Outcomes of pelvic arterial embolization in the management of postpartum haemorrhage: a case series study and systematic review

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• 作者：F.J. Ruiz Labarta^a ; M.P. Pintado Recarte^a ; A. Alvarez Luque^b ; L. Joigneau Prieto^a ; L. Perez Martí ; n^a ; M. Gonzalez Leyte^b ; F. Palacio Abizanda^c ; F. Morillas Ramirez^c ; A. Perez Corral^d ; L. Ortiz Quintana^a ; J. De Leon-Luis^a ; ^{jdeleonluis@yahoo.es" class="auth_mail" title="E-mail the corresponding author} ; ^{juandeleonluis@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Postpartum haemorrhage ; Pelvic arterial embolization ; Success rate ; Complication ; Systematic review ; Uterine atony
• 刊名：European Journal of Obstetrics & Gynecology and Reproductive Biology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：206
• 期：Complete
• 页码：12-21
• 全文大小：587 K

文摘

Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Pelvic arterial embolization (PAE) is considered as a second-line treatment, although the published results have not been reviewed systematically since 2007.

Objectives

To evaluate success and complication rates of PAE to treat PPH in the study hospital between 2009 and 2015, and to perform a systematic review of the literature on the reported efficacy and safety of PAE for the management of PPH.

Search strategy

A systematic review of articles on PAE in English or Spanish was conducted using Medline and the Cochrane Library.

Selection criteria

All published articles assessing success and complication rates of PAE in cases of PPH. The search was restricted to articles published in English or Spanish between 2000 and 2015, with at least 25 cases.

Data collection and analysis

Obstetric variables, maternal haemodynamic state, pre-/postembolization management, technique-related variables, post-PAE evolution and complications were recorded in the case series study. Study characteristics, success rates and PAE-related complication rates were recorded in the systematic review.

Main results

The case series included 29 patients. The majority of these patients were primiparous, with singleton term pregnancies and spontaneous labour. Caesarean section was performed in 62.1% of patients undergoing PAE for PPH. PAE was successful in 89.6% [95% confidence interval (CI) 78.3–100] of cases. Twenty studies were included in the systematic review, providing data from 1739 patients. PAE was successful in 89.4% (95% CI 87.9–90.9) of cases. The mortality rate was 0.9%, and other major complications were uncommon (1.8%).

Conclusions

PAE was found to be a minimally invasive, highly successful and safe technique for the management of PPH. It should be considered in PPH refractory to initial treatment.