Wada Natsuko, Tachibana Daisuke, Nakagawa Kayoko, Terada Hiroyuki, Nakano Akemi, Sumi Toshiyuki, Koyama Masayasu, Ishiko Osamu, Nishida Norifumi
Department of Obstetrics and Gynecology, Osaka City University, Osaka, Japan.
Jpn Clin Med. 2013 Apr 14;4:25-8. doi: 10.4137/JCM.S11317. eCollection 2013.
The reported success rate of uterine artery embolization (UAE) for obstetrical hemorrhage is more than 90%. We experienced a case of failed UAE for postpartum hemorrhage, although an embolic particle was found pathologically in the uterine vessels without coagulation. A 42-year-old woman (gravida 7, para 2) with placenta previa had genital bleeding at 35 weeks of gestation, and cesarean section was performed. We immediately added UAE aiming to reduce massive bleeding after the cesarean section, successful embolization of the bilateral uterine arteries and internal iliac arteries were confirmed by angiography regardless the vital sign was recovered with an appropriate amount of transfusion; the massive bleeding recurred after 1 hour of UAE. Hysterectomy was performed and pathological findings of the uterus showed that there was no coagulation in the vessels, which was supposed to be observed by the effect of gelatin sponge. In addition, despite the fact that no coagulation was found, only one gelatin sponge was found in 16 slices of the uterine wall specimens. We speculate that thrombotic materials were caught in vasoconstricted vessels triggered by hypovolemic shock due to acute blood loss, and then the gelatin sponge could be washed out after recovering to normalized circulation status leading to recurrent massive hemorrhage.
据报道，子宫动脉栓塞术（UAE）治疗产科出血的成功率超过90%。我们遇到一例产后出血UAE治疗失败的病例，尽管在子宫血管中病理检查发现有栓塞颗粒但未形成凝血。一名42岁女性（孕7产2），前置胎盘，孕35周时出现阴道出血，行剖宫产术。我们立即加做UAE以减少剖宫产术后的大量出血，血管造影证实双侧子宫动脉和髂内动脉栓塞成功，尽管经适量输血生命体征恢复，但UAE术后1小时再次出现大量出血。遂行子宫切除术，子宫病理检查结果显示血管内未形成凝血，而这应该是明胶海绵的作用所致。此外，尽管未发现凝血，但在16片子宫壁标本中仅发现一块明胶海绵。我们推测，急性失血导致低血容量性休克引发血管收缩，血栓物质被困在血管中，随后恢复到正常循环状态后明胶海绵可能被冲走，从而导致再次大量出血。
