Korean Journal of Radiology

  • 제18권2호
  • /
  • Pages.355-360
  • /
  • 2017
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Efficacy of Prophylactic Uterine Artery Embolization before Obstetrical Procedures with High Risk for Massive Bleeding

  • Ko, Heung Kyu (Department of Radiology, Asan Medical Center, Ulsan University College of Medicine) ;
  • Shin, Ji Hoon (Department of Radiology, Asan Medical Center, Ulsan University College of Medicine) ;
  • Ko, Gi Young (Department of Radiology, Asan Medical Center, Ulsan University College of Medicine) ;
  • Gwon, Dong Il (Department of Radiology, Asan Medical Center, Ulsan University College of Medicine) ;
  • Kim, Jin Hyung (Department of Radiology, Asan Medical Center, Ulsan University College of Medicine) ;
  • Han, Kichang (Department of Radiology, Asan Medical Center, Ulsan University College of Medicine) ;
  • Lee, Shin-Wha (Department of Obstetrics and Gynecology, Asan Medical Center, Ulsan University College of Medicine)
  • 투고 : 2016.06.13
  • 심사 : 2016.10.20
  • 발행 : 2017.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. Materials and Methods: A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D&C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D&C for retained placenta with vascularity (n = 5), and D&C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. Results: All women received successful bilateral prophylactic UAE followed by D&C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. Conclusion: Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.

키워드

참고문헌

  1. De Sutter TC, Lohle PN, Boekkooi PF. [Severe blood loss days after suction and curettage: consider a pseudoaneurysm]. Ned Tijdschr Geneeskd 2013;157:A6004
  2. Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, et al. Risk factors for legal induced abortionrelated mortality in the United States. Obstet Gynecol 2004;103:729-737 https://doi.org/10.1097/01.AOG.0000116260.81570.60
  3. Kerns J, Steinauer J. Management of postabortion hemorrhage: release date November 2012 SFP Guideline #20131. Contraception 2013;87:331-342 https://doi.org/10.1016/j.contraception.2012.10.024
  4. Zhuang Y, Huang L. Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar. Am J Obstet Gynecol 2009;201:152.e1-152.e3 https://doi.org/10.1016/j.ajog.2009.04.038
  5. Wang JH, Qian ZD, Zhuang YL, Du YJ, Zhu LH, Huang LL. Risk factors for intraoperative hemorrhage at evacuation of a cesarean scar pregnancy following uterine artery embolization. Int J Gynaecol Obstet 2013;123:240-243 https://doi.org/10.1016/j.ijgo.2013.06.029
  6. Steinauer JE, Diedrich JT, Wilson MW, Darney PD, Vargas JE, Drey EA. Uterine artery embolization in postabortion hemorrhage. Obstet Gynecol 2008;111:881-889 https://doi.org/10.1097/AOG.0b013e3181685780
  7. Izbizky G, Meller C, Grasso M, Velazco A, Peralta O, Otano L, et al. Feasibility and safety of prophylactic uterine artery catheterization and embolization in the management of placenta accreta. J Vasc Interv Radiol 2015;26:162-169; quiz 170 https://doi.org/10.1016/j.jvir.2014.10.013
  8. Le Gall J, Fichez A, Lamblin G, Philip CA, Huissoud C. [Cesarean scar ectopic pregnancies: combined modality therapies with uterine artery embolization before surgical procedure]. Gynecol Obstet Fertil 2015;43:191-199 https://doi.org/10.1016/j.gyobfe.2015.01.015
  9. Grimes DA, Flock ML, Schulz KF, Cates W Jr. Hysterectomy as treatment for complications of legal abortion. Obstet Gynecol 1984;63:457-462
  10. Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 2006;108(3 Pt 1):573-581 https://doi.org/10.1097/01.AOG.0000233155.62906.6d
  11. Borgatta L, Chen AY, Reid SK, Stubblefield PG, Christensen DD, Rashbaum WK. Pelvic embolization for treatment of hemorrhage related to spontaneous and induced abortion. Am J Obstet Gynecol 2001;185:530-536 https://doi.org/10.1067/mob.2001.116750
  12. Haddad L, Delli-Bovi L. Uterine artery embolization to treat hemorrhage following second-trimester abortion by dilatation and surgical evacuation. Contraception 2009;79:452-455 https://doi.org/10.1016/j.contraception.2008.11.020
  13. Godfrey CD, Zbella EA. Uterine necrosis after uterine artery embolization for leiomyoma. Obstet Gynecol 2001;98(5 Pt 2):950-952 https://doi.org/10.1016/S0029-7844(01)01483-1
  14. Cottier JP, Fignon A, Tranquart F, Herbreteau D. Uterine necrosis after arterial embolization for postpartum hemorrhage. Obstet Gynecol 2002;100(5 Pt 2):1074-1077 https://doi.org/10.1016/S0029-7844(02)02050-1
  15. Hong TM, Tseng HS, Lee RC, Wang JH, Chang CY. Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage. Clin Radiol 2004;59:96-101 https://doi.org/10.1016/j.crad.2003.08.007

피인용 문헌

  1. Endovascular interventional modalities for haemorrhage control in abnormal placental implantation deliveries: a systematic review and meta-analysis vol.28, pp.7, 2018, https://doi.org/10.1007/s00330-017-5222-0
  2. Recent Update of Embolization of Postpartum Hemorrhage vol.19, pp.4, 2017, https://doi.org/10.3348/kjr.2018.19.4.585
  3. Prophylactic uterine artery embolization in second-trimester pregnancy termination with complete placenta previa vol.47, pp.1, 2019, https://doi.org/10.1177/0300060518801455
  4. Transient Occlusion of Uterine Arteries in Procedures with High Risk of Uterine Bleeding vol.23, pp.1, 2019, https://doi.org/10.4293/jsls.2018.00072
  5. Management of Cervical Ectopic Pregnancies : A Scoping Review vol.138, pp.1, 2017, https://doi.org/10.1097/aog.0000000000004423
  6. Can uterine artery embolization be an alternative to plastic and reconstructive uterus operation by minimally invasive surgery? vol.10, pp.None, 2017, https://doi.org/10.3205/iprs000157
  7. Investigation and Analysis of Influencing Factors of Moderate to Severe Pain After Uterine Artery Embolization in Patients with Cesarean Scar Pregnancy vol.14, pp.None, 2017, https://doi.org/10.2147/ijgm.s342735
  8. The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control s vol.21, pp.1, 2017, https://doi.org/10.1186/s12884-021-04083-y