J Korean Soc Radiol.  2019 Jan;80(1):88-97. 10.3348/jksr.2019.80.1.88.

Uterine Artery Embolization in Patients with Postpartum Hemorrhage: Clinical Efficacy and Safety of Treatment with N-Butyl-2-Cyanoacrylate

• Kwon Y
• So YH
• Kim BJ
• Kim SM
• Choi YH
• Moon MH

• KMID: 2442467
• DOI: http://doi.org/10.3348/jksr.2019.80.1.88

Abstract

PURPOSE
To evaluate the clinical efficacy and safety of uterine artery embolization (UAE) using N-butyl-2-cyanoacrylate (NBCA) in patients with postpartum hemorrhage (PPH).
MATERIALS AND METHODS
From February 2010 to May 2018, 14 patients (age: 28-39 years; mean: 33 years) underwent UAE using NBCA among 82 patients with PPH. Medical records were retrospectively reviewed to evaluate the patients characteristics, cause of PPH, embolization procedure, and outcomes.
RESULTS
Angiograms revealed extravasation (n = 10) or pseudoaneurysm (n = 4) in all patients. The causes of PPH were hysterotomy or hysterectomy related arterial injury (n = 11), cervical laceration (n = 2), and abnormal placentation (n = 1). UAE was performed with NBCA in all patients. Additional UAE with gelatin sponge particles was performed in two patients. Additional non-uterine artery embolization was performed in three patients. Coagulopathy was found in five (35.7%) patients. The technical and clinical success rates were 92.9% and 85.7%, respectively. One patient died from multi-organ failure eight days after UAE. One patient with abnormal placentation had pelvic organ ischemia due to multiple pelvic artery embolization.
CONCLUSION
UAE using NBCA is safe and effective for the patients with PPH showing extravasation or pseudoaneurysm.

MeSH Terms

Aneurysm, False
Arteries
Cyanoacrylates
Embolization, Therapeutic
Enbucrilate*
Gelatin
Humans
Hysterectomy
Hysterotomy
Ischemia
Lacerations
Medical Records
Placentation
Porifera
Postpartum Hemorrhage*
Postpartum Period*
Retrospective Studies
Treatment Outcome*
Uterine Artery Embolization*
Uterine Artery*
Cyanoacrylates
Enbucrilate
Gelatin

Figure

• 

  Fig. 1. A 34-year-old woman presented with postpartum hemorrhage after cesarean delivery. A. Pelvic aortography shows extravasation of contrast material (arrowhead) at the proximal portion of the uterine artery (arrow). B. A radiograph obtained immediately after embolization shows a microcatheter advanced into the uterine artery (arrow) and N-butyl-2-cyanoacrylate filled in the pseudoaneurysm and uterine artery (arrow heads).

• 

  Fig. 2. A 38-year-old woman presented with postpartum hemorrhage after vaginal delivery. A. Axial CT scan shows contrast material extravasation at the posterior aspect of the lacerated uterine cervix (arrows). Extravasated contrast material pooling in the posterior fornix of the vagina (arrowheads). B. Bilateral internal iliac arteriography showing extravasation (arrowheads) from bilateral cervical arteries (arrows). C. Post-embolic spot image showing the microcatheter advanced into the cervical artery (arrows) and the casted N-butyl-2-cyanoacrylate at the bleeding focus (arrowheads).

• 

  Fig. 3. A 31-year-old woman presented with postpartum hemorrhage after cesarean delivery. A. Right internal iliac arteriography showing extravasation of contrast material at the uterine fundus (arrow). B. A radiograph showing the microcatheter advanced into the far distal uterine arterial branch through the tortuous segment (arrows). C. Post-embolic arteriography showing the casted N-butyl-2-cyanoacrylate at the bleeding segment without reflux to the proximal or distal uterine artery (arrows).

Reference

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