Cheng Hsin-Hsin, Tsang Leo Leung-Chit, Hsu Te-Yao, Kung Chia-Te, Ou Chia-Yu, Chang Ching-Di, Tsai Ching-Chang, Cheng Yu-Fan, Kung Fu-Tsai
Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Formos Med Assoc. 2017 May;116(5):380-387. doi: 10.1016/j.jfma.2016.06.011. Epub 2016 Sep 19.
BACKGROUND/PURPOSE: To assess the risk factors for intractable and controllable postpartum hemorrhage (PPH) and to evaluate the safety, efficacy, and outcome of transcatheter arterial embolization (TAE).
An emergency PPH rescue system including the 24-hour-available TAE was established in 2004. TAE with gelatine sponge particles placed on bilateral uterine or internal iliac arteries served as the first-line treatment for intractable PPH. Delivery methods, parity, causes of bleeding, clinical vital signs, coagulopathy, success rate, resumption of menstruation, and subsequent pregnancy outcome after TAE were recorded.
From the years 2005 to 2013, 301 women experienced PPH, of whom 178 had controllable PPH and 123 intractable PPH. Tachycardia and disseminated intravascular coagulation were significant risk factors for intractable PPH. All of the women with intractable PPH underwent TAE, and 89 (72.3%) were transferred by ground transport to receive treatment in this system. The mean travel distance was 15 km ± 12.5 km. The mean time of order to angiography room was 24.9 minutes ± 14.2 minutes. The mean blood loss before TAE was 2247 mL ± 1482 mL (range, 900-11,110 mL). The first TAE successfully controlled bleeding in 118 of the 123 (95.9%) women with intractable PPH. Of the 70 women with complete follow-up, 69 (98.6%) recovered menstruation. Twenty-three women tried to get pregnant and 19 (82.6%) of them succeeded, giving birth to 12 full-term live infants.
TAE was safe and effective in treating intractable primary PPH with a high success rate and preservation of menstruation and fertility.
背景/目的：评估难治性和可控性产后出血（PPH）的危险因素，并评估经导管动脉栓塞术（TAE）的安全性、有效性及结局。
2004年建立了包括24小时可用TAE的紧急PPH救援系统。将明胶海绵颗粒置于双侧子宫动脉或髂内动脉的TAE作为难治性PPH的一线治疗方法。记录分娩方式、产次、出血原因、临床生命体征、凝血病、成功率、月经恢复情况以及TAE后的后续妊娠结局。
2005年至2013年，301名女性发生PPH，其中178例为可控性PPH，123例为难治性PPH。心动过速和弥散性血管内凝血是难治性PPH的重要危险因素。所有难治性PPH的女性均接受了TAE治疗，其中89例（72.3%）通过地面转运至本系统接受治疗。平均转运距离为15 km±12.5 km。从下达医嘱到进入血管造影室的平均时间为24.9分钟±14.2分钟。TAE前的平均失血量为2247 mL±1482 mL（范围为900 - 11,110 mL）。123例难治性PPH女性中，首次TAE成功控制出血的有118例（95.9%）。在70例完成随访的女性中，69例（98.6%）恢复月经。23例女性尝试怀孕，其中19例（82.6%）成功怀孕，产下12例足月活婴。
TAE治疗难治性原发性PPH安全有效，成功率高，可保留月经和生育能力。
