Uterine Artery Embolization in Management of Post-Partum Hemorrhage
Essam Tarek Essameldien Abdullah;
Abstract
PPH remains one of the major worldwide causes of maternal mortality.
The post-partum period is typically defined as the 6 weeks after delivery of the infant.
Post-partum hemorrhage may occur immediately or several hours or days after delivery. In most published studies about puerperal bleeding, primary and secondary postpartum hemorrhage were treated in the aggregate when clinical presentation, causes, and maternal mortality rates were different.
Post-partum hemorrhage that occurs during the first 24 hours following delivery is termed primary, or early, post-partum hemorrhage.
Secondary, or delayed post-partum hemorrhage is usually defined as excessive bleeding from genital tract, with a blood loss of 500 ml or more, that occurs after 24 hours following delivery until the 6th week of the puerperium.
A decision to perform uterine artery embolization is made on the basis of active or persistent bleeding despite appropriate medical treatment and obstetrical measures, these include excluding retained products of conception and suturing lacerations of the birth canal. At the same time, the uterus should be massaged and oxytocic drugs administered. Blood should be taken for hemoglobin and/or hematocrit estimation plus coagulation studies and cross matching. If uterine atony persists despite pharmacological intervention or if excessive bleeding continues in the face of adequate uterine tone, more aggressive methods of hemostasis may be required. Uterine examination should be undertaken and surgical intervention performed if bleeding persists.
Uterine Artery Embolization (UAE) for PPH is an effective minimally invasive treatment for PPH and it can allow women to avoid hysterectomy in 80% of cases. The procedure has been rapidly accepted by the public and has gained acceptance from gynecologists around the world. Through the diligent efforts of researchers across the world, it has gained level 1 evidence from randomized trials that demonstrate the efficacy and safety of this procedure.
The choice of the best embolic agent is crucial in order to maintain the clinical success of the procedure and preserve the public and the gynecologists trust in it. The embolic agent of choice in most of literatures is gel foam, attributed to its ability to temporary occlude the embolized uterine artery.
The post-partum period is typically defined as the 6 weeks after delivery of the infant.
Post-partum hemorrhage may occur immediately or several hours or days after delivery. In most published studies about puerperal bleeding, primary and secondary postpartum hemorrhage were treated in the aggregate when clinical presentation, causes, and maternal mortality rates were different.
Post-partum hemorrhage that occurs during the first 24 hours following delivery is termed primary, or early, post-partum hemorrhage.
Secondary, or delayed post-partum hemorrhage is usually defined as excessive bleeding from genital tract, with a blood loss of 500 ml or more, that occurs after 24 hours following delivery until the 6th week of the puerperium.
A decision to perform uterine artery embolization is made on the basis of active or persistent bleeding despite appropriate medical treatment and obstetrical measures, these include excluding retained products of conception and suturing lacerations of the birth canal. At the same time, the uterus should be massaged and oxytocic drugs administered. Blood should be taken for hemoglobin and/or hematocrit estimation plus coagulation studies and cross matching. If uterine atony persists despite pharmacological intervention or if excessive bleeding continues in the face of adequate uterine tone, more aggressive methods of hemostasis may be required. Uterine examination should be undertaken and surgical intervention performed if bleeding persists.
Uterine Artery Embolization (UAE) for PPH is an effective minimally invasive treatment for PPH and it can allow women to avoid hysterectomy in 80% of cases. The procedure has been rapidly accepted by the public and has gained acceptance from gynecologists around the world. Through the diligent efforts of researchers across the world, it has gained level 1 evidence from randomized trials that demonstrate the efficacy and safety of this procedure.
The choice of the best embolic agent is crucial in order to maintain the clinical success of the procedure and preserve the public and the gynecologists trust in it. The embolic agent of choice in most of literatures is gel foam, attributed to its ability to temporary occlude the embolized uterine artery.
Other data
| Title | Uterine Artery Embolization in Management of Post-Partum Hemorrhage | Other Titles | غلق الشريان الرحمي في علاج نزيف ما بعد الولادة | Authors | Essam Tarek Essameldien Abdullah | Issue Date | 2016 |
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