Classification of uterine artery angiographic images: a predictive factor of failure in uterine artery embolization for postpartum hemorrhage

  • Eisuke Ueshima
  • Koji Sugimoto
  • Takuya Okada
  • Naoto Katayama
  • Yutaka Koide
  • Keitaro Sofue
  • Mayumi Morizane
  • Kenji Tanimura
  • Masashi Deguchi
  • Masato Yamaguchi
Original Article
  • 28 Downloads

Abstract

Purpose

To justify a classification system for angiographic images of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) and identify new risk factors associated with failed embolization.

Materials and methods

A retrospective analysis of 63 consecutive patients who underwent UAE for severe PPH was performed. Uterine artery angiography (UA) before embolization was classified into two types: type 1 was defined as complete staining and type 2 was defined as partial staining of the uterine arteries. The clinical outcome, UA classification, and other possible factors previously reported were evaluated. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes.

Results

Sixty-three patients were enrolled (type 1, 22; type 2, 41). The clinical success rates of the primary UAE session were 90.9% (20/22) for type 1 and 61.0% (25/41) for type 2 (p = 0.018). Univariate and multivariate analyses demonstrated that the only UA classification was significantly associated with primary UAE failure (p = 0.033).

Conclusions

The UA classification is an independent predictive factor of the clinical success rate of the primary UAE session for PPH; thus, it is an intuitive and optimal predictor for interventional radiologists to decide whether additional therapy is necessary.

Keywords

Uterine artery embolization Postpartum hemorrhage UA classification 

Notes

Compliance with ethical standards

Ethical approval

This study has been approved by Kobe University Research Ethics Committee.

References

  1. 1.
    Marshall AL, Durani U, Bartley A, Hagen CE, Ashrani A, Rose C, et al. The impact of postpartum hemorrhage on hospital length of stay and impatient mortality: a National Inpatient Sample-based analysis. Am J Obstet Gynecol. 2017;217(3):344.e1-344.CrossRefGoogle Scholar
  2. 2.
    Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health; WHO Multicountry Survey on Maternal and Newborn Health Research Network. BJOG. 2014;121(Suppl 1):5–13.CrossRefPubMedGoogle Scholar
  3. 3.
    Kramer MS, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A, Joseph KS. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209(5):449.e1-7.CrossRefPubMedGoogle Scholar
  4. 4.
    Pelage JP, Le Dref O, Mateo J, Soyer P, Jacob D, Kardache M, et al. Life threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolisation. Radiology. 1998;208:359–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Poujade O, Zappa M, Letendre I, Ceccaldi PF, Vilgrain V, Luton D. Predictive factors for failure of pelvic arterial embolization for postpartum hemorrhage. Int J Gynaecol Obstet. 2012;117:119–23.CrossRefPubMedGoogle Scholar
  6. 6.
    Tanahashi Y, Goshima S, Kondo H, Ando T, Noda Y, Kawada H, et al. Transcatheter arterial embolization for primary postpartum hemorrhage: predictive factors of need for embolic material conversion of gelatin sponge particles to n-butyl cyanoacrylate. Cardiovasc Intervent Radiol. 2017;40:236–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Kim YJ, Yoon CJ, Seong NJ, Kang SG, An SW, Kim YS, et al. Failed pelvic arterial embolization for postpartum hemorrhage: clinical outcomes and predictive factors. J Vasc Interv Radiol. 2013;24:703–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Zhang E, Liu L, Owen R. Pelvic artery embolization in the management of obstetrical hemorrhage: predictive factors for clinical outcomes. Cardiovasc Intervent Radiol. 2015;38:1477–86.CrossRefPubMedGoogle Scholar
  9. 9.
    Bros S, Chabrot P, Kastler A, Ouchchane L, Cassagnes L, Gallot D, et al. Recurrent bleeding within 24 hours after uterine artery embolization for severe postpartum hemorrhage: are there predictive factors? Cardiovasc Interv Radiol. 2012;35:508–14.CrossRefGoogle Scholar
  10. 10.
    Lee HY, Shin JH, Kim J, Yoon HK, Ko GY, Won HS, et al. Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution. Radiology. 2012;264(3):903–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Mohri M, Hiramatsu K. Simplified bilateral selective catheterization of the uterine artery. Radiology. 1978;129:239–41.CrossRefPubMedGoogle Scholar
  12. 12.
    Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86:1327–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Wada H, Thachil J, Nisio Di, Mathew P, Kurosawa S, Gando S, et al. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost. 2013.  https://doi.org/10.1111/jth.12155.Google Scholar
  14. 14.
    Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. J Intensive Care. 2014;2(1):15.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ouyang Z, Liu P, Yu Y, Chen C, Song X, Liang B, et al. Role of ovarian artery-to-uterine artery anastomoses in uterine artery embolization: initial anatomic and radiologic studies. Surg Radiol Anat. 2012;34:737–41.CrossRefPubMedGoogle Scholar
  16. 16.
    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;20:1031–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Kirby JM, Kachura JR, Rajan DK, Sniderman KW, Simons ME, Windrim RC, et al. Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol. 2009;20:1036–45.CrossRefPubMedGoogle Scholar
  18. 18.
    Matson M, Nicholson A, Belli AM. Anastomoses of the ovarian and uterine arteries: a potential pitfall and cause of failure of uterine embolization. Cardiovasc Interv Radiol. 2000;23:393–6.CrossRefGoogle Scholar
  19. 19.
    Kroencke TJ, Scheurig C, Lampmann LE, Boekkooi PF, Kissner L, Kluner C, et al. Acrylamido polyvinyl alcohol microspheres for uterine artery embolization: 12-month clinical and MR imaging results. J Vasc Interv Radiol. 2008;19:47–57.CrossRefPubMedGoogle Scholar
  20. 20.
    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;26:154–61.CrossRefPubMedGoogle Scholar
  21. 21.
    Kanematsu M, Watanabe H, Kondo H, Goshima S, Kato H, Furui T. Postpartum hemorrhage in coagulopathic patients: preliminary experience with uterine arterial embolization with N-butyl cyanoacrylate. J Vasc Interv Radiol. 2011;22:1773–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Park HS, Shin JH, Yoon HK, Kim JH, Gwon DI, Ko GY, et al. Transcatheter arterial embolization for secondary postpartum hemorrhage: outcome in 52 patients at a single tertiary referral center. J Vasc Interv Radiol. 2014;9:1751–7.CrossRefGoogle Scholar
  23. 23.
    Yonemitsu T, Kawai N, Sato M, Tanihara H, Takasaka I, Nakai M, et al. Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and n-butyl cyanoacrylate for acuter arterial bleeding in a coagulopathic condition. J Vasc Interv Radiol. 2009;20(9):1176–87.CrossRefPubMedGoogle Scholar

Copyright information

© Japan Radiological Society 2018

Authors and Affiliations

  • Eisuke Ueshima
    • 1
    • 2
  • Koji Sugimoto
    • 1
    • 2
  • Takuya Okada
    • 1
    • 2
  • Naoto Katayama
    • 1
    • 2
  • Yutaka Koide
    • 2
  • Keitaro Sofue
    • 2
  • Mayumi Morizane
    • 3
  • Kenji Tanimura
    • 3
  • Masashi Deguchi
    • 3
  • Masato Yamaguchi
    • 1
    • 2
  1. 1.Center for Endovascular TherapyKobe University HospitalKobeJapan
  2. 2.Department of RadiologyKobe University Graduate School of MedicineKobeJapan
  3. 3.Department of Obstetrics and GynecologyKobe University Graduate School of MedicineKobeJapan

Personalised recommendations