Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation

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  • Soichiro Obata
    Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan
  • Michi Kasai
    Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan
  • Junko Kasai
    Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan
  • Kazuo Seki
    Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan
  • Zenjiro Sekikawa
    Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
  • Izumi Torimoto
    Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
  • Shigeo Takebayashi
    Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
  • Fumiki Hirahara
    Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Japan
  • Shigeru Aoki
    Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan

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<jats:p>Although it is widely accepted that uterine artery embolization (UAE) is an effective therapeutic strategy for postpartum hemorrhage (PPH), no consensus has been reached regarding the efficacy of UAE in patients with PPH with disseminated intravascular coagulation (DIC). This single-center retrospective cohort study included patients treated with UAE using NBCA for PPH between 2010 and 2015. The patients were divided into DIC and non-DIC groups, according to the obstetrical DIC score and the overt DIC diagnostic criteria issued by the International Society of Thrombosis and Haemostasis (ISTH), and their clinical outcomes were compared. There were 28 patients treated with UAE using NBCA. Complete hemostasis was achieved by UAE in 19 of 28 patients. In eight of nine patients with unsuccessful hemostasis, surgical hemostatic interventions were performed after UAE, and hemostasis was achieved in seven patients. UAE using NBCA showed no significant intergroup differences in complete hemostasis according to the presence or absence of DIC based on obstetrical DIC score (70% versus 62.5%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">1.000</mml:mn></mml:math>) or ISTH DIC score (54.5% versus 76.5%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn fontstyle="italic">0.409</mml:mn></mml:math>). UAE using NBCA may be a useful first-choice treatment for PPH with DIC.</jats:p>

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