Departments of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, 951-8510, Niigata, Japan.
Radiology and Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata, Japan.
BMC Pregnancy Childbirth. 2021 Oct 22;21(1):710. doi: 10.1186/s12884-021-04191-9.
Postpartum hemorrhage (PPH) is a potentially fatal condition requiring urgent and appropriate intervention. Uterine artery embolization (UAE) has a high hemostatic capacity for PPH, but it may fail. Disseminated intravascular coagulation (DIC) has been reported as a risk factor associated with the failure of UAE.
A 37-year-old primigravida with dichorionic diamniotic twins and placenta previa underwent cesarean section. The blood loss during surgery was 4950 mL. Hemostasis was achieved using an intrauterine balloon tamponade device. However, she lost a further 2400 mL of blood 5 h after surgery. We embolized both uterine arteries using gelatin sponges and confirmed hemostasis. She was suffering from DIC and received ample blood transfusions. However, a further 1300 mL of blood was lost 18 h after surgery and we performed repeated UAE, with complete recanalization of the uterine arteries on both sides and re-embolization with gelatin sponges. Her DIC was treated successfully by blood transfusions at this time, and she showed no further bleeding after the repeated UAE.
DIC is a risk factor for the failure of UAE. Repeated UAE may be effective after sufficient improvement of the hematological status in patients with PPH and DIC.
产后出血（PPH）是一种潜在的致命病症，需要紧急和适当的干预。子宫动脉栓塞术（UAE）对 PPH 具有很高的止血能力，但也可能失败。弥散性血管内凝血（DIC）已被报道为与 UAE 失败相关的危险因素。
一位 37 岁的初产妇，怀有双绒毛膜双羊膜囊双胞胎且胎盘前置，行剖宫产术。术中失血量为 4950 毫升。使用宫内球囊填塞装置止血成功。然而，术后 5 小时她又失血 2400 毫升。我们使用明胶海绵栓塞了双侧子宫动脉，并确认止血成功。她患有 DIC，并接受了大量输血。然而，术后 18 小时又失血 1300 毫升，我们再次进行 UAE，双侧子宫动脉完全再通，并再次使用明胶海绵栓塞。此时通过输血成功治疗了她的 DIC，并且在重复 UAE 后她没有再出血。
DIC 是 UAE 失败的危险因素。对于患有 PPH 和 DIC 的患者，在充分改善血液学状态后，重复 UAE 可能有效。
