Farname Inc. in collaboration with Iranian Society of Gynecology Oncology

Document Type : Original Research Article

Authors

1 Department of Obstetrics and Gynecology, School of Medicine, Shahid Motahari Hospital, Urmia University of Medical Sciences, Urmia, Iran

2 Department of Radiology, School of Medicine, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Background & Objective: Postpartum hemorrhage is the most common cause of maternal morbidity, especially in developing countries, and a major cause of direct maternal death worldwide. Considering the importance of timely postpartum hemorrhage management and access to low-risk methods, assessing the efficacy of uterine artery embolization (UAE) is essential. Therefore, the present study was conducted to evaluate the success rate and outcomes of UAE in the treatment of delayed postpartum hemorrhage.
Materials & Methods: This cross-sectional study was performed on women with delayed postpartum hemorrhage who were referred to the gynecology and obstetrics clinic of a referral hospital in Urmia city under treatment of UAE. The census method was used for choosing the patients and all women with delayed postpartum hemorrhage between April 2019 and March 2020 were entered into the study.
Results: During the study period, he number of 22 women with delayed postpartum hemorrhage were entered into the study. The mean age of the women was 29.36±5.09 years. The success rate of UAE was 95.6%. The number of 20 (90.9%) cases did not report complications. For one case, UAE complication was associated with amenorrhea and for the other one with vaginal bleeding.
Conclusion: The results showed that the UAE method as an effective method with high efficacy and low complications can be considered a suitable choice for the treatment of delayed postpartum hemorrhage.

Highlights

 The results showed that the UAE method as an effective method with high efficacy and low complications can be considered a suitable choice for the treatment of delayed postpartum hemorrhage.

