Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation

Although it is widely accepted that uterine artery embolization (UAE) is an effective therapeutic strategy for postpartum hemorrhage (PPH), no consensus has been reached regarding the efficacy of UAE in patients with PPH with disseminated intravascular coagulation (DIC). This single-center retrospective cohort study included patients treated with UAE using NBCA for PPH between 2010 and 2015. The patients were divided into DIC and non-DIC groups, according to the obstetrical DIC score and the overt DIC diagnostic criteria issued by the International Society of Thrombosis and Haemostasis (ISTH), and their clinical outcomes were compared. There were 28 patients treated with UAE using NBCA. Complete hemostasis was achieved by UAE in 19 of 28 patients. In eight of nine patients with unsuccessful hemostasis, surgical hemostatic interventions were performed after UAE, and hemostasis was achieved in seven patients. UAE using NBCA showed no significant intergroup differences in complete hemostasis according to the presence or absence of DIC based on obstetrical DIC score (70% versus 62.5%, P=1.000) or ISTH DIC score (54.5% versus 76.5%, P=0.409). UAE using NBCA may be a useful first-choice treatment for PPH with DIC.

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Successful repeated uterine artery embolization in postpartum hemorrhage with disseminated intravascular coagulation: a case report and literature review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04191-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shunya Sugai ◽

Taro Nonaka ◽

Kana Tamegai ◽

Tatsuhiko Sato ◽

Kazufumi Haino ◽

...

Keyword(s):

Risk Factor ◽

Disseminated Intravascular Coagulation ◽

Postpartum Hemorrhage ◽

Uterine Artery Embolization ◽

Uterine Artery ◽

Placenta Previa ◽

Blood Transfusions ◽

Artery Embolization ◽

Intravascular Coagulation ◽

Uterine Arteries

Abstract Background Postpartum hemorrhage (PPH) is a potentially fatal condition requiring urgent and appropriate intervention. Uterine artery embolization (UAE) has a high hemostatic capacity for PPH, but it may fail. Disseminated intravascular coagulation (DIC) has been reported as a risk factor associated with the failure of UAE. Case presentation A 37-year-old primigravida with dichorionic diamniotic twins and placenta previa underwent cesarean section. The blood loss during surgery was 4950 mL. Hemostasis was achieved using an intrauterine balloon tamponade device. However, she lost a further 2400 mL of blood 5 h after surgery. We embolized both uterine arteries using gelatin sponges and confirmed hemostasis. She was suffering from DIC and received ample blood transfusions. However, a further 1300 mL of blood was lost 18 h after surgery and we performed repeated UAE, with complete recanalization of the uterine arteries on both sides and re-embolization with gelatin sponges. Her DIC was treated successfully by blood transfusions at this time, and she showed no further bleeding after the repeated UAE. Conclusions DIC is a risk factor for the failure of UAE. Repeated UAE may be effective after sufficient improvement of the hematological status in patients with PPH and DIC.

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Transcatheter Arterial Embolization for Postpartum Hemorrhage with Disseminated Intravascular Coagulation: Outcome Assessment

Journal of the Korean Society of Radiology ◽

10.3348/jksr.2011.65.6.547 ◽

2011 ◽

Vol 65 (6) ◽

pp. 547 ◽

Cited By ~ 1

Author(s):

Eun Jung An ◽

Young Hwan Kim ◽

Bo Ra Kwon ◽

See Hyung Kim

Keyword(s):

Outcome Assessment ◽

Disseminated Intravascular Coagulation ◽

Transcatheter Arterial Embolization ◽

Postpartum Hemorrhage ◽

Arterial Embolization ◽

Intravascular Coagulation

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Abstract No. 41 Utilization and comparative effectiveness of hysterectomy versus uterine artery embolization for clinically significant postpartum hemorrhage: a national inpatient sample study

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2021.03.458 ◽

2021 ◽

Vol 32 (5) ◽

pp. S19

Author(s):

L. Arndt ◽

J. Newsome ◽

M. Guo ◽

S. Lee ◽

K. Garcia-Reyes ◽

...

Keyword(s):

Postpartum Hemorrhage ◽

Comparative Effectiveness ◽

Uterine Artery Embolization ◽

Uterine Artery ◽

National Inpatient Sample ◽

Artery Embolization ◽

Clinically Significant

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Selective Uterine Artery Embolization in Postpartum Hemorrhage; Updates on 5 Years' Single-Center Experience

10.1055/s-0041-1729084 ◽

2020 ◽

Author(s):

Nadine Mohamed ◽

Rana Tarek Khafagy ◽

Hend Gamal Abd Elgalil ◽

Mark Michael ◽

Karim Ahmed Abd El Tawab

Keyword(s):

Postpartum Hemorrhage ◽

Uterine Artery Embolization ◽

Uterine Artery ◽

Single Center ◽

Artery Embolization ◽

Single Center Experience

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The value of the portable fibrinogen measuring device—a case report of severe postpartum hemorrhage with obstetric disseminated intravascular coagulation

JA Clinical Reports ◽

10.1186/s40981-021-00426-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yoko Hikida ◽

Hiroyuki Sumikura ◽

Hisako Okada ◽

Takashi Fujino ◽

Mayumi Tanaka ◽

...

Keyword(s):

Disseminated Intravascular Coagulation ◽

Postpartum Hemorrhage ◽

Point Of Care ◽

Fresh Frozen Plasma ◽

Fibrinogen Concentration ◽

Important Indicator ◽

Measuring Device ◽

Intravascular Coagulation ◽

Estimated Blood Loss ◽

Care Assessment

Abstract Background Fibrinogen concentration is an important indicator of the treatment for obstetric disseminated intravascular coagulation (DIC). We present how using the fibrinogen measuring device could solve problems in the treatment of postpartum hemorrhage with complicated DIC. Case presentation A 32-year-old woman with monochorionic diamniotic twins at 22 weeks of pregnancy was diagnosed with placental abruption and underwent emergent cesarean section. The estimated blood loss was 8375 g. She was transferred to our hospital for further treatment. Compressive uterine sutures and balloon tamponade were performed. We transfused fibrinogen and fresh frozen plasma actively during the operation to maintain plasma fibrinogen above 200 mg/dL by using a point-of-care fibrinogen measuring device. In spite of massive hemorrhage exceeding 10 L, she was extubated at the end of the operation and discharged on the 7th day after the operation. Conclusion The portable fibrinogen measuring device was useful for point-of-care assessment of obstetric DIC.

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