title: Postpartum haemorrhage from ruptured pseudoaneurysm: efficacy of transcatheter arterial embolisation using N-butyl-2-cyanoacrylate.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
authors.forename: Gyoung Min
authors.initials: GM
authors.lastname: Kim
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Yoon
authors.forename: Nak Jong
authors.initials: NJ
authors.lastname: Seong
authors.forename: Sung-Gwon
authors.initials: SG
authors.lastname: Kang
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000628:therapy*; D000792:Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics; D006487:Hemostasis; D006801:Humans; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055988:Uterine Artery / Q000473:pathology; D014621:Vagina / Q000098:blood supply; D055815:Young Adult
chemical_list: D004659:Enbucrilate
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