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Postpartum Hemorrhage Treated with Gelfoam Slurry Embolization Using the Superselective Technique: Immediate Results and 1-Month MRI Follow-up.
MedLine Citation:
PMID:  22327604     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: To evaluate the efficacy and safety of superselective embolization of the uterine arteries in a postpartum hemorrhage. MATERIALS AND METHODS: Between November 2004 and January 2011, a total of 44 consecutive women (median ± standard deviation age 34 ± 3 years, range 23-41 years) were referred to our institution for postpartum intractable hemorrhage management. All patients were embolized with a microcatheter that was placed deep into the uterine arteries upstream of the cervical arteries. The embolic agent was a mixture of contrast medium and 5 × 5 × 5 cm pieces of gelfoam (Gelita-Spon) modified into a gelatin emulsion as follows: rapid mixing through a three-way stopcock with two 2.5-ml syringes. A 1-ml syringe was used for injection. One month after embolization, all patients underwent magnetic resonance imaging and clinical examination. RESULTS: Technical and clinical success was obtained in all cases. Thirty-five patients experienced bleeding related to poor retraction of the uterus, 7 patients because of a tear of the cervix and 2 because of a vaginal hematoma. Pre- and postembolization red blood cell transfusions were (mean ± standard deviation [SD]) 6 ± 1.2 (range 3-8) U and 2 ± 0.7 (range 2-4) U, respectively. One-month magnetic resonance imaging follow-up revealed no sign of ischemic myometrium or necrosis, and no instances of uterine rupture and no pelvic vein thrombosis. Incidental findings included two small intramyometrial hematic collections. All uterine arteries were patent via magnetic resonance angiography. Seventeen patients had concomitant fibroids, all of which appeared hypovascular. CONCLUSION: This technique permits good, safe clinical results with no marked damage to the uterine arteries or the uterus itself.
Authors:
Olivier Pellerin; Anne-Sophie Bats; Massimiliano Di Primio; Ana Palomera-Ricco; Gabrielle Pinot de Villechenon; Laure Fournier; Jean-Yves Pagny; Bernard Beyssen; Bertrand Louail; Fabrice Lécuru; Marc Sapoval
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-11
Journal Detail:
Title:  Cardiovascular and interventional radiology     Volume:  -     ISSN:  1432-086X     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003538     Medline TA:  Cardiovasc Intervent Radiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Interventional Radiology Department, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine - Assistance Publique-Hôpitaux de Paris - Hôpital Européen Georges-Pompidou, Paris, France, 20 Rue Leblanc, 75908, Paris CEDEX 15, France, olivier.pellerin@egp.aphp.fr.
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