Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, College of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam-si 13496, South Korea.
Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, College of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam-si 13496, South Korea.
J Vasc Interv Radiol. 2021 Jan;32(1):99-105. doi: 10.1016/j.jvir.2020.08.025. Epub 2020 Nov 4.
To evaluate efficacy and safety of transcatheter arterial embolization (TAE) in managing postpartum hemorrhage (PPH) due to genital tract injury after vaginal delivery and to investigate factors associated with outcome of TAE.
A retrospective review of 43 women (mean age, 32.6 years) who underwent TAE to manage PPH secondary to genital tract injury after vaginal delivery was performed at a single institution between January 2007 and December 2018. Clinical data and outcomes were obtained. Patients were classified into clinical success (n = 39) and failure (n = 4) groups, and comparisons between the groups were performed.
The clinical success rate of TAE for PPH due to genital tract injury was 90.7%. In the clinical failure group, transfusion volumes were higher (failure vs success: packed red blood cells, 14 pt ± 3.37 vs 6.26 pt ± 4.52, P = .003; platelets, 10.33 pt ± 4.04 vs 2.92 pt ± 6.15, P = .036); hemoglobin levels before the procedure were lower (failure vs success: 7.3 g/dL vs 10.7, P = .016). Periprocedural complications included pulmonary edema (25.6%), fever (23.3%), and pain (9.3%). Twenty-four patients were either followed for > 6 months or answered a telephone survey; 23 (95.8%) recovered regular menstruation, and pregnancy was confirmed in 11 (45.8%). Regarding fertility desires, 7 women attempted to conceive, 6 of whom (85.7%) became pregnant.
TAE is an effective and safe method for managing PPH due to genital tract injury after vaginal delivery. Lower hemoglobin levels before the procedure and higher transfusion volumes were associated with clinical failure of TAE.
评估经导管动脉栓塞术（TAE）治疗阴道分娩后生殖道损伤引起的产后出血（PPH）的疗效和安全性，并探讨与 TAE 结果相关的因素。
对 2007 年 1 月至 2018 年 12 月在一家单中心接受 TAE 治疗阴道分娩后生殖道损伤引起的 PPH 的 43 名女性（平均年龄 32.6 岁）进行回顾性分析。获取临床数据和结局。将患者分为临床成功（n=39）和失败（n=4）组，并进行组间比较。
TAE 治疗生殖道损伤引起的 PPH 的临床成功率为 90.7%。在临床失败组中，输血量更高（失败与成功：浓缩红细胞 14 个单位±3.37 个单位与 6.26 个单位±4.52 个单位，P=.003；血小板 10.33 个单位±4.04 个单位与 2.92 个单位±6.15 个单位，P=.036）；术前血红蛋白水平较低（失败与成功：7.3 g/dL 与 10.7 g/dL，P=.016）。围手术期并发症包括肺水肿（25.6%）、发热（23.3%）和疼痛（9.3%）。24 名患者随访时间超过 6 个月或接受了电话调查；23 名（95.8%）恢复了正常月经，11 名（45.8%）确认怀孕。关于生育愿望，7 名女性尝试怀孕，其中 6 名（85.7%）怀孕。
TAE 是治疗阴道分娩后生殖道损伤引起的 PPH 的一种有效且安全的方法。术前血红蛋白水平较低和输血量较高与 TAE 临床失败相关。
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