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Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate

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Abstract

Purpose

To identify predictive factors for embolic material conversion to N-butyl cyanoacrylate (NBCA) for the treatment of primary postpartum hemorrhage (PPH) after failed transcatheter arterial embolization (TAE) using gelatin sponge (GS).

Materials and Methods

Institutional review board approval was obtained. We retrospectively studied 62 consecutive women with primary PPH who underwent TAE between January 2006 and March 2015. Five of them were excluded for the following: cardiopulmonary arrest at arrival (n = 1), uterine inversion (n = 1), and hysterectomy after TAE (n = 3). Remaining 57 women (age range, 21–43 years; mean, 32.6 years) comprised study population. TAE was initially performed using GS in all cases and then converted to NBCA after two embolizations using GS with persistent hemodynamic instability or vaginal bleeding. The patients’ background, uterine height, vital signs, laboratory tests, disseminated intravascular coagulation score, and details of procedure were reviewed. Univariate and multivariate analyses were performed to determine factors related to embolic material conversion.

Results

Technical success rate was 100%. Fourteen patients (25%) needed embolic material conversion to NBCA. Univariate analysis showed that uterine height, systolic blood pressure (sBP), and hemoglobin level were significantly related to embolic material conversion to NBCA (P = 0.029, 0.030, and 0.042). Logistic regression analysis showed that uterine height (odds ratio, 1.37; P = 0.025) and sBP (odds ratio, 0.96; P = 0.003) were associated with embolic material conversion to NBCA.

Conclusion

Uterine height and sBP can be predictive factors for embolic material conversion to NBCA for the treatment of PPH.

Level of Evidence

Level 4, Case Control Study

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References

  1. Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33. doi:10.1016/S2214-109X(14)70227-X.

    Article  PubMed  Google Scholar 

  2. AbouZahr C. Global burden of maternal death and disability. Br Med Bull. 2003;67:1–11.

    Article  PubMed  Google Scholar 

  3. Hong TM, Tseng HS, Lee RC, Wang JH, Chang CY. Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage. Clin Radiol. 2004;59(1):96–101.

    Article  PubMed  Google Scholar 

  4. Ganguli S, Stecker MS, Pyne D, Baum RA, Fan CM. Uterine artery embolization in the treatment of postpartum uterine hemorrhage. J Vasc Interv Radiol. 2011;22(2):169–76. doi:10.1016/j.jvir.2010.09.031.

    Article  PubMed  Google Scholar 

  5. Lee HY, Shin JH, Kim J, Yoon HK, Ko GY, Won HS, et al. Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution. Radiology. 2012;264(3):903–9. doi:10.1148/radiol.12111383.

    Article  PubMed  Google Scholar 

  6. Deux JF, Bazot M, Le Blanche AF, Tassart M, Khalil A, Berkane N, et al. Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage? AJR Am J Roentgenol. 2001;177(1):145–9. doi:10.2214/ajr.177.1.1770145.

    Article  CAS  PubMed  Google Scholar 

  7. Dohan A, Soyer P, Subhani A, Hequet D, Fargeaudou Y, Morel O, et al. Postpartum hemorrhage resulting from pelvic pseudoaneurysm: a retrospective analysis of 588 consecutive cases treated by arterial embolization. Cardiovasc Interv Radiol. 2013;36(5):1247–55. doi:10.1007/s00270-013-0668-1.

    Article  Google Scholar 

  8. 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(2):119–23. doi:10.1016/j.ijgo.2011.11.025.

    Article  PubMed  Google Scholar 

  9. 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(8):2344–9. doi:10.1007/s00330-013-2830-1.

    Article  PubMed  Google Scholar 

  10. Park KJ, Shin JH, Yoon HK, Gwon DI, Ko GY, Sung KB. Postpartum hemorrhage from extravasation or pseudoaneurysm: efficacy of transcatheter arterial embolization using N-butyl cyanoacrylate and comparison with gelatin sponge particle. J Vasc Interv Radiol. 2015;26(2):154–61. doi:10.1016/j.jvir.2014.10.001.

    Article  PubMed  Google Scholar 

  11. Kanematsu M, Watanabe H, Kondo H, Goshima S, Kato H, Furui T, et al. Postpartum hemorrhage in coagulopathic patients: preliminary experience with uterine arterial embolization with N-butyl cyanoacrylate. J Vasc Interv Radiol. 2011;22(12):1773–6. doi:10.1016/j.jvir.2011.08.016.

    Article  PubMed  Google Scholar 

  12. ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363–13639. doi:10.1097/TA.0b013e31828b82f5.

    Google Scholar 

  13. Takeuchi Y, Morishita H, Sato Y, Hamaguchi S, Sakamoto N, Tokue H, et al. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol. 2014;32(8):500–17. doi:10.1007/s11604-014-0328-7.

    Article  PubMed  Google Scholar 

  14. Stoesslein F, Ditscherlein G, Romaniuk PA. Experimental studies on new liquid embolization mixtures (histoacryl-lipiodol, histoacryl-panthopaque). Cardiovasc Interv Radiol. 1982;5(5):264–7.

    Article  CAS  Google Scholar 

  15. Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M, Scientific Subcommittee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemotasis. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86(5):1327–30.

