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Recurrent Bleeding Within 24 Hours After Uterine Artery Embolization for Severe Postpartum Hemorrhage: Are There Predictive Factors?

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Abstract

Purpose

To retrospectively identify predictive factors of recurrent bleeding within 24 h after uterine artery embolization (UAE) for postpartum hemorrhage (PPH).

Materials and Methods

A total of 194 patients underwent UAE for PPH between August 1999 and April 2009 at our institution. Twelve patients experienced recurrent bleeding within the next 24 h; a second attempt at UAE was thus necessary, which was successful in 10 cases. In two cases, hemostatic hysterectomy was performed. Epidemiological, gynecological-obstetrical, anatomic, and biological data were analyzed.

Results

Complete data were available for 148 of the 194 (76%) included patients. Sixty-four (43%) were primiparous, 18 (12.2%) had a placenta accreta, 21 (14%) had a coagulopathy, and 28 (18.9%) had an anatomic variant of the uterine arterial vasculature. Mean age and pregnancy term were similar in both recurring and nonrecurrent bleeding groups. After multivariate analysis, three criteria emerged as risk factors of recurrent bleeding: primiparity (10 patients, 83%; odds ratio [OR] = 18.84; P = 0.014), coagulation disorders (6 patients, 50%; OR = 12.08; P = 0.006), and anatomic variant of the uterine arterial vasculature (28 patients; OR = 9.83; P = 0.003).

Conclusion

Search for uterine collaterals must be performed before UAE for PPH. Primiparity and coagulation disorders increase the risk of recurrent bleeding after UAE for PPH.

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References

  1. Chabrot P, Gallot D, Louail B, Storme B, Brazzalotto I, Vidal V (2009) Recommendations pour la SFICV. SFICV

  2. d’Ercole C, Shojai R, Desbriere R et al (2004) Surgical management of primary postpartum hemorrhage. J Gynecol Obstet Biol Reprod (Paris) 33(8 suppl):4S103–104S119

    Google Scholar 

  3. Hosmer DW, Lemeshow LS (1999) Applied logistic regression. Wiley, New York

    Google Scholar 

  4. Combs CA, Murphy EL, Laros RK Jr (1991) Factors associated with hemorrhage in Cesarean deliveries. Obstet Gynecol 77:77–82

    PubMed  CAS  Google Scholar 

  5. Combs CA, Murphy EL, Laros RK Jr (1991) Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol 77:69–76

    PubMed  CAS  Google Scholar 

  6. Sergent F, Resch B, Verspyck E et al (2004) Les hèmorragies graves de la dèlivrance: doit-on lier, hystèrectomiser ou emboliser? Gynecol Obstet Fertil 32:320–329

    Article  PubMed  CAS  Google Scholar 

  7. Goffinet F (2004) Postpartum hemorrhage: methods used and topics discussed. J Gynecol Obstet Biol Reprod (Paris) 33(8 suppl):4S7–4S8

    CAS  Google Scholar 

  8. Boulleret C, Chahid T, Gallot D et al (2004) Hypogastric arterial selective and superselective embolization for severe postpartum hemorrhage: a retrospective review of 36 cases. Cardiovasc Intervent Radiol 27:344–348

    Article  PubMed  CAS  Google Scholar 

  9. Gaia G, Chabrot P, Cassagnes L et al (2009) Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study. Eur Radiol 19:481–487

    Article  PubMed  CAS  Google Scholar 

  10. Bouchet A, Cuilleret J (1983) Anatomie topographique et fonctionnelle. Simel, Paris

    Google Scholar 

  11. Pelage JP, Le Dref O, Soyer P et al (1999) Arterial anatomy of the female genital tract: variations and relevance to transcatheter embolization of the uterus. AJR Am J Roentgenol 172:989–994

    PubMed  CAS  Google Scholar 

  12. Wang MQ, Liu FY, Duan F et al (2009) Ovarian artery embolization supplementing hypogastric–uterine artery embolization for control of severe postpartum hemorrhage: report of eight cases. J Vasc Interv Radiol 20:971–976

    Article  PubMed  Google Scholar 

  13. Maassen MS, app Lambers MD, Tutein Nolthenius RP et al (2009) Complications and failure of uterine artery embolisation for intractable postpartum haemorrhage. BJOG 116:55–61

    Article  PubMed  CAS  Google Scholar 

  14. Wi JY, Kim HC, Chung JW et al (2009) Importance of angiographic visualization of round ligament arteries in women evaluated for intractable vaginal bleeding after uterine artery embolization. J Vasc Interv Radiol 20:1031–1035

    Article  PubMed  Google Scholar 

  15. Diop AN, Chabrot P, Bertrand A et al (2010) Placenta accreta: management with uterine artery embolization in 17 cases. J Vasc Interv Radiol 21:644–648

    Article  PubMed  Google Scholar 

  16. Sentilhes L, Gromez A, Clavier E et al (2010) Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG 117:84–93

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France

    Sébastien Bros, Pascal Chabrot, Adrian Kastler, Lucie Cassagnes & Louis Boyer

  2. Department of Public Health, Gabriel Montpied Hospital, Clermont-Ferrand, France

    Lemlih Ouchchane

  3. Department of Gynecology, Gabriel Montpied Hospital, Clermont-Ferrand, France

    Denis Gallot

Authors
  1. Sébastien Bros
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  2. Pascal Chabrot
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  3. Adrian Kastler
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  4. Lemlih Ouchchane
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  5. Lucie Cassagnes
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  6. Denis Gallot
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  7. Louis Boyer
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Corresponding author

Correspondence to Adrian Kastler.

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Bros, S., Chabrot, P., Kastler, A. et al. Recurrent Bleeding Within 24 Hours After Uterine Artery Embolization for Severe Postpartum Hemorrhage: Are There Predictive Factors?. Cardiovasc Intervent Radiol 35, 508–514 (2012). https://doi.org/10.1007/s00270-011-0181-3

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  • DOI: https://doi.org/10.1007/s00270-011-0181-3

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