CardioVascular and Interventional Radiology

, Volume 42, Issue 2, pp 195–204 | Cite as

The Relationship Between Gelatin Sponge Preparation Methods and the Incidence of Intrauterine Synechia Following Uterine Artery Embolization for Postpartum Hemorrhage

  • Atsushi SaigaEmail author
  • Hajime Yokota
  • Takashi Higashide
  • Hazuki Takishima
  • Akiko Omoto
  • Yoshihiro Kubota
  • Takuro Horikoshi
  • Takashi Uno
Clinical Investigation Arterial Interventions
Part of the following topical collections:
  1. Arterial Interventions



To evaluate the relationship between gelatin sponge preparation methods and the incidence of intrauterine synechia following uterine artery embolization (UAE) for postpartum hemorrhage (PPH).

Materials and Methods

In a retrospective monocentric study, we used data from 20 consecutive UAE procedures (19 patients) for PPH, performed in 2007–2016, in which gelatin sponge had been used. The gelatin sponge was processed either into a slurry by pumping it back and forth about 10 times through two syringes connected to a three-way stopcock or into pledgets using a scalpel and small scissors to obtain pieces approximately 2 × 2 × 2 mm in size. Patient information was obtained from medical records, and the data were compared between patients treated with the slurry (n = 7) or pledgets (n = 13) forms. Due to the lack of follow-up data and hysterectomy after UAE, the sample size was 6 and 12 because 1 patient with 2 procedures was excluded.


The rate of intrauterine synechia was significantly higher in the slurry group (5/6, 83.3%) than that in the pledgets group (0/12, 0%; P < 0.001). In contrast, there were no significant differences in population characteristics, such as the incidence of placenta accreta, non-placental diseases, and severity of shock (DIC score, shock index, or blood loss) between the groups.


Although non-randomization and small sample size were the two main limitations, our observations suggest that UAE using gelatin sponge slurry may be associated with a high incidence of intrauterine synechia compared to UAE using pledgets.


Uterine arterial embolization Intrauterine synechia Postpartum hemorrhage Gelatin sponge preparation methods Pledgets Slurry 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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 declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

Consent for publication was obtained for every individual person’s data included in the study.


