科出血患者在初始药物和手术方法失败后进行了导管插入和栓塞。5例根据超声检查结果确定有产时出血风险的患者，在择期剖宫产术前将导管插入腹下血管。这5例患者中有3例随后需要进行选择性栓塞。与预防性放置导管后进行选择性栓塞的患者相比，紧急组患者在栓塞时均存在凝血功能障碍，失血量大得多，产后并发症发生率更高。最后，在选择性栓塞前进行预防性导管放置的患者，总栓塞时间显著缩短，因此辐射暴露也减少。这些数据支持以下结论：对于确定有产时或产后出血风险的患者，预防性放置导管可在凝血指标稳定、血流动力学正常的患者中进行选择性栓塞，理论上可降低孕产妇发病甚至死亡的风险。
