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Keywords:
Interventional vascular, Obstetrics (Pregnancy / birth / postnatal period), Fluoroscopy, MR, Ultrasound, Embolisation, Intraoperative, Surgery, Obstetrics
Authors:
A. Rebonato, S. Mosca, M. J. Fischer, D. Maiettini, L. Bellantonio, C. Fusco, C. D'Elia, G. A. Crinò, M. Scialpi; Perugia/IT
DOI:
10.1594/ecr2015/B-1268
Conclusion
PAE is a suitable alternative to hysterectomy to control PPH in API pregnancies.
Among API,
placenta previa is the more susceptible of hysterectomy sparing procedures,
both for the different approach of the physician that for the minor blood loss during the delivery.
Is reasonable to attempt PAE before hysterectomy more on placenta previa,
while surgeons and IR team should carefully consider the timing of hysterectomy/PAE on placenta percreta.
If there is no active pooling at the angiograms,
the embolization should be performed on the suspected site of hemorrhage according to information gathered by the surgeon during previous manoeuvres.
The possibility of performing promptly embolic procedures without patient transfer using a radiologic interventional standby allows to further reduce the blood loss and the mortality,
having more chances to avoid hysterectomy.
Moreover,
using our protocol PAE could be performed on hemodynamic unstable patient.
The PAE is also a valuable and efficacious aid in the event of persistent post-hysterectomy bleeding.