ABSTRACT
There are many interventional techniques that can be used to aid the obstetrician
or gynecologist in caring for their patients in the acute setting. Embolization can
be life saving in the case of postpartum hemorrhage. Bleeding related to cervical
cancer or the threat of bleeding from cervical ectopic pregnancy is amenable to embolization
as is hemorrhage related to uterine arteriovenous malformations. Postpartum women
are also at a uniquely high risk for deep vein thrombosis and pulmonary emboli and
may benefit from consultation and treatment by an interventional radiologist. The
goal of this article is to discuss the valuable role that the interventional radiologist
plays in the treatment of these obstetric and gynecologic conditions.
KEYWORDS
Postpartum hemorrhage - embolization - pelvic hemorrhage - uterine arteriovenous malformations
- venous thromboembolic disease
REFERENCES
- 1 Maternal Mortality in 2005. Estimates developed by WHO, UNICEP, UNFPA, and The World
Bank. Geneva; World Heath Organization Publications 2007
- 2
Chang J, Elam-Evans L D, Berg C J et al..
Pregnancy-related mortality surveillance – United States, 1991–1999.
MMWR Surveill Summ.
2003;
52
1-8
- 3
Dildy G A.
Postpartum hemorrhage: new management options.
Clin Obstet Gynecol.
2002;
45
330-344
- 4
Combs C A, Murphy E L, Laros R K.
Factors associated with hemorrhage in cesarean deliveries.
Obstet Gynecol.
1991;
77
77-82
- 5
Clark S L, Phelan J P, Yeh S Y et al..
Hypogastric artery ligation for obstetric hemorrhage.
Obstet Gynecol.
1985;
66
353-356
- 6
Oyelese Y, Smulian J C.
Placenta previa, placenta accreta, and vasa previa.
Obstet Gynecol.
2006;
107
927-941
- 7
Hudon L, Belfort M A, Broome D R.
Diagnosis and management of placenta percreta: a review.
Obstet Gynecol Surv.
1998;
53
509-517
- 8
Clark S L, Koonings P P, Phelan J P.
Placenta previa/accreta and prior cesarean section.
Obstet Gynecol.
1985;
66
89-92
- 9
El-Miligy M, Gordon A, Houston G.
Focal myometrial defect and partial placenta accreta in a pregnancy following bilateral
uterine artery embolization.
J Vasc Interv Radiol.
2007;
18
789-791
- 10
Pron G, Mocarski E, Bennett J et al..
Pregnancy after uterine artery embolization for leiomyomata: The Ontario Multicenter
trial.
Obstet Gynecol.
2005;
105
67-76
- 11
Brown B J, Heaston K D, Poulson A M, Gabert H A, Mineau D E, Miller Jr F J.
Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic
arterial embolization.
Obstet Gynecol.
1979;
54(3)
361-365
- 12
Heaston D K, Mineau D E, Brown B J, Miller Jr F J.
Transcatheter arterial embolization for control of persistent massive puerperal hemorrhage
after bilateral surgical hypogastric artery ligation.
AJR Am J Roentgenol.
1979;
133(1)
152-154
- 13
Vedantham S, Goodwin S C, McLucas B, Mohr G.
Uterine artery embolization: an underused method of controlling pelvic hemorrhage.
Am J Obstet Gynecol.
1997;
176
938-948
- 14
Vegas G, Illescas T, Munoz M, Perez-Pinar A.
Selective pelvic arterial embolization in the management of obstetric hemorrhage.
Eur J Obstet Gynecol Reprod Biol.
2006;
127
68-72
- 15
Hansch E, Chitkara U, McAlpine J, El-Sayed Y, Dake M D, Razavi M K.
Pelvic arterial embolization for control of obstetric hemorrhage: A five-year experience.
Am J Obstet Gynecol.
1999;
180
1454-1460
- 16
Descargues G, Douvrin F, Degre S, Lemoine J P, Marpeau L, Clavier E.
Abnormal placentation and selective embolization of the uterine arteries.
