Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., SR-340, Boston, MA 02115, USA.
J Vasc Interv Radiol. 2011 Feb;22(2):169-76. doi: 10.1016/j.jvir.2010.09.031. Epub 2010 Dec 22.
To evaluate the clinical effectiveness and safety of uterine artery embolization (UAE) in the treatment of primary postpartum hemorrhage (PPH), secondary PPH, and PPH associated with cesarean section.
All women who underwent UAE for obstetric-related hemorrhage during a 52-month period culminating in April 2009 were included. Clinical success was defined as obviation of hysterectomy. Blood product requirements before and after UAE were calculated. Statistically significant associations between subject characteristics and clinical success were evaluated. The two subgroups of women with uterine artery pseudoaneurysms and women who underwent cesarean section were examined separately as well.
Sixty-six women (mean age, 33 years; range, 17-47 y) underwent UAE, with an overall clinical success rate of 95% (98% for primary PPH, 88% for secondary PPH, and 94% for PPH associated with cesarean section) and an overall complication rate of 4.5%. Mean pre- and postembolization transfusion requirements were 3.1 U and 0.4 U of packed red blood cells, respectively. The only significant characteristic identified for the cases that necessitated hysterectomy was an increased transfusion requirement after UAE (increase of 1.0 U ± 0.5; P = .02). Uterine artery pseudoaneurysms were associated with secondary PPH (P = .01) and cesarean section (P = .03).
The threshold for UAE in women with PPH should be low, as it is associated with a high clinical effectiveness rate and a low complication rate. Uterine artery pseudoaneurysms should be suspected in women presenting with secondary PPH after cesarean section.
评估子宫动脉栓塞术（UAE）在治疗原发性产后出血（PPH）、继发性 PPH 和剖宫产相关 PPH 的临床疗效和安全性。
纳入 2009 年 4 月前 52 个月内因产科出血接受 UAE 的所有女性。临床成功定义为避免子宫切除术。计算 UAE 前后血制品的需求。评估患者特征与临床成功之间的统计学显著关联。还分别检查了存在子宫动脉假性动脉瘤的妇女和行剖宫产的妇女这两个亚组。
66 名女性（平均年龄 33 岁；范围，17-47 岁）接受了 UAE，总体临床成功率为 95%（原发性 PPH 为 98%，继发性 PPH 为 88%，剖宫产相关 PPH 为 94%），总体并发症发生率为 4.5%。平均栓塞前和栓塞后的输血需求分别为 3.1U 和 0.4U 的浓缩红细胞。需要子宫切除术的病例唯一显著特征是 UAE 后输血需求增加（增加 1.0U±0.5；P=0.02）。子宫动脉假性动脉瘤与继发性 PPH（P=0.01）和剖宫产（P=0.03）相关。
对于 PPH 女性，应降低 UAE 的阈值，因为它与高临床有效率和低并发症发生率相关。对于剖宫产术后出现继发性 PPH 的女性，应怀疑存在子宫动脉假性动脉瘤。