  1. 1.
    Rath WH. Postpartum hemorrhage-update on problems of definitions and diagnosis. Acta Obstet Gynecol Scand. 2011;90:421–8.CrossRefGoogle Scholar
  2. 2.
    Brown BJ, Heaston DK, Poulson AM, Gabert HA, Mineau DE, Miller JF. Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol. 1979;54:361–5.Google Scholar
  3. 3.
    Soncini E, Pelicelli A, Larini P, Marcato C, Monaco D, Grignaffini A. Uterine artery embolization in the treatment and prevention of postpartum hemorrhage. Int J Gynaecol Obstet. 2007;96:181–5.CrossRefGoogle Scholar
  4. 4.
    Boulleret C, Chahid T, Gallot D, Mofid R, Hai DT, Ravel A, Garcier JM, Lemery D, Boyer L. Hypogastric arterial selective and superselective embolization for severe postpartum hemorrhage: a retrospective review of 36 cases. Cardiovasc Interv Radiol. 2004;27:344–8.CrossRefGoogle Scholar
  5. 5.
    Pelage JP, Le Dref O, Mateo J, Soyer P, Jacob D, Kardache M, Dahan H, Repiquet D, Payen D, Truc JB, Merland JJ. Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology. 1998;208:359–62.CrossRefGoogle Scholar
  6. 6.
    Roge P, D’Ercole C, Cravello L, Boubli L, Blanc B. Hysteroscopic management of uterine synechiae: a series of 102 observations. Eur J Obstet Gynecol Reprod Biol. 1996;65:189–93.CrossRefGoogle Scholar
  7. 7.
    Katsumori T, Kasahara T. The size of gelatin sponge particles: differences with preparation method. Cardiovasc Interv Radiol. 2006;29:1077–83.CrossRefGoogle Scholar
  8. 8.
    Gaia G, Chabrot P, Cassagnes L, Calcagno A, Gallot D, Botchorishvili R, Canis M, Mage G, Boyer L. Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study. Eur Radiol. 2009;19:481–7.CrossRefGoogle Scholar
  9. 9.
    Chitrit Y, Zafy S, Pelage JP, Ledref O, Khoury R, Caubel P. Amenorrhea due to partial uterine necrosis after uterine artery embolization for control of refractory postpartum hemorrhage. Eur J Obset Gynecol Reprod Biol. 2006;127:140–2.CrossRefGoogle Scholar
  10. 10.
    Kirby JM, Kachura JR, Rajan DK, Sniderman KW, Simons ME, Windrim RC. Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol. 2009;20:1036–45.CrossRefGoogle Scholar
  11. 11.
    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 view of literature. Arch Gynecol Obstet. 2014;290:819–23.CrossRefGoogle Scholar
  12. 12.
    Eboue C, Barjot P, Huet H, Jeanne-Pasquier C, Herlicoviez M. Uterine and ovarian necrosis following embolisation of the uterine arteries for postpartum haemorrhagia. J Gynecol Obstet Biol Reprod. 2007;36:298–301 (in French).CrossRefGoogle Scholar
  13. 13.
    Cottier JP, Fignon A, Tranquart F, Herbreteau D. Uterine necrosis after arterial embolization for postpartum hemorrhage. Obstet Gynecol. 2002;100:1074–7.Google Scholar
  14. 14.
    Pirard C, Squifflet J, Gilles A, Donnez J. Uterine necrosis and sepsis after vascular embolization and surgical ligation in a patient with postpartum hemorrhage. Fertil Steril. 2002;78:412–3.CrossRefGoogle Scholar
  15. 15.
    Pellerin O, Bats AS, Di Primio M, Palomera-Ricco A, De Villechenon GP, Fournier L, Pagny JY, Beyssen B, Louail B, Lécuru F, Sapoval M. Postpartum hemorrhage treated with gelfoam slurry embolization using the superselective technique: immediate results and 1-month MRI follow-up. Cardiovasc Interv Radiol. 2013;36:98–104.CrossRefGoogle Scholar
  16. 16.
    Fiori O, Deux JF, Kambale JC, Uzan S, Bougdhene F, Berkane N. Impact of pelvic arterial embolization for intractable postpartum hemorrhage on fertility. Am J Obstet Gynecol. 2009;200:384–6.CrossRefGoogle Scholar
  17. 17.
    Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG. 2009;117:84–93.CrossRefGoogle Scholar
  18. 18.
    Poujade O, Zappa M, Letendre I, Ceccaldi PF, Vilgrain V, Luton D. Predictive factors for failure of pelvic arterial embolization for postpartum hemorrhage. Int J Gynaecol Obstet. 2012;117:119–23.CrossRefGoogle Scholar
  19. 19.
    Porcu G, Roger V, Jacquier A, Mazouni C, Rojat-Habib MC, Girard G, Pellegrin V, Bartoli JM, Gamerre M. Uterus and bladder necrosis after uterine artery embolisation for postpartum haemorrhage. BJOG. 2005;112:122–3.CrossRefGoogle Scholar
  20. 20.
    Maki M, Terao T, Ikenoue T. Obstetrical DIC score. Sanfujinka-chiryo. 1985;50:119–24 (in Japanese).Google Scholar
  21. 21.
    Coulange L, Butori N, Loffroy R, Filipuzzi L, Cercueil JP, Douvier S, Sagot P, Krause D, Tixier H. Uterine necrosis following selective embolization for postpartum hemorrhage using absorbable material. Acta Obstet Gynecol Scand. 2009;88:238–40.CrossRefGoogle Scholar
  22. 22.
    Pelage JP, Limot O. Current indication for uterine artery embolization to treat postpartum hemorrhage. Gynecol Obstet Fertil. 2008;36:714–20 (in French).CrossRefGoogle Scholar
  23. 23.
    Sonomura T, Yamada R, Kishi K, Nishida N, Yang RJ, Sato M. Dependency of tissue necrosis on gelatin sponge particle size after canine hepatic artery embolization. Cardiovasc Interv Radiol. 1997;20:50–3.CrossRefGoogle Scholar
  24. 24.
    Makuuchi M, Sukigara M, Mori T, Kobayashi J, Yamazaki S, Hasegawa H, Moriyama N, Takayasu K, Hirohashi S. Bile duct necrosis: complication of transcatheter hepatic arterial embolization. Radiology. 1985;156:331–4.CrossRefGoogle Scholar
  25. 25.
    Takayasu K, Moriyama N, Muramatsu Y, Shima Y, Ushio K, Yamada T, Kishi K, Hasegawa H. Gallbladder infarction after hepatic artery embolization. AJR Am J Roentgenol. 1985;144:135–8.CrossRefGoogle Scholar
  26. 26.
    Brown AC, Ray CE. Anterior spinal cord infarction following bronchial artery embolization. Semin Interv Radiol. 2012;29:241–4.CrossRefGoogle Scholar
  27. 27.
    Maramattom BV, Krishna Prasad BP, Padmanabhan S, Baby J. Spinal cord infarction after bronchial artery embolization. Ann Indian Acad Neurol. 2016;19:156–7.CrossRefGoogle Scholar
  28. 28.
    Knight EMP, Novelli PM, Joshi SM. Cerebral and systemic infarcts after bronchial artery embolization. Pediatr Neurol. 2011;45:324–7.CrossRefGoogle Scholar
  29. 29.
    van Doorn CS, De Boo DW, Weersink EJ, van Delden OM, Reekers JA, van Lienden KP. Permanent cortical blindness after bronchial artery embolization. Cardiovasc Interv Radiol. 2013;36:1686–9.CrossRefGoogle Scholar
  30. 30.
    Shalev J, Meizner I, Bar-Hava I, Dicker D, Mashiach R, Ben-Rafael Z. Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility. Fertil Steril. 2000;73:412–7.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of RadiologyChiba University HospitalChiba CityJapan
  2. 2.Department of RadiologyJapanese Red Cross Narita HospitalNarita CityJapan
  3. 3.Department of Maternal-Fetal MedicineChiba University HospitalChiba CityJapan
  4. 4.Department of Diagnostic Radiology and Radiation OncologyChiba University Graduate School of MedicineChiba CityJapan

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