DOI 10.1515/jpm-2014-0092 J. Perinat. Med. 2014; 42(6): 777–778
Letter to the Editor Sandro Gerli*, Alessandro Favilli, Stefano Mosca and Gian Carlo Di Renzo
The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage Keywords: Arterial embolization; postpartum hemorrhage; retained placenta. *Corresponding author: Dr. Sandro Gerli, MD, Department of Obstetrics and Gynecology, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, Italy, Tel.: +39.075.578.3231, E-mail: [email protected] Alessandro Favilli and Gian Carlo Di Renzo: Department of Obstetrics and Gynecology, University of Perugia, 06156 Perugia, Italy Stefano Mosca: Department of Radiology, University of Perugia, 06156 Perugia, Italy
Dear Editor, Recently, Yamasaki et al. [3] published an interesting study about “the factors associated with the failure of transcatheter pelvic arterial embolization (TAE) for intractable postpartum hemorrhage”. The results reported by the authors were very significant. In fact, among the patients with a postpartum hemorrhage (PPH) treated with TAE, 87.3% of the patients achieved a sufficient hemostasis without surgical treatments. Forty-one of the 55 women with TAE for intractable PPH were referred from other hospitals. The catheterization from the right femoral artery and subsequent embolization of uni- or bilateral uterine arteries with the use of absorbable gelatine sponge was performed by a team of expert radiologists. In the conclusions, the authors affirmed that advanced maternal age and retained placenta were independent factors associated with TAE failure for intractable PPH. There is little available information on the factors related to an inefficiency of the procedure but abnormal placentation, previous cesarean section, hemostatic factors alterations, and blood loss volume might be considered as the main causes of the TAE failure [2, 4]. In 2009, Sentilhes et al. [2] stated “the only factors significantly
associated with failed pelvic arterial embolization were a higher rate of estimated blood loss (more than 1500 mL) and more than 5 transfused red blood cell units”. According to a previous report by Yu et al. [4], we believe that a major role in the failure of the procedure may be played by the vascular spasm that occurs in the shock due to a massive blood loss. Therefore, time is crucial for a successful procedure. Nevertheless, Yamasaki et al. obtained excellent results despite a median blood loss of 3484 mL (1505–7000) in the “success group” and 3000 mL (1807–4680) in the “failure group”. Recently, we reported preliminary results of a new management for patients at risk of PPH [1]. In order to avoid the blood loss due to the patients transferring in emergency conditions from the operating room to the angiography room, we suggested the preventive arterial catheterization before the cesarean section, moving the angiography with the material for the embolization to the surgery room. In case of uncontrolled bleeding, it was possible to perform a timely selective embolization saving precious blood and time. Contrary to this, Yamasaki et al. [3] transferred 41 patients in an emergency state with PPH from other hospitals to the department where the embolization was performed. We wonder if the failure group of patients could be reduced in case of an immediate angiographic management of PPH. We agree with Yamasaki et al. about the importance of a retained placenta and advanced maternal age, but we believe that prophylactic arterial catheterization could reduce the interval between the onset of bleeding and the embolization, improving the outcome in the patients who are at risk of PPH. Received March 17, 2014. Accepted March 24, 2014. Previously published online April 11, 2014.
778 Gerli et al., The factors associated with the failure of TAE for intractable postpartum hemorrhage
References [1] Gerli S, Favilli A, Affronti G, Acanfora MM, Sabatini A, Floridi C, et al. Prophylactic arterial catheterization in the management of high risk patients for obstetric haemorrhage. Eur Rev Med Pharmacol Sci. 2013;17:2822–6. [2] Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Obstet Gynecol. 2009;113: 992–9. [3] Yamasaki Y, Morita H, Miyahara Y, Ebina Y, Okada T, Yamaguchi M, et al. The factors associated with the failure
of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage. J Perinat Med. 2013;5:1–4. [4] Yu PC, Ou HY, Tsang LL, Kung FT, Hsu TY, Cheng YF. Prophylactic intraoperative uterine artery embolization to control hemorrhage in abnormal placentation during late gestation. Fertil Steril. 2009;91:1951–5.
The authors stated that there are no conflicts of interest regarding the publication of this article.
