Lindquist Jonathan D, Vogelzang Robert L
Division of Interventional Radiology, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital and McGaw Medical Center, Chicago, Illinois.
Semin Intervent Radiol. 2018 Mar;35(1):41-47. doi: 10.1055/s-0038-1636520. Epub 2018 Apr 5.
Postpartum hemorrhage (PPH) is the leading cause of maternal perinatal morbidity and mortality worldwide. Defined as greater than 500 mL blood loss after vaginal delivery, and greater than 1,000 mL blood loss after cesarean delivery, PPH has many causes, including uterine atony, lower genital tract lacerations, coagulopathy, and placental anomalies. Correction of coagulopathy and identification of the cause of bleeding are mainstays of treatment. Medical therapies such as uterotonics, balloon tamponade, pelvic artery embolization, and uterine-sparing surgical options are available. Hysterectomy is performed when conservative therapies fail. Pelvic artery embolization is safe and effective, and is the first-line therapy for medically refractory PPH. A thorough knowledge of pelvic arterial anatomy is critical. Recognition of variant anatomy can prevent therapeutic failure. Pelvic embolization is minimally invasive, has a low complication rate, spares the uterus, and preserves fertility.
产后出血（PPH）是全球孕产妇围产期发病和死亡的主要原因。PPH定义为阴道分娩后失血超过500毫升，剖宫产术后失血超过1000毫升，其病因众多，包括子宫收缩乏力、下生殖道裂伤、凝血功能障碍和胎盘异常。纠正凝血功能障碍和确定出血原因是治疗的主要方法。有宫缩剂、球囊压迫、盆腔动脉栓塞和保留子宫的手术等医疗疗法可供选择。保守治疗失败时则进行子宫切除术。盆腔动脉栓塞安全有效，是难治性PPH的一线治疗方法。全面了解盆腔动脉解剖结构至关重要。识别变异解剖结构可防止治疗失败。盆腔栓塞微创，并发症发生率低，可保留子宫并维持生育能力。
