Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2023; 11(15): 3471-3480
Published online May 26, 2023. doi: 10.12998/wjcc.v11.i15.3471
Usefulness of transcatheter arterial embolization for eighty-three patients with secondary postpartum hemorrhage: Focusing on difference in angiographic findings
Bong Man Kim, Gyeong Sik Jeon, Min Jeong Choi, Nam-Soo Hong
Bong Man Kim, Min Jeong Choi, Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan-si 31116, Chungcheongnam-do, South Korea
Gyeong Sik Jeon, Department of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si 13496, Gyeonggi-do, South Korea
Nam-Soo Hong, Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
Author contributions: Kim BM collected the data and wrote the paper; Jeon GS designed the study and collected the data and supervised the report; Choi MJ provided clinical advice; Hong NS contributed to the analysis of the data.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Dankook University Hospital, Dankook University College of Medicine.
Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board at our institution.
Conflict-of-interest statement: All the authors declare no conflicts of interest.
Data sharing statement: The data and materials described in the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gyeong Sik Jeon, MD, PhD, Associate Professor, Department of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si 13496, Gyeonggi-do, South Korea. hae0820@naver.com
Received: January 30, 2023
Peer-review started: January 30, 2023
First decision: February 17, 2023
Revised: March 13, 2023
Accepted: April 20, 2023
Article in press: April 20, 2023
Published online: May 26, 2023
Processing time: 115 Days and 13.7 Hours
Abstract
BACKGROUND

Transcatheter arterial embolization (TAE) has been widely used as an effective and a safe treatment method and was often used as an alternative to the surgical management, but there are limited studies on the efficacy and the safety for patients undergoing their secondary postpartum hemorrhage (PPH).

AIM

To evaluate the usefulness of TAE for secondary PPH focusing on the angiographic findings.

METHODS

We conducted a research from January 2008 to July 2022 on all 83 patients (mean: 32 years, range: 24-43 years) presented with secondary PPH and they were treated with TAE in two university hospitals. The medical records and angiography were retrospective reviewed in order to evaluate the patients’ characteristics, delivery details, clinical status and peri-embolization management, angiography and embolization details, technical/clinical success and complications. The group with active bleeding sign and the group without it were also compared and analyzed.

RESULTS

On angiography, 46 (55.4%) patients showed active bleeding signs such as contrast extravasation (n = 37) or pseudoaneurysm (n = 8) or both (n = 1), and 37 (44.6%) patients showed non-active bleeding signs such as only spastic uterine artery (n = 2) or hyperemia (n = 35). In the active bleeding sign group there were more multiparous patients, low platelet count, prothrombin time prolongation, and high transfusion requirements. The technical success rates were 97.8% (45/46) in active bleeding sign group and 91.9% (34/37) in non-active bleeding sign group, and the overall clinical success rates were 95.7% (44/46) and 97.3% (36/37). An uterine rupture with peritonitis and abscess formation occurred to one patient after the embolization, therefore hysterostomy and retained placenta removal were performed which was a major complication.

CONCLUSION

TAE is an effective and a safe treatment method for controlling secondary PPH regardless of angiographic findings.

Keywords: Postpartum hemorrhage; Angiography; Transcatheter arterial embolization; Pseudoaneurysm; N-butylcyanoacrylate

Core Tip: This is a retrospective study aimed to investigate the efficacy and safety of transcatheter arterial embolization (TAE) for treating secondary postpartum hemorrhage (PPH). Patients were divided into two groups according to the presence or absence of active bleeding signs and analyzed. TAE was performed in 83 patients, 46 (55.4%) patients with active bleeding signs showed contrast extravasation or pseudoaneurysm while 37 (44.6%) patients did not. In the active bleeding sign group there were more multiparous patients, low platelet count, prothrombin time prolongation, and high transfusion requirements. TAE was useful for treating secondary PPH regardless of their angiographic findings.