Copyright of Journal of Perinatal Medicine is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letter to the Editor Sandro Gerli*, Alessandro Favilli, Stefano Mosca and Gian Carlo Di Renzo
The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage Keywords: Arterial embolization; postpartum hemorrhage; retained placenta. *Corresponding author: Dr. Sandro Gerli, MD, Department of Obstetrics and Gynecology, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, Italy, Tel.: +39.075.578.3231, E-mail: [email protected] Alessandro Favilli and Gian Carlo Di Renzo: Department of Obstetrics and Gynecology, University of Perugia, 06156 Perugia, Italy Stefano Mosca: Department of Radiology, University of Perugia, 06156 Perugia, Italy
Dear Editor, Recently, Yamasaki et al. [3] published an interesting study about “the factors associated with the failure of transcatheter pelvic arterial embolization (TAE) for intractable postpartum hemorrhage”. The results reported by the authors were very significant. In fact, among the patients with a postpartum hemorrhage (PPH) treated with TAE, 87.3% of the patients achieved a sufficient hemostasis without surgical treatments. Forty-one of the 55 women with TAE for intractable PPH were referred from other hospitals. The catheterization from the right femoral artery and subsequent embolization of uni- or bilateral uterine arteries with the use of absorbable gelatine sponge was performed by a team of expert radiologists. In the conclusions, the authors affirmed that advanced maternal age and retained placenta were independent factors associated with TAE failure for intractable PPH. There is little available information on the factors related to an inefficiency of the procedure but abnormal placentation, previous cesarean section, hemostatic factors alterations, and blood loss volume might be considered as the main causes of the TAE failure [2, 4]. In 2009, Sentilhes et al. [2] stated “the only factors significantly
associated with failed pelvic arterial embolization were a higher rate of estimated blood loss (more than 1500 mL) and more than 5 transfused red blood cell units”. According to a previous report by Yu et al. [4], we believe that a major role in the failure of the procedure may be played by the vascular spasm that occurs in the shock due to a massive blood loss. Therefore, time is crucial for a successful procedure. Nevertheless, Yamasaki et al. obtained excellent results despite a median blood loss of 3484 mL (1505–7000) in the “success group” and 3000 mL (1807–4680) in the “failure group”. Recently, we reported preliminary results of a new management for patients at risk of PPH [1]. In order to avoid the blood loss due to the patients transferring in emergency conditions from the operating room to the angiography room, we suggested the preventive arterial catheterization before the cesarean section, moving the angiography with the material for the embolization to the surgery room. In case of uncontrolled bleeding, it was possible to perform a timely selective embolization saving precious blood and time. Contrary to this, Yamasaki et al. [3] transferred 41 patients in an emergency state with PPH from other hospitals to the department where the embolization was performed. We wonder if the failure group of patients could be reduced in case of an immediate angiographic management of PPH. We agree with Yamasaki et al. about the importance of a retained placenta and advanced maternal age, but we believe that prophylactic arterial catheterization could reduce the interval between the onset of bleeding and the embolization, improving the outcome in the patients who are at risk of PPH. Received March 17, 2014. Accepted March 24, 2014. Previously published online April 11, 2014.
778 Gerli et al., The factors associated with the failure of TAE for intractable postpartum hemorrhage
References [1] Gerli S, Favilli A, Affronti G, Acanfora MM, Sabatini A, Floridi C, et al. Prophylactic arterial catheterization in the management of high risk patients for obstetric haemorrhage. Eur Rev Med Pharmacol Sci. 2013;17:2822–6. [2] Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Obstet Gynecol. 2009;113: 992–9. [3] Yamasaki Y, Morita H, Miyahara Y, Ebina Y, Okada T, Yamaguchi M, et al. The factors associated with the failure
of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage. J Perinat Med. 2013;5:1–4. [4] Yu PC, Ou HY, Tsang LL, Kung FT, Hsu TY, Cheng YF. Prophylactic intraoperative uterine artery embolization to control hemorrhage in abnormal placentation during late gestation. Fertil Steril. 2009;91:1951–5.
The authors stated that there are no conflicts of interest regarding the publication of this article.
Copyright of Journal of Perinatal Medicine is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
