Pelage J P, Le Dref O, Mateo J, Soyer P, Jacob D, Kardache M, Dahan H, Repiquet D, Payen D, Truc J B, Merland J J, Rymer R
Department of Body and Vascular Imaging, Hôpital Lariboisière, AP-HP, Paris, France.
Radiology. 1998 Aug;208(2):359-62. doi: 10.1148/radiology.208.2.9680559.
To prospectively evaluate the efficacy and safety of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage.
Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before embolization failed to stop the bleeding.
Angiography revealed extravasation in nine patients and spasm of the branches of the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian (n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminution of external bleeding was observed in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women except the two who underwent hysterectomy. One woman became pregnant after embolization.
Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.
前瞻性评估急诊选择性动脉栓塞术治疗难治性原发性产后出血的有效性和安全性。
连续27例出现危及生命的原发性产后出血的妇女接受了子宫栓塞术。所有病例均因经阴道填塞和使用宫缩剂无法控制的难治性出血而进行止血栓塞。栓塞前平均血红蛋白水平为7.48 g/dL±2.39（74.8 g/L±23.9）（1个标准差）。两名患者在栓塞前进行子宫切除术未能止血。
血管造影显示9例有造影剂外渗，5例有髂内动脉分支痉挛。栓塞的血管包括子宫动脉（n = 46）、阴道动脉（n = 5）、卵巢动脉（n = 2）或髂内动脉前干（n = 8）。所有病例均立即出现外出血消失或显著减少。两名患者第二天需要重复栓塞。未发现与栓塞相关的严重并发症。1例胎盘植入患者需要延迟子宫切除术。除两名接受子宫切除术的妇女外，所有妇女月经恢复正常。1名妇女在栓塞后怀孕。
急诊动脉栓塞是控制原发性产后出血的一种安全有效的方法。该方法避免了高风险手术，并能维持生殖能力。
