Pelvic Artery Embolization for Treatment of Postpartum Hemorrhage

Jonathan D. Lindquist; Robert L. Vogelzang

doi:10.1055/s-0038-1636520

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2018; 35(01): 041-047
DOI: 10.1055/s-0038-1636520

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pelvic Artery Embolization for Treatment of Postpartum Hemorrhage

Jonathan D. Lindquist

¹Division of Interventional Radiology, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado

,

Robert L. Vogelzang

²Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital and McGaw Medical Center, Chicago, Illinois

› Author Affiliations

Abstract

Postpartum hemorrhage (PPH) is the leading cause of maternal perinatal morbidity and mortality worldwide. Defined as greater than 500 mL blood loss after vaginal delivery, and greater than 1,000 mL blood loss after cesarean delivery, PPH has many causes, including uterine atony, lower genital tract lacerations, coagulopathy, and placental anomalies. Correction of coagulopathy and identification of the cause of bleeding are mainstays of treatment. Medical therapies such as uterotonics, balloon tamponade, pelvic artery embolization, and uterine-sparing surgical options are available. Hysterectomy is performed when conservative therapies fail. Pelvic artery embolization is safe and effective, and is the first-line therapy for medically refractory PPH. A thorough knowledge of pelvic arterial anatomy is critical. Recognition of variant anatomy can prevent therapeutic failure. Pelvic embolization is minimally invasive, has a low complication rate, spares the uterus, and preserves fertility.

Keywords

postpartum hemorrhage - uterine artery - embolization - fertility - interventional radiology

