Storms Jazz, Van Calsteren Kristel, Lewi Liesbeth, Maleux Geert, van der Merwe Johannes
Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Arch Gynecol Obstet. 2025 Feb;311(2):251-258. doi: 10.1007/s00404-024-07595-y. Epub 2024 Jun 16.
Postpartum haemorrhage (PPH) remains a leading cause of maternal death despite current medical management. Surgical interventions are still needed for refractory bleeding. Interventional radiology (IR) can be a successful intermediary that avoids the need for hysterectomy. Nevertheless, IR outcome data in a peripartum setting are limited. The objective of this study is to document the efficacy and safety of IR.
Retrospective study reviewed the records of consecutive patients who underwent peripartum IR from 01/01/2010 until 31/12/2020 in a tertiary academic centre. Patients were divided in a prophylactic and a therapeutic group. Information about interventions before and after IR, and IR specific complications was retrieved. Efficacy was defined by the number of transfusions and additional surgical interventions needed after IR, and safety was assessed by the incidence of IR related complications.
Fifty-four patients, prophylactic group (n = 24) and therapeutic group (n = 30), were identified. In both groups, IR was successful with 1.5 ± 2.9 packed cells transfused post-IR (1.0 ± 2.1 prophylactic vs 1.9 ± 3.3 therapeutic; p = 0.261). Additional surgical interventions were required in n = 5 patients (9.2%), n = 1 (4.2%) in the prophylactic vs. n = 4 (13.3%) in the therapeutic group. Complications were reported in n = 12 patients (22.2%), n = 2 (8.3%) prophylactic vs. n = 10 (33.3%) in therapeutic group. Mostly minor complications, as puncture site hematoma or bleeding, were reported in n = 4 (7.4%). Severe complications as necrosis and metabolic complications were reported in n = 2 patients (3.9%).
IR for prevention and treatment of PPH was highly successful and associated with minor complications.
尽管目前有医学管理措施，但产后出血（PPH）仍是孕产妇死亡的主要原因。对于难治性出血仍需要手术干预。介入放射学（IR）可以成为避免子宫切除术的成功中间手段。然而，围产期环境下的IR结果数据有限。本研究的目的是记录IR的有效性和安全性。
回顾性研究回顾了2010年1月1日至2020年12月31日在一家三级学术中心接受围产期IR的连续患者的记录。患者分为预防组和治疗组。检索IR前后的干预措施以及IR特异性并发症的信息。有效性通过IR后所需的输血次数和额外手术干预来定义，安全性通过IR相关并发症的发生率来评估。
共确定了54例患者，预防组（n = 24）和治疗组（n = 30）。两组中，IR均成功，IR后输注1.5±2.9单位浓缩红细胞（预防组1.0±2.1 vs治疗组1.9±3.3；p = 0.261）。5例患者（9.2%）需要额外的手术干预，预防组1例（4.2%），治疗组4例（13.3%）。12例患者（22.2%）报告有并发症，预防组2例（8.3%），治疗组10例（33.3%）。大多数为轻微并发症，如穿刺部位血肿或出血，共4例（7.4%）。2例患者（3.9%）报告有严重并发症，如坏死和代谢并发症。
IR预防和治疗PPH非常成功，且并发症轻微。