Eur J Obstet Gynecol Reprod Biol.
2001;
99
47-52
- 17
Cheng Y Y, Hwang J L, Hung S W et al..
Angiographic embolization for emergent and prophylactic management of obstetric hemorrhage:
a four-year experience.
J Chin Med Assoc.
2003;
66
727-734
- 18
Chung J W, Jeong H J, Joh J H, Park J S, Jun J K, Kim S H.
Percutaneous transcatheter angiographic embolization in the management of obstetric
hemorrhage.
J Reprod Med.
2003;
48
268-276
- 19
Ornan D, White R, Pollak J, Tal M.
Pelvic embolization for intractable postpartum hemorrhage: long-term follow-up and
implications for fertility.
Obstet Gynecol.
2003;
102
904-910
- 20
Boulleret C, Chahid T, Gallot D et al..
Hypogastric arterial selective and superselective embolization for severe postpartum
hemorrhage: a retrospective review of 36 cases.
Cardiovasc Intervent Radiol.
2004;
27
344-348
- 21
Hong T M, Tseng H S, Lee R C, Wang J H, Chang C Y.
Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage.
Clin Radiol.
2004;
59
96-101
- 22
Ojala K, Perala J, Kariniemi J, Ranta P, Raudaskoski T, Tekay A.
Arterial embolization and prophylactic catheterization for the treatment for severe
obstetric hemorrhage.
Acta Obstet Gynecol Scand.
2005;
84
1075-1080
- 23
Yong S P, Cheung K B.
Management of primary postpartum hemorrhage with arterial embolization in Hong Kong
public hospitals.
Hong Kong Med J.
2006;
12
437-441
- 24
Shim J Y, Yoon H K, Won H S, Kim S K, Lee P R, Kim A.
Angiographic embolization for obstetrical hemorrhage: effectiveness and follow-up
outcome of fertility.
Acta Obstet Gynecol Scand.
2006;
85
815-820
- 25
Mathe M L, Morau E, Vernhet-Kovacsik H, Picot M C, Boulot P.
Impact of the new French clinical practice recommendations in embolization in postpartum
and post-abortion hemorrhage: study of 48 cases.
J Perinat Med.
2007;
35
532-537
- 26
La Folie T, Vidal V, Mehanna M et al..
Results of endovascular treatment in cases of abnormal placentation with post-partum
hemorrhage.
J Obstet Gynaecol Res.
2007;
33
624-630
- 27
Eriksson L G, Mulic-Lutvica A, Jangland L, Nyman R.
Massive postpartum hemorrhage treated with transcatheter arterial embolization: technical
aspects and long-term effects of fertility and menstrual cycle.
Acta Radiol.
2007;
48(6)
635-642
- 28
Soncini E, Pelicelli A, Larini P, Marcato C, Monaco D, Grignaffini A.
Uterine artery embolization in the treatment and prevention of postpartum hemorrhage.
Int J Gynaecol Obstet.
2007;
96
181-185
- 29
Subtil D, Somme A, Ardiet E, Deptet-Mosser S.
Postpartum hemorrhage: frequency, consequences in terms of health status, and risk
factors before delivery.
J Gynecol Obstet Biol Reprod (Paris).
2004;
33(8 Suppl)
4S9-4S16
- 30
Cottier J P, Fignon A, Tranquart F, Herbreteau D.
Uterine necrosis after arterial embolization for postpartum hemorrhage.
Obstet Gynecol.
2002;
100
1074-1077
- 31
Bodner L J, Nosher J L, Gribbin C, Siegel R L, Beale S, Scorza W.
Balloon-assisted occlusion of the internal iliac arteries in patients with placenta
accrete/percreta.
Cardiovasc Intervent Radiol.
2006;
29
354-361
- 32
Levine A B, Kuhlman K, Bonn J.
Placenta accrete: comparison of cases managed with and without pelvic artery balloon
catheters.
J Matern Fetal Med.