Full Text

References

References
1 Say L, Chou D, Gemmill A. , et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2 (06) e323-e333
2 Devine PC. Obstetric hemorrhage. Semin Perinatol 2009; 33 (02) 76-81
3 WHO. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organisation; 2012
4 WHO, UNFPA, The World Bank. Trends in Maternal Mortality: 1990 to 2010 - WHO, UNICEF, UNFPA and the World Bank Estimates; 2012
5 Kumar N. Postpartum hemorrhage; a major killer of woman: review of current scenario. Obstet Gynecol Int J 2016; 4 (04) 00116
6 Ronsmans C, Graham WJ. ; Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet 2006; 368 (9542): 1189-1200
7 Karoshi M, Keith L. Challenges in managing postpartum hemorrhage in resource-poor countries. Clin Obstet Gynecol 2009; 52 (02) 285-298
8 Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. ; United Kingdom Obstetric Surveillance System Steering Committee. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol 2008; 111 (01) 97-105
9 Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008; 22 (06) 999-1012
10 Calvert C, Thomas SL, Ronsmans C, Wagner KS, Adler AJ, Filippi V. Identifying regional variation in the prevalence of postpartum haemorrhage: a systematic review and meta-analysis. PLoS One 2012; 7 (07) e41114
11 Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994-2006. Am J Obstet Gynecol 2010; 202 (04) 353.e1-353.e6
12 Rath WH. Postpartum hemorrhage–update on problems of definitions and diagnosis. Acta Obstet Gynecol Scand 2011; 90 (05) 421-428
13 Kavle JA, Khalfan SS, Stoltzfus RJ, Witter F, Tielsch JM, Caulfield LE. Measurement of blood loss at childbirth and postpartum. Int J Gynaecol Obstet 2006; 95 (01) 24-28
14 Stafford I, Dildy GA, Clark SL, Belfort MA. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol 2008; 199 (05) 519.e1-519.e7
15 Schorn MN. Measurement of blood loss: review of the literature. J Midwifery Womens Health 2010; 55 (01) 20-27
16 Conner SN, Tuuli MG, Colvin R, Shanks AL, Macones GA, Cahill AG. Accuracy of estimated blood loss in predicting need for transfusion after delivery. Am J Perinatol 2015; 32 (13) 1225-1230
17 Tita AT, Szychowski JM, Rouse DJ. , et al. Higher-dose oxytocin and hemorrhage after vaginal delivery: a randomized controlled trial. Obstet Gynecol 2012; 119 (2, Pt 1): 293-300
18 Cunningham F, Leveno KJ, Bloom SL. , et al , eds. Obstetrical hemorrhage. In: Williams Obstetrics. 24th ed. New York, NY: McGraw-Hill; 2013: 780-828
19 Ganguli S, Stecker MS, Pyne D, Baum RA, Fan CM. Uterine artery embolization in the treatment of postpartum uterine hemorrhage. J Vasc Interv Radiol 2011; 22 (02) 169-176
20 Bonnar J. Massive obstetric haemorrhage. Best Pract Res Clin Obstet Gynaecol 2000; 14 (01) 1-18
21 Flood KM, Said S, Geary M, Robson M, Fitzpatrick C, Malone FD. Changing trends in peripartum hysterectomy over the last 4 decades. Am J Obstet Gynecol 2009; 200 (06) 632.e1-632.e6
22 Brown BJ, Heaston DK, Poulson AM, Gabert HA, Mineau DE, Miller Jr FJ. Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol 1979; 54 (03) 361-365
23 Gonsalves M, Belli A. The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol 2010; 33 (05) 887-895
24 Abada HT, Golzarian J, Sun S. Interventional management of postpartum hemorrhage. In: Vascular Embolotherapy: A Comprehensive Approach, Vol 1. Berlin, Germany: Springer; 2006: 107-118
25 Bick RL. Syndromes of disseminated intravascular coagulation in obstetrics, pregnancy, and gynecology. Objective criteria for diagnosis and management. Hematol Oncol Clin North Am 2000; 14 (05) 999-1044
26 Combs CA, Murphy EL, Laros Jr RK. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol 1991; 77 (01) 69-76
27 Chichakli LO, Atrash HK, MacKay AP, Musani AS, Berg CJ. Pregnancy-related mortality in the United States due to hemorrhage: 1979–1992. Obstet Gynecol 1999; 94 (5, Pt 1): 721-725
28 Jackson Jr KW, Allbert JR, Schemmer GK, Elliot M, Humphrey A, Taylor J. A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage. Am J Obstet Gynecol 2001; 185 (04) 873-877
29 Stones RW, Paterson CM, Saunders NJ. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol 1993; 48 (01) 15-18
30 Blomberg M. Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol 2011; 118 (03) 561-568
31 Mavrides E, Allard S, Chandraharan E. , et al; on behalf of the Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage. BJOG 2017; 124 (05) e106-e149
32 Magann EF, Evans S, Hutchinson M, Collins R, Howard BC, Morrison JC. Postpartum hemorrhage after vaginal birth: an analysis of risk factors. South Med J 2005; 98 (04) 419-422
33 Ohkuchi A, Onagawa T, Usui R. , et al. Effect of maternal age on blood loss during parturition: a retrospective multivariate analysis of 10,053 cases. J Perinat Med 2003; 31 (03) 209-215
34 Horng HC, Hu WM, Tseng HS, Chang WH, Chao KC, Yang MJ. Uterine arterial embolization in the management of severe post-partum hemorrhage: a successful rescue method to avoid peripartum hysterectomy. J Chin Med Assoc 2011; 74 (06) 255-258
