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Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To retrospectively evaluate safety and efficacy of pelvic artery embolisation (PAE) in post-partum haemorrhage (PPH) in abnormal placental implantation (API) deliveries.

Methods

From January 2009 to November 2013, 12 patients with API and intractable intraoperative PPH underwent PAE after caesarean delivery to control a haemorrhage (in four of these cases after hysterectomy). Arterial access was obtained prior to the delivery; PAE was performed in the obstetrics operating room by an interventional radiologist that was present with an interventional radiology (IR) team during the delivery.

Results

PAE was successful in preventing bleeding and avoid hysterectomy in four cases (group A). Uterine atony and disseminated intravascular coagulation caused failure of PAE requiring hysterectomy in four patients (group B). PAE prevented bleeding post-hysterectomy in the remaining four cases (group C). Technical success (cessation of contrast extravasation on angiography or occlusion of the selected artery) was 100 %. Maternal and foetal mortality and morbidity were 0 %.

Conclusions

PAE is a minimal invasive technique that may help to prevent hysterectomy and control PPH in API pregnancies without complications. Embolisation should be performed on an emergency basis. For such cases, an IR team on standby in the obstetrics theatre may be useful to prevent hysterectomy, blood loss and limit morbidity.

Key Points

• Endovascular treatment is a validated technique in post-partum haemorrhage.

• Abnormal placental implantation is a risk factor for post-partum haemorrhage.

• We propose an interventional radiologist standby in the delivery room.

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Acknowledgments

This research originated in the “Santa Maria della Misericordia” University Hospital, University of Perugia, Sant’Andrea delle Fratte, Perugia, 06132, Italy. The abstract was presented as an oral communication at ECR 2015.

The scientific guarantor of this publication is Dr. Alberto Rebonato. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all patients in this study. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant’Andrea delle Fratte, Perugia, 06132, Italy

    Alberto Rebonato, Sandro Gerli, Luigina Graziosi, Daniele Maiettini, Gian Carlo Di Renzo & Michele Scialpi

  2. Radiology Unit, Santa Maria della Misericordia University Hospital, Sant’Andrea delle Fratte, Perugia, 06132, Italy

    Stefano Mosca & Matthias Fischer

  3. St. Andrea Hospital, Radiology Department, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Via di Grottarossa, 1035-39, 00189, Rome, Italy

    Gianluigi Orgera

  4. Obsterics and Ginecology Unit, Santa Maria della Misericordia University Hospital, Sant’Andrea delle Fratte, Perugia, 06132, Italy

    Giorgio Epicoco

  5. Department of Radiology, “Guy’s and St Thomas’ NHS Foundation Trust”, 1st Floor Lambeth Wing, St Thomas’ Hospital Westminster Bridge Road, London, SE1 7EH, UK

    Miltiadis Krokidis

  6. Radiology Department, St. Andrea Hospital, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy

    Michele Rossi

Authors
  1. Alberto Rebonato
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  2. Stefano Mosca
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  3. Matthias Fischer
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  11. Michele Rossi
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  12. Michele Scialpi
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Correspondence to Alberto Rebonato.

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Rebonato, A., Mosca, S., Fischer, M. et al. Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries. Eur Radiol 26, 1620–1630 (2016). https://doi.org/10.1007/s00330-015-4001-z

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  • DOI: https://doi.org/10.1007/s00330-015-4001-z

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