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Title: Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

Abstract

PurposeWe evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.Materials and MethodsWe reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.ResultsThe vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.ConclusionPostpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications.more » After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.« less

Authors:
; ; ; ; ; ;  [1];  [2]; ;  [1]
  1. Kurume University School of Medicine, Department of Radiology (Japan)
  2. Kurume University School of Medicine, Department of Obstetrics and Gynecology (Japan)
Publication Date:
OSTI Identifier:
22645492
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 8; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; HEMATOMAS; HEMORRHAGE; MAPPING; PATIENTS; REVIEWS; VASCULAR DISEASES

Citation Formats

Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp, Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp, Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp, Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp, Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp, Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp, Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp, Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp, Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp, and Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration. United States: N. p., 2016. Web. doi:10.1007/S00270-016-1309-2.
Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp, Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp, Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp, Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp, Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp, Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp, Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp, Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp, Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp, & Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration. United States. doi:10.1007/S00270-016-1309-2.
Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp, Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp, Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp, Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp, Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp, Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp, Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp, Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp, Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp, and Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp. Mon . "Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration". United States. doi:10.1007/S00270-016-1309-2.
@article{osti_22645492,
title = {Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration},
author = {Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp and Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp and Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp and Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp and Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp and Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp and Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp and Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp and Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp and Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp},
abstractNote = {PurposeWe evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.Materials and MethodsWe reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.ResultsThe vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.ConclusionPostpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.},
doi = {10.1007/S00270-016-1309-2},
journal = {Cardiovascular and Interventional Radiology},
number = 8,
volume = 39,
place = {United States},
year = {Mon Aug 15 00:00:00 EDT 2016},
month = {Mon Aug 15 00:00:00 EDT 2016}
}