Soyer Philippe, Fargeaudou Yann, Morel Olivier, Boudiaf Mourad, Le Dref Olivier, Rymer Roland
Department of Abdominal Imaging, Hopital Lariboisière-AP-HP Université Paris 7, 2, rue Ambroise Paré, 75475 Paris cedex 10, France.
Eur Radiol. 2008 Jun;18(6):1181-7. doi: 10.1007/s00330-008-0876-2. Epub 2008 Feb 13.
The purpose of this retrospective study was to evaluate the role of transcatheter arterial embolization in the management of severe postpartum haemorrhage due to a ruptured pseudoaneurysm and to analyse the clinical symptoms that may suggest a pseudoaneurysm as a cause of postpartum haemorrhage. A retrospective search of our database disclosed seven women with severe postpartum haemorrhage in whom angiography revealed the presence of a uterine or vaginal artery pseudoaneurysm and who were treated using transcatheter arterial embolization. Clinical files were reviewed for possible clinical findings that could suggest pseudoaneurysm as a cause of bleeding. Angiography revealed extravasation of contrast material in five out of seven patients. Transcatheter arterial embolization allowed to control the bleeding in all patients and subsequently achieve vaginal suture in four patients with vaginal laceration. No complications related to transcatheter arterial embolization were noted. Only two patients had uterine atony, and inefficiency of sulprostone was observed in all patients. Transcatheter arterial embolization is an effective and secure technique for the treatment of severe postpartum haemorrhage due to uterine or vaginal artery pseudoaneurysm. Ineffectiveness of suprostone and absence of uterine atony should raise the possibility of a ruptured pseudoaneurysm.
本回顾性研究的目的是评估经导管动脉栓塞术在因假性动脉瘤破裂导致的严重产后出血管理中的作用，并分析可能提示假性动脉瘤为产后出血原因的临床症状。对我们数据库进行回顾性检索，发现7例严重产后出血的女性，血管造影显示存在子宫或阴道动脉假性动脉瘤，她们接受了经导管动脉栓塞术治疗。对临床病历进行了审查，以寻找可能提示假性动脉瘤为出血原因的临床发现。血管造影显示7例患者中有5例存在造影剂外渗。经导管动脉栓塞术使所有患者的出血得到控制，随后4例阴道裂伤患者实现了阴道缝合。未发现与经导管动脉栓塞术相关的并发症。仅2例患者存在子宫收缩乏力，所有患者均观察到磺前列酮无效。经导管动脉栓塞术是治疗因子宫或阴道动脉假性动脉瘤导致的严重产后出血的一种有效且安全的技术。磺前列酮无效且无子宫收缩乏力应增加假性动脉瘤破裂的可能性。
