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  • Title: Postpartum haemorrhage from ruptured pseudoaneurysm: efficacy of transcatheter arterial embolisation using N-butyl-2-cyanoacrylate.
    Author: Kim GM, Yoon CJ, Seong NJ, Kang SG, Kim YJ.
    Journal: Eur Radiol; 2013 Aug; 23(8):2344-9. PubMed ID: 23559143.
    Abstract:
    OBJECTIVES: To evaluate the efficacy of transcatheter arterial embolisation (TAE) using N-butyl-2-cyanoacrylate (NBCA) in the treatment of postpartum haemorrhage (PPH) due to ruptured pseudoaneurysm. METHODS: From March 2004 to December 2010, 33 patients underwent TAE using NBCA for massive PPH. Twenty-one patients (63.6 %) were in coagulopathic condition. Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent haemorrhage after TAE. Telephone interviews were conducted to obtain fertility-related data. RESULTS: Emergent angiograms revealed ruptured pseudoaneurysms at the uterine (n = 17), vaginal (n = 14), internal pudendal (n = 3) and obturator (n = 1) arteries, which were successfully embolised with NBCA. Four patients required additional embolisation of the uterine (n = 3) or ovarian artery (n = 1) with an absorbable gelatine sponge. Adequate haemostasis was achieved in 31 patients (93.9 %) after TAE. Two patients experienced persistent (n = 1) or recurrent (n = 1) haemorrhage, which required hysterectomy. There were no major embolisation-related complications. All 29 patients who were interviewed reported regaining of their regular menstruation. Nine patients had normal pregnancies and delivered healthy babies at full term. CONCLUSIONS: TAE using NBCA is an effective treatment of PPH from ruptured pseudoaneurysms. In particular, NBCA is a potent embolic material in patients with coagulopathy. It does not seem to adversely affect future fertility. KEY POINTS: • Transcatheter arterial embolisation is a safe and effective treatment for postpartum haemorrhage. • NBCA is potent embolic material to treat bleeding patients with severe coagulopathy. • NBCA does not seem to adversely affect future fertility.
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