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Postpartum Hemorrhage Treated with Gelfoam Slurry Embolization Using the Superselective Technique: Immediate Results and 1-Month MRI Follow-up

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Abstract

Purpose

To evaluate the efficacy and safety of superselective embolization of the uterine arteries in a postpartum hemorrhage.

Materials and Methods

Between November 2004 and January 2011, a total of 44 consecutive women (median ± standard deviation age 34 ± 3 years, range 23–41 years) were referred to our institution for postpartum intractable hemorrhage management. All patients were embolized with a microcatheter that was placed deep into the uterine arteries upstream of the cervical arteries. The embolic agent was a mixture of contrast medium and 5 × 5 × 5 cm pieces of gelfoam (Gelita-Spon) modified into a gelatin emulsion as follows: rapid mixing through a three-way stopcock with two 2.5-ml syringes. A 1-ml syringe was used for injection. One month after embolization, all patients underwent magnetic resonance imaging and clinical examination.

Results

Technical and clinical success was obtained in all cases. Thirty-five patients experienced bleeding related to poor retraction of the uterus, 7 patients because of a tear of the cervix and 2 because of a vaginal hematoma. Pre- and postembolization red blood cell transfusions were (mean ± standard deviation [SD]) 6 ± 1.2 (range 3–8) U and 2 ± 0.7 (range 2–4) U, respectively. One-month magnetic resonance imaging follow-up revealed no sign of ischemic myometrium or necrosis, and no instances of uterine rupture and no pelvic vein thrombosis. Incidental findings included two small intramyometrial hematic collections. All uterine arteries were patent via magnetic resonance angiography. Seventeen patients had concomitant fibroids, all of which appeared hypovascular.

Conclusion

This technique permits good, safe clinical results with no marked damage to the uterine arteries or the uterus itself.

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Abbreviations

PPH:

Postpartum hemorrhage

IR:

Interventional radiology

UEA:

Uterine arterial embolization

ICU:

Intensive care unit

MRI:

Magnetic resonance image

MRA:

Magnetic resonance angiography

EPR:

Electronic patients record

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Interventional Radiology Department, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine - Assistance Publique-Hôpitaux de Paris - Hôpital Européen Georges-Pompidou, Paris, France, 20 Rue Leblanc, 75908, Paris CEDEX 15, France

    Olivier Pellerin, Massimiliano Di Primio, Ana Palomera-Ricco & Marc Sapoval

  2. Gynecologic and Oncologic Surgery Department, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine - Assistance Publique-Hôpitaux de Paris - Hôpital Européen Georges-Pompidou, Paris, France, 20 Rue Leblanc, 75908, Paris CEDEX 15, France

    Anne-Sophie Bats & Fabrice Lécuru

  3. Anesthesia and Surgical Intensive Care Unit, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine - Assistance Publique-Hôpitaux de Paris - Hôpital Européen Georges-Pompidou, Paris, France, 20 Rue Leblanc, 75908, Paris CEDEX 15, France

    Gabrielle Pinot de Villechenon

  4. Interventional Radiology Department, Assistance Publique-Hôpitaux de Paris - Hôpital Européen Georges-Pompidou, Paris, France, 20 Rue Leblanc, 75908, Paris CEDEX 15, France

    Jean-Yves Pagny, Bernard Beyssen & Bertrand Louail

  5. Radiology Department, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine - Assistance Publique-Hôpitaux de Paris - Hôpital Européen Georges-Pompidou, Paris, France, 20 Rue Leblanc, 75908, Paris CEDEX 15, France

    Laure Fournier

Authors
  1. Olivier Pellerin
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  2. Anne-Sophie Bats
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  3. Massimiliano Di Primio
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  4. Ana Palomera-Ricco
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  5. Gabrielle Pinot de Villechenon
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  6. Laure Fournier
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  7. Jean-Yves Pagny
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  8. Bernard Beyssen
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  9. Bertrand Louail
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  10. Fabrice Lécuru
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  11. Marc Sapoval
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Corresponding author

Correspondence to Olivier Pellerin.

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Pellerin, O., Bats, AS., Di Primio, M. et al. Postpartum Hemorrhage Treated with Gelfoam Slurry Embolization Using the Superselective Technique: Immediate Results and 1-Month MRI Follow-up. Cardiovasc Intervent Radiol 36, 98–104 (2013). https://doi.org/10.1007/s00270-012-0355-7

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  • DOI: https://doi.org/10.1007/s00270-012-0355-7

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