35 Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2015; (03) CD007412
36 Shakur H, Roberts I, Fawole B. , et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. Published online, April 26, 2017. Available at: http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)30638-4 . Accessed April 27, 2017
37 Franchini M, Franchi M, Bergamini V. , et al. The use of recombinant activated FVII in postpartum hemorrhage. Clin Obstet Gynecol 2010; 53 (01) 219-227
38 Laas E, Bui C, Popowski T, Mbaku OM, Rozenberg P. Trends in the rate of invasive procedures after the addition of the intrauterine tamponade test to a protocol for management of severe postpartum hemorrhage. Am J Obstet Gynecol 2012; 207 (04) 281.e1-281.e7
39 Chan LL, Lo TK, Lau WL. , et al. Use of second-line therapies for management of massive primary postpartum hemorrhage. Int J Gynaecol Obstet 2013; 122 (03) 238-243
40 Ferrazzani S, Iadarola R, Perrelli A. , et al. Use of an intrauterine inflated catheter balloon in massive post-partum hemorrhage: a series of 52 cases. J Obstet Gynaecol Res 2014; 40 (06) 1603-1610
41 Evans S, McShane P. The efficacy of internal iliac artery ligation in obstetric hemorrhage. Surg Gynecol Obstet 1985; 160 (03) 250-253
42 Clark SL, Phelan JP, Yeh SY, Bruce SR, Paul RH. Hypogastric artery ligation for obstetric hemorrhage. Obstet Gynecol 1985; 66 (03) 353-356
43 Kayem G, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Specific second-line therapies for postpartum haemorrhage: a national cohort study. BJOG 2011; 118 (07) 856-864
44 Kayem G, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M. ; U.K. Obstetric Surveillance System (UKOSS). Uterine compression sutures for the management of severe postpartum hemorrhage. Obstet Gynecol 2011; 117 (01) 14-20
45 Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv 2007; 62 (08) 540-547
46 Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Obstet Gynecol 2009; 113 (05) 992-999
47 Sentilhes L, Vayssière C, Deneux-Tharaux C. , et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol 2016; 198: 12-21
48 Lee HJ, Jeon GS, Kim MD, Kim SH, Lee JT, Choi MJ. Usefulness of pelvic artery embolization in cesarean section compared with vaginal delivery in 176 patients. J Vasc Interv Radiol 2013; 24 (01) 103-109
49 Kim YJ, Yoon CJ, Seong NJ. , et al. Failed pelvic arterial embolization for postpartum hemorrhage: clinical outcomes and predictive factors. J Vasc Interv Radiol 2013; 24 (05) 703-709
50 Lee HY, Shin JH, Kim J. , et al. Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution. Radiology 2012; 264 (03) 903-909
51 Hwang SM, Jeon GS, Kim MD, Kim SH, Lee JT, Choi MJ. Transcatheter arterial embolisation for the management of obstetric haemorrhage associated with placental abnormality in 40 cases. Eur Radiol 2013; 23 (03) 766-773
52 Fargeaudou Y, Morel O, Soyer P. , et al. Persistent postpartum haemorrhage after failed arterial ligation: value of pelvic embolisation. Eur Radiol 2010; 20 (07) 1777-1785
53 Kirby JM, Kachura JR, Rajan DK. , et al. Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol 2009; 20 (08) 1036-1045
54 Bros S, Chabrot P, Kastler A. , et al. Recurrent bleeding within 24 hours after uterine artery embolization for severe postpartum hemorrhage: are there predictive factors?. Cardiovasc Intervent Radiol 2012; 35 (03) 508-514
55 Worthington-Kirsch RL. Anatomy of the uterine artery. AJR Am J Roentgenol 2000; 174 (01) 258
56 Pelage JP, Le Dref O, Soyer P. , et al. Arterial anatomy of the female genital tract: variations and relevance to transcatheter embolization of the uterus. AJR Am J Roentgenol 1999; 172 (04) 989-994
57 Razavi MK, Wolanske KA, Hwang GL, Sze DY, Kee ST, Dake MD. Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology 2002; 224 (03) 707-712
58 Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Song L. Ovarian artery embolization supplementing hypogastric-uterine artery embolization for control of severe postpartum hemorrhage: report of eight cases. J Vasc Interv Radiol 2009; 20 (07) 971-976
59 Saraiya PV, Chang TC, Pelage JP, Spies JB. Uterine artery replacement by the round ligament artery: an anatomic variant discovered during uterine artery embolization for leiomyomata. J Vasc Interv Radiol 2002; 13 (9, Pt 1): 939-941
60 Wi JY, Kim HC, Chung JW, Jun JK, Jae HJ, Park JH. Importance of angiographic visualization of round ligament arteries in women evaluated for intractable vaginal bleeding after uterine artery embolization. J Vasc Interv Radiol 2009; 20 (08) 1031-1035
61 Leleup G, Fohlen A, Dohan A. , et al. Value of round ligament artery embolization in the management of postpartum hemorrhage. J Vasc Interv Radiol 2017; 28 (05) 696-701
62 Waltman AC, Courey WR, Athanasoulis C, Baum S. Technique for left gastric artery catheterization. Radiology 1973; 109 (03) 732-734
63 Naydich M, Friedman A, Aaron G, Silberzweig J. Arterial embolization of vaginal arterial branches for severe postpartum hemorrhage despite hysterectomy. J Vasc Interv Radiol 2007; 18 (08) 1047-1050
