Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지

Transcatheter Arterial Embolization for Postpartum Hemorrhage with Disseminated Intravascular Coagulation: Outcome Assessment

파종성혈관내응고를 동반한 분만 후 출혈에 대한 경도관동맥색전술: 결과 평가

  • An, Eun-Jung (Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine) ;
  • Kim, Young-Hwan (Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine) ;
  • Kwon, Bo-Ra (Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine) ;
  • Kim, See-Hyung (Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine)
  • 안은정 (계명대학교 의과대학 동산의료원 영상의학과학교실) ;
  • 김영환 (계명대학교 의과대학 동산의료원 영상의학과학교실) ;
  • 권보라 (계명대학교 의과대학 동산의료원 영상의학과학교실) ;
  • 김시형 (계명대학교 의과대학 동산의료원 영상의학과학교실)
  • Published : 2011.12.01
⟨ Previous Next ⟩

Abstract

Purpose: We evaluated the efficacy and predictors of clinical outcome after transcatheter arterial embolization (TAE) for treatment of postpartum hemorrhage with disseminated intravascular coagulation (DIC). Materials and Methods: Of 127 patients who underwent TAE for postpartum hemorrhage, 46 progressed to DIC (group 1), 81 showed normal range hematological parameters (group 2). We retrospectively evaluated etiology, embolization methods and the efficacy of TAE for intergroup comparison Pearson Chi-Square test and logistic regression model. Results: Overall TAE failed to control bleeding in 9 patients in spite of technical success. Lower bleeding control rate was found in group 2 (82.6%) relative to group 1 (98.8%, p = 0.001). And embolization methods were not statistically different between two groups no statistically significant predictors associated with failed hemostasis except the amount of transfusion in group 1. Conclusion: Although bleeding control rate is lower in postpartum hemorrhage with DIC than without DIC, we believe that TAE with correction of DIC is an effective method for postpartum hemorrhage with DIC.

목적: 파종성혈관내응고를 동반한 분만 후 출혈의 치료로서 경도관동맥색전술의 효용성과 결과에 영향을 미치는 인자들에 대해 알아보고자 하였다. 대상과 방법: 분만 후 출혈로 인해 동맥색전술을 시행받은 127명의 환자를 대상으로 하였다. 46명의 환자는 시술 전 파종성혈관내응고(집단 1)로 진행되었고 81명의 환자는 혈액응고검사에서 정상 범위의 수치를 보였다(집단 2). 집단 간의 원인질환, 동맥색전술 방법과 지혈 성공률 등을 후향적으로 평가하였으며 통계학적 분석은 Pearson Chi-Square test와 logistic regression model을 이용하였다. 결과: 기술적인 성공에도 불구하고 9명의 환자에서는 동맥색전술 후에도 출혈이 멈추지 않았다. 지혈 성공률은 집단 2(98.8%)에 비해 집단 1(82.6%)에서 더 낮았다(p = 0.001). 집단 간의 원인질환, 동맥색전술 방법에는 차이가 없었으며 집단 1에서 수혈량을 제외하고 시술 전 통계학적으로 의미 있게 지혈 실패에 영향을 미치는 인자들은 보이지 않았다. 결론: 비록 지혈의 성공률은 파종성혈관내응고집단에서 유의하게 낮았지만, 파종성혈관내응고의 교정을 동반한 경도관색전술은 효과적인 치료법이라 생각된다.

Keywords

References

  1. Gilbert L, Porter W, Brown VA. Postpartum haemorrhage--a continuing problem. Br J Obstet Gynaecol 1987;94:67-71 https://doi.org/10.1111/j.1471-0528.1987.tb02255.x
  2. Vegas G, Illescas T, Munoz M, Perez-Pinar A. Selective pelvic arterial embolization in the management of obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol 2006;127: 68-72 https://doi.org/10.1016/j.ejogrb.2005.09.008
  3. Badawy SZ, Etman A, Singh M, Murphy K, Mayelli T, Philadelphia M. Uterine artery embolization: the role in obstetrics and gynecology. Clin Imaging 2001;25:288-295 https://doi.org/10.1016/S0899-7071(01)00307-2
  4. 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;208:359-362
  5. 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;177:145-149 https://doi.org/10.2214/ajr.177.1.1770145
  6. Lee SY, Ko GY, Song HY, Gwon DI, Sung KB, Yoon HK. Postpartum bleeding: efficacy of endovascular management. J Korean Radiol Soc 2003;48:459-465
  7. Boulleret C, Chahid T, Gallot D, Mofid R, Tran Hai D, Ravel A, et al. Hypogastric arterial selective and superselective embolization for severe postpartum hemorrhage: a retrospective review of 36 cases. Cardiovasc Intervent Radiol 2004;27:344-348
  8. Lee JS, Shepherd SM. Endovascular treatment of postpartum hemorrhage. Clin Obstet Gynecol 2010;53:209-218 https://doi.org/10.1097/GRF.0b013e3181ce09f5
  9. Wi JY, Kim HC, Chung JW, Jun JK, Jae HJ, Park JH. Importance of angiographic visualization of round ligament arteries in women evaluated for intractable vaginal bleeding after uterine artery embolization. J Vasc Interv Radiol 2009; 20:1031-1035 https://doi.org/10.1016/j.jvir.2009.05.003
  10. Bros S, Chabrot P, Kastler A, Ouchchane L, Cassagnes L, Gallot D, et al. Recurrent bleeding within 24 hours after uterine artery embolization for severe postpartum hemorrhage: are there predictive factors? Cardiovasc Intervent Radiol 2011 [Epub ahead of print]
  11. Maassen MS, Lambers MD, Tutein Nolthenius RP, van der Valk PH, Elgersma OE. Complications and failure of uterine artery embolisation for intractable postpartum haemorrhage. BJOG 2009;116:55-61 https://doi.org/10.1111/j.1471-0528.2008.01939.x
  12. Descargues G, Douvrin F, Degre S, Lemoine JP, Marpeau L, Clavier E. Abnormal placentation and selective embolization of the uterine arteries. Eur J Obstet Gynecol Reprod Biol 2001;99:47-52 https://doi.org/10.1016/S0301-2115(01)00355-4
  13. Gayat E, Resche-Rigon M, Morel O, Rossignol M, Mantz J, Nicolas-Robin A, et al. Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med 2011;37:1816-1825 https://doi.org/10.1007/s00134-011-2315-0
  14. Padmanabhan A, Schwartz J, Spitalnik SL. Transfusion therapy in postpartum hemorrhage. Semin Perinatol 2009; 33:124-127 https://doi.org/10.1053/j.semperi.2009.01.002
  15. Loffroy R, Guiu B, D'Athis P, Mezzetta L, Gagnaire A, Jouve JL, et al. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol 2009;7: 515-523 https://doi.org/10.1016/j.cgh.2009.02.003
  16. Aina R, Oliva VL, Therasse E, Perreault P, Bui BT, Dufresne MP, et al. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol 2001;12:195-200 https://doi.org/10.1016/S1051-0443(07)61825-9
  17. Soyer P, Morel O, Fargeaudou Y, Sirol M, Staub F, Boudiaf M, et al. Value of pelvic embolization in the management of severe postpartum hemorrhage due to placenta accreta, increta or percreta. Eur J Radiol 2011;80:729-735 https://doi.org/10.1016/j.ejrad.2010.07.018