Uterine necrosis following pelvic arterial embolization for post-partum hemorrhage: review of the literature

详细信息    查看全文

• 作者：Olivier Poujade ; Pierre Fran?ois Ceccaldi ; Carine Davitian ; Pascale Amate ; Paul Chatel ; Carine Khater ; Nizar Aflak ; Val¨¦rie Vilgrain ; Dominique Luton
• 关键词：Uterine necrosis ; Pelvic arterial embolization ; Postpartum hemorrhage
• 刊名：European Journal of Obstetrics and Gynecology and Reproductive Biology
• 出版年：2013
• 出版时间：October, 2013
• 年：2013
• 卷：170
• 期：2
• 页码：309-314
• 全文大小：343 K

文摘

Uterine necrosis is one of the rarest complications following pelvic arterial embolization for postpartum hemorrhage (PPH). With the increasing incidence of cesarean section and abnormal placental localization (placenta previa) or placental invasion (placenta accreta/increta/percreta), more and more cases of uterine necrosis after embolization are being diagnosed and reported. Pelvic computed tomography or magnetic resonance imaging provides high diagnostic accuracy, and surgical management includes hysterectomy. We performed a Medline database query following the first description of uterine necrosis after pelvic embolization (between January 1985 and January 2013). Medical subheading search words were the following: ¡°uterine necrosis¡±; ¡°embolization¡±; ¡°postpartum hemorrhage¡±. Seventeen citations reporting at least one case of uterine necrosis after pelvic embolization for PPH were included, with a total of 19 cases.

This literature review discusses the etiopathogenesis, clinical and therapeutic aspects of uterine necrosis following pelvic arterial embolization, and guidelines are detailed. The mean time interval between pelvic embolization and diagnosis of uterine necrosis was 21 days (range 9-730). The main symptoms of uterine necrosis were fever, abdominal pain, menorrhagia and leukorrhea. Surgical management included total hysterectomy (n = 15, 78 % ) or subtotal hysterectomy (n = 2, 10 % ) and partial cystectomy with excision of the necrotic portion in three cases of associated bladder necrosis (15 % ). Uterine necrosis was partial in four cases (21 % ). Regarding the pathophysiology, four factors may be involved in uterine necrosis: the size and nature of the embolizing agent, the presence of the anastomotic vascular system and the embolization technique itself with the use of free flow embolization.