64 Salomon LJ, deTayrac R, Castaigne-Meary V. , et al. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod 2003; 18 (04) 849-852
65 Deux JF, Bazot M, Le Blanche AF. , et al. Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage?. AJR Am J Roentgenol 2001; 177 (01) 145-149
66 Pelage JP, Le Dref O, Mateo J. , et al. Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology 1998; 208 (02) 359-362
67 Poujade O, Ceccaldi PF, Davitian C. , et al. Uterine necrosis following pelvic arterial embolization for post-partum hemorrhage: review of the literature. Eur J Obstet Gynecol Reprod Biol 2013; 170 (02) 309-314
68 Cottier JP, Fignon A, Tranquart F, Herbreteau D. Uterine necrosis after arterial embolization for postpartum hemorrhage. Obstet Gynecol 2002; 100 (5, Pt 2): 1074-1077
69 Hardeman S, Decroisette E, Marin B. , et al. Fertility after embolization of the uterine arteries to treat obstetrical hemorrhage: a review of 53 cases. Fertil Steril 2010; 94 (07) 2574-2579
70 Matsubara S, Sato T, Nakata M. Vaginal artery embolization with a permanent embolic agent for intractable postpartum hemorrhage. J Obstet Gynaecol Res 2011; 37 (04) 377-378
71 Coulange L, Butori N, Loffroy R. , et al. Uterine necrosis following selective embolization for postpartum hemorrhage using absorbable material. Acta Obstet Gynecol Scand 2009; 88 (02) 238-240
72 Tseng JJ, Ho JY, Wen MC, Hwang JI. Uterine necrosis associated with acute suppurative myometritis after angiographic selective embolization for refractory postpartum hemorrhage. Am J Obstet Gynecol 2011; 204 (06) e4-e6
73 Park KJ, Shin JH, Yoon HK, Gwon DI, Ko GY, Sung KB. Postpartum hemorrhage from extravasation or pseudoaneurysm: efficacy of transcatheter arterial embolization using N-butyl cyanoacrylate and comparison with gelatin sponge particle. J Vasc Interv Radiol 2015; 26 (02) 154-161
74 Igarashi S, Izuchi S, Ishizuka B, Yoshimatu M, Takizawa K. A case of pregnancy and childbirth after uterine artery embolization with a permanent embolic agent. Fertil Steril 2011; 95 (01) 290.e9-290.e11
75 Pardo MI, Trujillo MV, Campos S. , et al. Successful uterine artery embolization for intractable postpartum hemorrhage using a novel embolic agent: ONYX. J Gynecol Surg 2012; 28 (04) 309-311
76 Sathe NA, Likis FE, Young JL, Morgans A, Carlson-Bremer D, Andrews J. Procedures and uterine-sparing surgeries for managing postpartum hemorrhage: a systematic review. Obstet Gynecol Surv 2016; 71 (02) 99-113
77 Cheong JY, Kong TW, Son JH, Won JH, Yang JI, Kim HS. Outcome of pelvic arterial embolization for postpartum hemorrhage: a retrospective review of 117 cases. Obstet Gynecol Sci 2014; 57 (01) 17-27
78 Yamasaki Y, Morita H, Miyahara Y. , et al. The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage. J Perinat Med 2014; 42 (03) 359-362
79 Mohan PP, Hamblin MH, Vogelzang RL. Uterine artery embolization and its effect on fertility. J Vasc Interv Radiol 2013; 24 (07) 925-930
80 Sentilhes L, Gromez A, Marpeau L. Fertility after pelvic arterial embolization, stepwise uterine devascularization, hypogastric artery ligation, and B-Lynch suture to control postpartum hemorrhage. Int J Gynaecol Obstet 2010; 108 (03) 249
81 Poggi SH, Yaeger A, Wahdan Y, Ghidini A. Outcome of pregnancies after pelvic artery embolization for postpartum hemorrhage: retrospective cohort study. Am J Obstet Gynecol 2015; 213 (04) 576.e1-576.e5
82 Gizzo S, Saccardi C, Patrelli TS. , et al. Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature. Fertil Steril 2013; 99 (07) 2097-2107
83 Doumouchtsis SK, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG 2014; 121 (04) 382-388
84 Holub Z, Mara M, Kuzel D, Jabor A, Maskova J, Eim J. Pregnancy outcomes after uterine artery occlusion: prospective multicentric study. Fertil Steril 2008; 90 (05) 1886-1891
85 Niola R, Giurazza F, Nazzaro G. , et al. Uterine artery embolization before delivery to prevent postpartum hemorrhage. J Vasc Interv Radiol 2016; 27 (03) 376-382
86 Diop AN, Chabrot P, Bertrand A. , et al. Placenta accreta: management with uterine artery embolization in 17 cases. J Vasc Interv Radiol 2010; 21 (05) 644-648
87 Lee JS, Shepherd SM. Endovascular treatment of postpartum hemorrhage. Clin Obstet Gynecol 2010; 53 (01) 209-218
88 Angstmann T, Gard G, Harrington T, Ward E, Thomson A, Giles W. Surgical management of placenta accreta: a cohort series and suggested approach. Am J Obstet Gynecol 2010; 202 (01) 38.e1-38.e9
89 Li Q, Yang ZQ, Mohammed W, Feng YL, Shi HB, Zhou X. Prophylactic uterine artery embolization assisted cesarean section for the prevention of intrapartum hemorrhage in high-risk patients. Cardiovasc Intervent Radiol 2014; 37 (06) 1458-1463
90 Mok M, Heidemann B, Dundas K, Gillespie I, Clark V. Interventional radiology in women with suspected placenta accreta undergoing caesarean section. Int J Obstet Anesth 2008; 17 (03) 255-261