1999;
8
173-176
- 33
McCollough C H, Schueler B A, Atwell T D et al..
Radiation exposure and pregnancy: when should we be concerned?.
Radiographics.
2007;
27
909-917
- 34
Bayati J, Garcia J E, Dorsey J H, Padilla S L.
Combined intrauterine and cervical pregnancy from in vitro fertilization and embryo
transfer.
Fertil Steril.
1989;
51
725-727
- 35
Frates M C, Benson C B, Boubilet P M et al..
Cervical ectopic pregnancy: results of conservative treatment.
Radiology.
1994;
191
773-775
- 36
Salomon L J, deTayrac R, Castaigne-Meary V et al..
Fertility and pregnancy outcome following pelvic arterial embolization for sever post-partum
haemorrhage. A cohort study.
Hum Reprod.
2003;
18
849-852
- 37
O'Brien P, Neyastani A, Buckley A R, Chang S D, Legiehn G M.
Uterine arteriovenous malformations: from diagnosis to treatment.
J Ultrasound Med.
2006;
25
1387-1392
- 38
Ghai S, Rajan D K, Asch M R, Muradali D, Simons M E, TerBrugge K G.
Efficacy of embolization in traumatic uterine malformations.
J Vasc Interv Radiol.
2003;
14
1401-1408
- 39
Timmerman D, Van den Bosch T, Peeraer K et al..
Vascular malformations in the uterus: ultrasonographic diagnosis and conservative
management.
Eur J Obstet Gynecol Reprod Biol.
2000;
92
171-178
- 40
Mihmanli I, Cantasdemir M, Kantarci F, Halit Yilmaz M, Numan F, Mihmanli V.
Percutaneous embolization in the management of intractable vaginal bleeding.
Arch Gynecol Obstet.
2001;
264
211-214
- 41
Pisco J M, Martins J M, Correia M G.
Internal iliac artery: Embolization to control hemorrhage from pelvic neoplasms.
Radiology.
1989;
172
337-339
- 42
James A H, Tapson V F, Goldhaber S Z.
Thrombosis during pregnancy and the postpartum period.
Am J Obstet Gynecol.
2005;
193
216-219
- 43
McColl M D, Ramsay J E, Tait R C et al..
Risk factors for pregnancy-associated venous thromboembolism.
Thromb Haemost.
1997;
78
1183-1188
- 44
Greer I A.
The acute management of venous thromboembolism in pregnancy.
Curr Opin Obstet Gynecol.
2001;
13
569-575
- 45
Miller D L, Balter S, Cole P E et al..
Radiation doses in interventional radiology procedures: the RAD-IR study part I: overall
measures of dose.
J Vasc Interv Radiol.
2003;
14
711-727
- 46
Bonn J, Liu J B, Eschelman D, Sullivan K L, Pinheiro L W, Gardiner Jr G A.
Intravascular ultrasound as an alternative to positive-contrast vena cavography prior
to filter placement.
J Vasc Interv Radiol.
1999;
10
843-849
- 47 Chang J, Elam-Evans L D, Berg C J et al.. Pregnancy-related mortality surveillance—United
States, 1991–1999. Center for Disease Control MMWR Survey February 12, 2003/52(SS02);
1–8. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5202a1.htm Accessed March 3, 2008
- 48
Turrentine M A, Braems G, Ramirez M M.
Use of thrombolytics for the treatment of thromboembolic disease during pregnancy.
Obstet Gynecol Surv.
1995;
50
534-541
- 49
Ahearn G S, Hadjiliadis D, Govert J A, Tapson V F.
Massive pulmonary embolism during pregnancy successfully treated with recombinant
tissue plasminogen activator: A case report and review of treatment options.
Arch Intern Med.
2002;
162
1221-1227
Shellie C JosephsM.D.
Department of Radiology, Vascular and Interventional Radiology, University of Texas
Southwestern Medical Center
5323 Harry Hines Blvd., Dallas, TX 75390-8834
Email: Shellie.Josephs@UTSouthwestern.edu
