Learning objectives
Discussing the epidemiology and mechanism of Postpartum Haemorrhage.
Imaging findings on CT Angiography and DSA.
Discussing the management of Postpartum Haemorrhage.
Highlights the technique and principles for endovascular embolisation of acute bleed.
Post embolization imaging and potential complication.
Background
Postpartum haemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth or any amount of blood loss that makes a patient hemodynamically unstable.
Types of PPH
Primary PPH: Occurs in first 24hrs following the delivery.
Secondary PPH: Occurs between 24hrs and 12 weeks postnatal.
Typically,
patients were initially treated with uterotonic drugs,
for blood loss will start blood infusion,
FFB etc.
If bleeding was not controlled,
a decision of hysterectomy...
Findings and procedure details
Management of PPH
Patients with PPH require aggressive measures to restore and maintain the circulating blood volume to vital structures.
All medical units involved in the care of pregnant women must have a protocol for the management of severe PPH.
Implement the protocol in a manner similar to a cardiac arrest protocol,
with the same attention to detail and documentation.
The diagnosis of PPH is established by observing the amount of bleeding and the patient’s clinical status.
The amount of blood lost and the patient’s...
Conclusion
Emergency arterial embolization is a safe and effective means of control of primary postpartum haemorrhage.
The procedure obviates high-risk surgery and allows maintenance of reproductive ability.
Personal information
Sooraj S R,
Interventional Radiology Technologist,
Kerala Institute of Medical Sciences,Anayara,
Thiruvananthapuram.
Manish Kumar Yadav DMRD DNB FNVIR,Consultant and Co-ordinator,
Interventional Radiology,
Kerala Institute of Medical Sciences,Anayara,
Thiruvananthapuram.
Madhavan Unni MD DMRD,Consultant and Head of Department,
Imaging and Interventional Radiology,
Kerala Institute of Medical Sciences,Anayara,
Thiruvananthapuram.
Dheeraj Bindal MBBS,
Resident,
Imaging and Interventional Radiology,
Kerala Institute of Medical Sciences,Anayara,
Thiruvananthapuram.
References
Uterine Artery Embolization in the Treatment of Postpartum Uterine Hemorrhage: Suvranu Ganguli,
Michael S.
Stecker,
Deveraj Pyne,
Richard A.
Baum,
Chieh-Min Fan: Journal of Vascular and Interventional Radiology.
Angiographic classification of uterine artery in patients with postpartum hemorrhage: E.
Ueshima,
M.
Yamaguchi,
T.
Okada,
A.
Muradi,
K.
Sofue,
Y.
Koide,
N.
Katayama,
K.
Sugimoto: Journal of Vascular and Interventional Radiology.
Postpartum Hemorrhage from Extravasation or Pseudoaneurysm: Efficacy of Transcatheter Arterial Embolization Using N-Butyl Cyanoacrylate and Comparison with Gelatin Sponge Particle: Kye Jin Park,
Ji Hoon...