Angiographic classification of uterine artery in patients with postpartum hemorrhage

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Abstract

Purpose
To assess the efficacy of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) in the 3 types classified by the angiography and determine factors associated with the failure of the UAE.
Materials and Methods
In a retrospective study, data were analyzed from 50 consecutive women who underwent UAE for PPH between January 2007 and December 2013 at Kobe University Hospital, Hyogo, Japan. Birth canal larcerations and late PPHs (over 24 hours after delivery) were excluded. After the first UAEs, internal examinations were performed. If not hemostatic, re-UAEs were performed. If persistent bleeding occurred after re-UAEs, hysterectomies were performed. Angiographic findings of the uterine arteries were classified into the following 3 types. By the angiography from the bilateral uterine arteries, the entire distal branches of the uterine arteries and the uterine fundus staining were observed in Type A. By the angiography from the unilateral or bilateral uterine arteries, more than 2/3 distal branches of the uterine arteries (distal of ovarian-uterine anastomosis) and lack of uterine fundus staining were observed in Type B, and less than 2/3 distal branches of uterine arteries and lack of major part of uterine staining were observed in Type C. Ages, underlying diseases, classification of uterine arteries and clinical outcomes were evaluated by multivariate analysis.
Results
Initial success rate of the UAEs was 100%(15/15) in type A, 91%(21/23) in type B and 75%(9/12) in type C. Recurrent bleeding rate was 13%(2/15) in type A, 29%(5/21) in type B and 11%(1/9) in type C. The second success rate of the UAEs was 100%(2/2) in type A, 60%(3/5) in type B and 0%(0/1) in type C. The preservation rate of the uterus was 100%(15/15) in type A, 83%(19/23) in type B and 67%(8/12) in type C.
The multivariate analysis shows that obstetric critical hemorrhage is significantly related to the initial success rate (P = 0.02). The partial UA visualization (type B and C) and the dilatation of uterine collaterals tend to have a relation with the initial success rate and the uterine preservation.
Conclusion
Partial visualization of the uterine arteries by the angiography should be considered as a potential risk of UAE failure.
Original languageEnglish
JournalJournal of Vascular and Interventional Radiology
Volume2
Issue number26
DOIs
Publication statusPublished - 31 Jul 2015

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