Exploring the role of uterine artery embolization in the management of postpartum hemorrhage.
Postpartum hemorrhage is a potentially life-threatening obstetric emergency that requires prompt nursing and medical interventions. In the majority of cases, initial strategies such as fundal massage and uterotonic medications will effectively stop excessive bleeding. Unfortunately, the incidence and severity of postpartum hemorrhage are on the rise and peripartum hysterectomy remains a life-saving intervention in cases of intractable bleeding. As an emerging alternative to hysterectomy, uterine artery embolization (UAE) has demonstrated success rates of more than 90% in controlling postpartum hemorrhage unresponsive to other therapies. Research to date has shown UAE to be a safe, minimally invasive procedure with few reported complications and minimal effects on future fertility. For patients who are hemodynamically stable with access to an interventional radiology suite, UAE is an important consideration in the treatment of severe postpartum bleeding. This article explores the role of UAE as a part of this management algorithm. The technical aspects of this procedure, reported complications, and effects on future fertility are described. The prophylactic use of intra-arterial balloon catheters in the management of abnormal placentation is also discussed.
Hunter
Linda A
LA
Warren Alpert Medical School of Brown University, Department of Obstetrics & Gynecology, Nurse-Midwifery Section, Women & Infants Hospital, Providence, Rhode Island 02905, USA. lhunter@wihri.org
D000465:Algorithms; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008429:Maternal Welfare; D016389:Maternal-Child Nursing / Q000193:education / Q000458:organization & administration*; D015404:Nursing Methodology Research; D009773:Obstetric Nursing / Q000193:education / Q000458:organization & administration*; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000451:nursing / Q000628:therapy*; D011247:Pregnancy; D011859:Radiography; D012307:Risk Factors; D055357:Uterine Artery Embolization / Q000379:methods* / Q000451:nursing; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging / Q000451:nursing / Q000628:therapy*; D014599:Uterus / Q000098:blood supply