Keywords

Main Subjects

1. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage: World Health Organization; 2012.
2. Ford JB, Patterson JA, Seeho SK, Roberts CL. Trends and outcomes of postpartum haemorrhage, 2003-2011. BMC pregnancy childbirth. 2015;15(1):1-10. [DOI:10.1186/s12884-015-0788-5] [PMID] [PMCID]
3. Marshall AL, Durani U, Bartley A, Hagen CE, Ashrani A, Rose C, et al. The impact of postpartum hemorrhage on hospital length of stay and inpatient mortality: a National Inpatient Sample-based analysis. Am J Obstet Gynecol. 2017;217(3):344. e1-. e6. [DOI:10.1016/j.ajog.2017.05.004] [PMID]
4. Liu S, Liston RM, Joseph K, Heaman M, Sauve R, Kramer MS. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176(4):455-60. [DOI:10.1503/cmaj.060870] [PMID] [PMCID]
5. Yu P-C, Ou H-Y, Tsang LL-C, Kung F-T, Hsu T-Y, Cheng Y-F. Prophylactic intraoperative uterine artery embolization to control hemorrhage in abnormal placentation during late gestation. Fertil steril. 2009;91(5):1951-5. [DOI:10.1016/j.fertnstert.2008.02.170] [PMID]
6. Kim TH, Lee HH, Kim JM, Ryu AL, Chung SH, Lee WS. Uterine artery embolization for primary postpartum hemorrhage. Iran J Reprod Med. 2013;11(6):511.
7. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams's obstetrics. 23rd ed. New York: McGraw-Hill; 2010:823-39.
8. Papp Z, Tóth-Pál E, Papp C, Sziller I, Silhavy M, Gávai M, et al. Bilateral hypogastric artery ligation for control of pelvic hemorrhage, reduction of blood flow and preservation of reproductive potential. Experience with 117 cases. Orv Hetil. 2005;146(24):1279-85.
9. Ojala K, Perälä J, Kariniemi J, Ranta P, Raudaskoski T, Tekay A. Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage. Acta obstetricia et gynecologica Scandinavica. 2005;84(11):1075-80. [DOI:10.1080/j.0001-6349.2005.00727.x] [PMID]
10. Pelage J, Laissy J. Management of life-threatening postpartum hemorrhage: indications and technique of arterial embolization. J Gynecol Obstet Biol Reprod. 2004;33(8 Suppl):4S93-4S102.
11. Daskalakis G, Anastasakis E, Papantoniou N, Mesogitis S, Theodora M, Antsaklis A. Emergency obstetric hysterectomy. Acta Obstet Gynecol Scand. 2007;86(2):223-7. [DOI:10.1080/00016340601088448] [PMID]
12. Wang PH, Liu WM, Fuh JL, Chao HT, Yuan CC, Chao KC. Symptomatic myoma treated with laparoscopic uterine vessel occlusion and subsequent immediate myomectomy: which is the optimal surgical approach? Fertil Steril. 2009;92(2):762-9. [DOI:10.1016/j.fertnstert.2008.06.038] [PMID]
13. Madhubala M, Shukul M, Kasthuri C. Caesarean Myomectomy to Prevent Immediate or Interval Myomectomy, Hysterectomy and Postpartum Hemorrhage. J Obstet Gynecol Cancer Res (JOGCR). 2021;6(4):167-73. [DOI:10.30699/jogcr.6.4.167]
14. Kim MJ, Kim IJ, Kim S, Park IY. Postpartum hemorrhage with uterine artery embolization: the risk of complications of uterine artery embolization. Minim Invas Ther Allied Technol. 2020:1-8. [DOI:10.1080/13645706.2020.1789662] [PMID]
15. Aoki M, Tokue H, Miyazaki M, Shibuya K, Hirasawa S, Oshima K. Primary postpartum hemorrhage: outcome of uterine artery embolization. Br J Radiol. 2018;91(1087):20180132. [DOI:10.1259/bjr.20180132] [PMID] [PMCID]
16. Lee K, Lee S, Lee H, Lim H, Kim I, Park I, et al. Uterine necrosis following selective embolization for postpartum hemorrhage: report of four cases and review of literature. Clin Exper Obstet Gynecol. 2019;46(6):1020-5. [DOI:10.12891/ceog4935.2019]
17. Soncini E, Pelicelli A, Larini P, Marcato C, Monaco D, Grignaffini A. Uterine artery embolization in the treatment and prevention of postpartum hemorrhage. Int J Gynecol Obstet. 2007;96(3):181-5. [DOI:10.1016/j.ijgo.2006.12.010] [PMID]
18. Dildy Iii GA. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. 2002;45(2):330-44. [DOI:10.1097/00003081-200206000-00005] [PMID]
19. Wee L, Barron J, Toye R. Management of severe postpartum haemorrhage by uterine artery embolization. Br J Anaesth. 2004;93(4):591-4. [DOI:10.1093/bja/aeh237] [PMID]
20. Bloom AI, Verstandig A, Gielchinsky Y, Nadiari M, Elchalal U. Arterial embolisation for persistent primary postpartum haemorrhage: before or after hysterectomy? BJOG Int J Obstet Gynaecol. 2004;111(8):880-4. [DOI:10.1111/j.1471-0528.2004.00201.x] [PMID]
21. Hong TM, Tseng HS, Lee RC, Wang JH, Chang C-Y. Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage. Clin Radiol. 2004;59(1):96-101. [DOI:10.1016/j.crad.2003.08.007] [PMID]
22. Yong S, Cheung K. Management of primary postpartum haemorrhage with arterial embolisation in Hong Kong public hospitals. Hong Kong Medi J. 2006;12(6):437.
23. Ganguli S, Stecker MS, Pyne D, Baum RA, Fan C-M. Uterine artery embolization in the treatment of postpartum uterine hemorrhage. J Vas Interv Radiol. 2011;22(2):169-76. [DOI:10.1016/j.jvir.2010.09.031] [PMID]
24. Choi YH, Baba Y, Ikeda S, So YH, Hayashi S, Nakajo M. Efficacy of uterine artery embolization for patients with postpartum hemorrhage. 2013. [DOI:10.4236/ojrad.2013.32008]
25. Myers TT. Uterine artery embolization for postpartum hemorrhage. J Radiol Nur. 2016;35(2):142-5. [DOI:10.1016/j.jradnu.2016.01.008]
26. Lee HJ, Cho HY, Peck MJ, Ki HJ, Moon MJ, Kim HC, et al. Uterine artery embolization versus cesarean hysterectomy in the management of postpartum hemorrhage. Min Invas Ther Allied Technol. 2019;28(6):351-8. [DOI:10.1080/13645706.2018.1562943] [PMID]