Department of Radiology, Peking Union Medical College Hospital, Beijing, China.
Clin Radiol. 2012 Dec;67(12):e71-6. doi: 10.1016/j.crad.2012.07.021. Epub 2012 Sep 10.
To evaluate the efficacy and safety of uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta.
Between January 2005 and August 2011, 45 women with placenta accreta, which was discovered during delivery, were managed conservatively in Peking Union Medical College Hospital. They did not experience severe bleeding during delivery. Ten patients (mean age 31 ± 6.4 years) developed secondary postpartum haemorrhage and underwent uterine artery embolization. The complications, control of haemorrhage, and outcome of the placenta left inside the uterus were retrospectively reviewed.
All patients underwent transcatheter embolization of bilateral uterine arteries. The median time between delivery and uterine artery embolization was 11 days (range 3-76 days). The technical success rate of embolization was 100%. Bleeding was controlled in all patients during follow-up (11 ± 6.9 months; range 3-24 months), and no further bleeding occurred. One patient developed lower-extremity deep venous thrombosis after uterine artery embolization, and no other major complications occurred. The placentae that were left inside the uteri gradually decreased in size during follow-up, except in one case. Nine patients resumed normal menstruation. One patient subsequently became pregnant and had an uneventful intrauterine pregnancy carried to term.
Uterine artery embolization is safe and effective for the management of secondary postpartum haemorrhage associated with placenta accreta.
评估子宫动脉栓塞术治疗胎盘植入相关继发性产后出血的疗效和安全性。
2005 年 1 月至 2011 年 8 月，北京协和医院对 45 例分娩时发现胎盘植入的患者进行保守治疗，这些患者分娩时未发生严重出血。其中 10 例（平均年龄 31 ± 6.4 岁）发生继发性产后出血，并接受了子宫动脉栓塞术治疗。回顾性分析这些患者的并发症、出血控制情况以及子宫内残留胎盘的结局。
所有患者均接受了双侧子宫动脉的经导管栓塞术。从分娩到子宫动脉栓塞术的中位时间为 11 天（范围 3-76 天）。栓塞术的技术成功率为 100%。所有患者在随访期间（11 ± 6.9 个月；范围 3-24 个月）均止血成功，且未再发生出血。1 例患者在子宫动脉栓塞术后发生下肢深静脉血栓形成，但无其他严重并发症发生。随访期间，子宫内残留的胎盘逐渐缩小，除 1 例外。9 例患者恢复正常月经。1 例患者随后再次妊娠，宫内妊娠至足月。
子宫动脉栓塞术治疗胎盘植入相关继发性产后出血安全有效。
