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Endovascular treatment in postpartum haemorrhage

Trattamento endovascolare dell’emorragia post-partum

  • Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

Postpartum haemorrhage (PPH) is one of the main causes of maternal mortality and occurs in 5% of total deliveries. In this study we consider the indications for and technique and results of endovascular treatment for this serious event.

Materials and methods

Between January 2004 and December 2010, we conducted a nonrandomised prospective study on ten women with severe PPH who were treated endovascularly in an emergency setting. The procedure was considered to be clinically successful when the PPH resolved completely without the need for further surgical intervention. Laboratory values and the number of transfused blood packs were assessed for each patient.

Results

The endovascular procedure completely stopped the bleeding in 8/10 women. After embolisation, the remaining two patients underwent a second laparotomy, which completely arrested the bleeding. No patient died as a result of PPH, and no patient with PPH who avoided hysterectomy before endovascular treatment underwent it after the procedure.

Conclusions

In keeping with the literature, our study indicates that endovascular therapy can significantly help reduce the rates of hysterectomy and mortality due to PPH. This treatment, when performed in the angiography room, is safe and effective and is probably relatively uncommon and underused.

Riassunto

Obiettivo|L’emorragia post-partum (EP) si verifica nel 5% della totalità dei parti e rappresenta una delle principali cause di mortalità materna. In questo lavoro sono prese in considerazione indicazioni, tecnica e risultati del trattamento endovascolare di questa grave evenienza

Materiali e metodi

Nel periodo compreso tra gennaio 2004 e dicembre 2010 è stato condotto uno studio prospettico non randomizzato in cui 10 donne con diagnosi di EP severa sono state sottoposte a trattamento endovascolare in emergenza. Il successo clinico della procedura è stato definito come risoluzione della EP senza ricorso ad altri interventi chirurgici. Per ogni paziente sono stati valutati i valori laboratoristici ed il numero di sacche trasfuse.

Risultati

La procedura endovascolare ha ottenuto l’arresto completo del sanguinamento in 8/10 donne. Le 2 pazienti rimanenti, dopo l’embolizzazione sono state sottoposte a nuova laparotomia che ha determinato l’arresto completo del sanguinamento. Nessuna paziente è deceduta per EP e nessuna paziente con EP nonisterectomizzata prima è stata isterectomizzata dopo il trattamento endovascolare.

Conclusioni

La nostra esperienza e la revisione della letteratura evidenziano come il ricorso alla terapia endovascolare possa avere impatto significativo nella riduzione delle isterectomie e della mortalità per EP. Il trattamento in sala angiografica è sicuro, efficace e probabilmente poco diffuso e sotto-utilizzato.

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Authors and Affiliations

  1. U.O. Radiologia, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

    G. Mansueto, A. Contro, F. Liessi & R. Pozzi Mucelli

  2. Istituto Clinico S. Anna, Brescia, Italy

    G. Carbognin

  3. U.O. Ginecologia e Ostetricia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    G. Zanconato & M. Franchi

  4. Istituto di Radiologia, Policlinico “G.B. Rossi”, P.le L.A. Scuro 10, 37134, Verona, Italy

    A. Contro

Authors
  1. G. Mansueto
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  2. A. Contro
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  3. G. Carbognin
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  4. F. Liessi
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  5. G. Zanconato
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  6. M. Franchi
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  7. R. Pozzi Mucelli
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Correspondence to A. Contro.

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Mansueto, G., Contro, A., Carbognin, G. et al. Endovascular treatment in postpartum haemorrhage. Radiol med 118, 215–228 (2013). https://doi.org/10.1007/s11547-012-0821-y

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  • DOI: https://doi.org/10.1007/s11547-012-0821-y

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