Advertisement

CardioVascular and Interventional Radiology

, Volume 39, Issue 8, pp 1159–1164 | Cite as

Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

  • Masamichi KoganemaruEmail author
  • Masaaki Nonoshita
  • Ryoji Iwamoto
  • Asako Kuhara
  • Masakazu Nabeta
  • Masashi Kusumoto
  • Tomoko Kugiyama
  • Yutaka Kozuma
  • Shuji Nagata
  • Toshi Abe
Technical Note

Abstract

Purpose

We evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.

Materials and Methods

We 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.

Results

The 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.

Conclusion

Postpartum 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.

Keywords

Postpartum hemorrhage Vaginal laceration Transcatheter embolization Vaginal artery 

Notes

Compliance with Ethical Standards

Conflict of Interest

All authors declare no conflict of interest associated with this manuscript.

Statement of Informed Consent

Written informed consent was obtained from all individual participants included in this study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

References

  1. 1.
    Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066–74.CrossRefPubMedGoogle Scholar
  2. 2.
    Gipson MG, Smith MT. Endovascular therapies for primary postpartum hemorrhage: techniques and outcomes. Semin Intervent Radiol. 2013;30:333–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Gentric JC, Koch G, Lesoeur M, Hebert T, Nonent M. Diagnosis and management of puerperal hematomas: two cases. Cardiovasc Intervent Radiol. 2013;36:1174–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Ghirardini G, Alboni C, Mabrouk M. Use of balloon tamponade in management of severe vaginal postpartum hemorrhage and vaginal hematoma: a case series. Gynecol Obstet Invest. 2012;74:320–3.CrossRefPubMedGoogle Scholar
  5. 5.
    Katz MD, Sugay SB, Walker DK, Palmer SL, Marx MV. Beyond hemostasis: spectrum of gynecologic and obstetric indications for transcatheter embolization. Radiographics. 2012;32:1713–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Vegas G, Illescas T, Muñoz M, Pérez-Piñar A. Selective pelvic arterial embolization in the management of obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2006;127:68–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Kim GM, Yoon CJ, Seong NJ, Kang SG, Kim YJ. Postpartum haemorrhage from ruptured pseudoaneurysm: efficacy of transcatheter arterial embolisation using N-butyl-2-cyanoacrylate. Eur Radiol. 2013;23:2344–9.CrossRefPubMedGoogle Scholar
  8. 8.
    El-Shalakany AH, Nasr El-Din MH, Wafa GA, Azzam ME, El-Dorry A. Massive vault necrosis with bladder fistula after uterine artery embolisation. BJOG. 2003;110:215–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Löwenstein L, Solt I, Siegler E, Raz N, Amit A. Focal cervical and vaginal necrosis following uterine artery embolisation. Eur J Obstet Gynecol Reprod Biol. 2004;116:250–1.CrossRefPubMedGoogle Scholar
  10. 10.
    Rohilla M, Singh P, Kaur J, Prasad GR, Jain V, Lal A. Uterine necrosis and lumbosacral-plexopathy following pelvic vessel embolization for postpartum haemorrhage: report of two cases and review of literature. Arch Gynecol Obstet. 2014;290:819–23.CrossRefPubMedGoogle Scholar
  11. 11.
    Stainsby D, MacLennan S, Thomas D, Isaac J, Hamilton PJ. Guidelines on the management of massive blood loss. Br J Haematol. 2006;135:634–41.CrossRefPubMedGoogle Scholar
  12. 12.
    Standring Standring, editor-in-chief. Gray’s anatomy: the anatomical basis of clinical practice, fortieth edition 2008. 1281 pp.Google Scholar
  13. 13.
    Chang S, Lee MS, Kim MD, et al. Inferior mesenteric artery collaterals to the uterus during uterine artery embolization: prevalence, risk factors, and clinical outcomes. J Vasc Interv Radiol. 2013;24:1353–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Salazar GM, Petrozza JC, Walker TG. Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies. Tech Vasc Interv Radiol. 2009;12:139–47.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016

Authors and Affiliations

  • Masamichi Koganemaru
    • 1
    Email author
  • Masaaki Nonoshita
    • 1
  • Ryoji Iwamoto
    • 1
  • Asako Kuhara
    • 1
  • Masakazu Nabeta
    • 1
  • Masashi Kusumoto
    • 1
  • Tomoko Kugiyama
    • 1
  • Yutaka Kozuma
    • 2
  • Shuji Nagata
    • 1
  • Toshi Abe
    • 1
  1. 1.Department of RadiologyKurume University School of MedicineKurumeJapan
  2. 2.Department of Obstetrics and GynecologyKurume University School of MedicineKurumeJapan

Personalised recommendations