Kawashita Sayaka, Kaneuchi Masanori, Nakayama Daisuke, Fuchi Naoki, Murakami Yuko, Miura Kiyonori, Masuzaki Hideaki
Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, 7-1, Sakamoto 1-choume, Nagasaki-city 8528501, Japan.
Department of Obstetrics and Gynecology, Sasebo City General Hospital, Sasebo-city 8578511, Japan.
Radiol Case Rep. 2017 Feb 24;12(2):261-264. doi: 10.1016/j.radcr.2017.01.017. eCollection 2017 Jun.
Transcatheter arterial embolization has become a common management option for intractable postpartum uterine hemorrhage. Iodinated contrast agents are commonly used for embolotherapy but cannot be used in patients with renal dysfunction or iodine allergy. A 37-year-old woman spontaneously delivered a healthy girl but developed severe postpartum uterine hemorrhage, probably due to placenta accrete. Contrast-enhanced computed tomography revealed extravasation of the iodinated contrast agent into the uterine cavity. The patient subsequently developed allergic reaction to this agent. After recovery from the allergic reaction with appropriate treatment, we performed carbon dioxide angiography and found that the extravasation originated from the right uterine artery. Embolization of the right internal iliac artery was performed, and hemostasis was verified. Based on this experience, we suggest carbon dioxide angiography and arterial embolization can be used for treating intractable postpartum hemorrhage in patients with iodinated contrast media allergy or renal dysfunction.
经导管动脉栓塞术已成为难治性产后子宫出血的一种常见治疗选择。碘化造影剂常用于栓塞治疗,但不能用于肾功能不全或碘过敏的患者。一名37岁女性自然分娩出一名健康女婴,但出现了严重的产后子宫出血,可能是由于胎盘植入。增强计算机断层扫描显示碘化造影剂外渗至子宫腔内。该患者随后对该造影剂发生过敏反应。经适当治疗从过敏反应中恢复后,我们进行了二氧化碳血管造影,发现外渗源自右侧子宫动脉。对右侧髂内动脉进行了栓塞,并证实了止血效果。基于这一经验,我们建议二氧化碳血管造影和动脉栓塞可用于治疗对碘化造影剂过敏或肾功能不全患者的难治性产后出血。