Interventional radiology in the management of uncommon causes of obstetric haemorrhage. Issue 134 (January 2021)

• Record Type: Journal Article
• Authors: Gorsi, Ujjwal; Bansal, Akash; Chaluvashetty, Sreedhara B.; Lal, Anupam; Kalra, Naveen; Kang, Mandeep; Suri, Vanita; Sandhu, Manavjit Singh
• Is Part Of: European journal of radiology. Issue 134(2021)
• Publication Date: 2021-01
• Subjects: Post-partum haemorrhage -- Uterine artery embolization -- Pseudoaneurysm -- AVM -- Percutaneous; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.109415
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Post-partum haemorrhage (PPH) is an obstetric emergency, accounting for more than 30% maternal deaths. Secondary PPH includes haemorrhage after 24 hours of delivery and presents a management challenge. Uncommon causes include RPOC, placental abruption/accreta, trauma, uterine AVM and gestational trophoblastic disease. Interventional radiologists play a significant role in their management through a minimally invasive approach. Both endovascular and percutaneous approach are minimally invasive, with high clinical success and minimal complications. Abstract: Purpose: To delineate the uncommon causes of pregnancy related haemorrhage and discuss various endovascular, and direct percutaneous interventional radiology techniques that can be used for successful management. Materials and methods: Forty-four females with uncommon causes of pregnancy related haemorrhage, who were referred for uterine artery embolization, between January 2013 and May 2020, were retrospectively analyzed in this hospital-based study. Observations were tabulated under age, prior procedure, post procedure day, underlying pathology, route, embolizing agent used, complications and recurrence, and statistical analysis done. Results: The mean age of the studied population was 28.5 ± 4.9 years (range 20–41 years), and the most common prior procedure performed was caesarean section (31.8 %), followed by post abortive procedures (29.5 %) and normal vaginal deliveries (27.3 %). The median post procedure duration was 6.5 days (range 1–80 days). Most common underlying pathology was pseudoaneurysm (31.8 %), followed by arteriovenous malformations and uterine artery hypertrophy (18.2 % each). Percutaneous route was used in 6 patients while the remaining 38 patients underwent endovascular management. Overall, Gelfoam was used in 50 % patients, gelfoam plus another agent in 29.5 % and glue in 20.5 % patients. Technical success was achieved in 97.7 % and clinical success in 95.4 % with no major procedure related complications. Conclusion: Interventional Radiology offers minimally invasive, safe and effective embolization procedures for the management of uncommon causes of pregnancy related haemorrhage, with low complication rate and high clinical success.