Korean J Radiol.  2017 Apr;18(2):355-360. 10.3348/kjr.2017.18.2.355.

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

• Ko HK
• Shin JH
• Ko GY
• Gwon DI
• Kim JH
• Han K
• Lee SW

• KMID: 2427947
• DOI: http://doi.org/10.3348/kjr.2017.18.2.355

Abstract

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.

Keyword

Prophylaxis; Uterine artery embolization; Obstetrical procedure; Bleeding

MeSH Terms

Adult
Angiography
Dilatation and Curettage
Female
Humans
Labor, Obstetric
Middle Aged
Pregnancy
Pregnancy, Ectopic/surgery
Retrospective Studies
*Uterine Artery Embolization
Uterine Hemorrhage/*prevention & control
Young Adult

Figure

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  Fig. 1 Placenta previa. A, B. Angiograms of left (A) and right uterine arteries (B) showing diffuse contrast staining (arrows), suggesting placenta on lower uterine body. Fetus (arrowheads) was confirmed to be dead based on ultrasonography. C. Post-embolization angiogram after contrast injection from right internal iliac artery showing devascularized placenta and contrast stasis (arrows) suggesting complete embolization.

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  Fig. 2 Cervical pregnancy. A. Transabdominal ultrasonographic image showing gestational sac (arrows) in uterine cervix. Fetus (arrowhead) can also be seen. B. Late arterial angiogram showing engorged uterine artery and contrast staining at uterine cervix. C. Fluoroscopic image after embolization showing contrast stasis due to embolized gel foam in right uterine artery.

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  Fig. 3 Cesarean section scar pregnancy. A. Transvaginal ultrasonographic image showing gestational sac (arrows) in anterior wall of lower uterine body. Patient underwent cesarean section 5 years earlier. B. Angiogram of right internal iliac artery showing engorged uterine artery and contrast staining in lower uterine body. C. Fluoroscopic image after embolization showing contrast stasis due to embolized gel foam in right uterine artery.

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