    CAS  PubMed  Google Scholar 

  16. Wada H, Thachil J, Di Nisio M, Mathew P, Kurosawa S, Gando S, et al. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost. 2013. doi:10.1111/jth.12155.

    Google Scholar 

  17. Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. J Intensive Care. 2014;2(1):15. doi:10.1186/2052-0492-2-15.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.

    Article  PubMed  Google Scholar 

  19. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60. doi:10.3758/BRM.41.4.1149.

    Article  PubMed  Google Scholar 

  20. Brown BJ, Heaston DK, Poulson AM, Gabert HA, Mineau DE, Miller FJ Jr. Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol. 1979;54(3):361–5.

    CAS  PubMed  Google Scholar 

  21. Ratnam LA, Gibson M, Sandhu C, Torrie P, Chandraharan E, Belli AM. Transcatheter pelvic arterial embolisation for control of obstetric and gynaecological haemorrhage. J Obstet Gynaecol. 2008;28(6):573–9. doi:10.1080/01443610802273374.

    Article  CAS  PubMed  Google Scholar 

  22. Fargeaudou Y, Soyer P, Morel O, Sirol M, le Dref O, Boudiaf M, et al. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization. Eur Radiol. 2009;19(9):2197–203. doi:10.1007/s00330-009-1413-7.

    Article  PubMed  Google Scholar 

  23. Kirby JM, Kachura JR, Rajan DK, Sniderman KW, Simons ME, Windrim RC, et al. Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol. 2009;20(8):1036–45. doi:10.1016/j.jvir.2009.04.070.

    Article  PubMed  Google Scholar 

  24. Gonsalves M, Belli A. The role of interventional radiology in obstetric hemorrhage. Cardiovasc Interv Radiol. 2010;33(5):887–95. doi:10.1007/s00270-010-9864-4.

    Article  CAS  Google Scholar 

  25. Takeda A, Koike W, Imoto S, Nakamura H. Three-dimensional computerized tomographic angiography for diagnosis and management of intractable postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2014;176:104–11. doi:10.1016/j.ejogrb.2014.02.026.

    Article  PubMed  Google Scholar 

  26. Soyer P, Dohan A, Dautry R, Guerrache Y, Ricbourg A, Gayat E, et al. Transcatheter arterial embolization for postpartum hemorrhage: indications, technique, results, and complications. Cardiovasc Interv Radiol. 2015;38(5):1068–81. doi:10.1007/s00270-015-1054-y.

    Article  Google Scholar 

  27. Sierra A, Burrel M, Sebastia C, Radosevic A, Barrufet M, Albela S, et al. Utility of multidetector CT in severe postpartum hemorrhage. Radiographics. 2012;32(5):1463–81. doi:10.1148/rg.325115113.

    Article  PubMed  Google Scholar 

  28. Lee NK, Kim S, Kim CW, Lee JW, Jeon UB, Suh DS. Identification of bleeding sites in patients with postpartum hemorrhage: MDCT compared with angiography. AJR Am J Roentgenol. 2010;194(2):383–90. doi:10.2214/AJR.09.3073.

    Article  PubMed  Google Scholar 

  29. Cheong JY, Kong TW, Son JH, Won JH, Yang JI, Kim HS. Outcome of pelvic arterial embolization for postpartum hemorrhage: a retrospective review of 117 cases. Obstet Gynecol Sci. 2014;57(1):17–27. doi:10.5468/ogs.2014.57.1.17.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pelage JP, Le Dref O, Mateo J, Soyer P, Jacob D, Kardache M, et al. Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology. 1998;208(2):359–62. doi:10.1148/radiology.208.2.9680559.

    Article  CAS  PubMed  Google Scholar 

  31. Yonemitsu T, Kawai N, Sato M, Sonomura T, Takasaka I, Nakai M, et al. Comparison of hemostatic durability between N-butyl cyanoacrylate and gelatin sponge particles in transcatheter arterial embolization for acute arterial hemorrhage in a coagulopathic condition in a swine model. Cardiovasc Interv Radiol. 2010;33(6):1192–7. doi:10.1007/s00270-010-9863-5.

    Article  Google Scholar 

  32. Yonemitsu T, Kawai N, Sato M, Tanihata H, Takasaka I, Nakai M, et al. Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and n-butyl cyanoacrylate for acute arterial bleeding in a coagulopathic condition. J Vasc Interv Radiol. 2009;20(9):1176–87. doi:10.1016/j.jvir.2009.06.005.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Gifu University Hospital, 1-1 Yanagido, 501-1194, Gifu, Japan

    Yukichi Tanahashi, Satoshi Goshima, Tomohiro Ando, Yoshifumi Noda, Hiroshi Kawada, Nobuyuki Kawai & Masayuki Matsuo

  2. Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, 173-8605, Tokyo, Japan

    Yukichi Tanahashi, Hiroshi Kondo & Shigeru Furui

  3. Department of Radiological Technology, Faculty of Medical Technology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, 173-8605, Tokyo, Japan

    Junichi Kotoku

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  1. Yukichi Tanahashi
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Correspondence to Satoshi Goshima.

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The authors declare that they have no conflict of interest.

Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This retrospective study design was also approved by our institutional review board and written informed was not required.

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Tanahashi, Y., Goshima, S., Kondo, H. et al. Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate. Cardiovasc Intervent Radiol 40, 236–244 (2017). https://doi.org/10.1007/s00270-016-1496-x

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