title: Predictive factors related to the efficacy of pelvic arterial embolization for postpartum hemorrhage: a retrospective analysis of 21 cases.
abstract: OBJECTIVE
  This retrospective study aimed to determine the predictive factors for the efficacy of pelvic arterial embolization for postpartum hemorrhage.
  
  
  METHODS
  Twenty-one patients who underwent pelvic arterial embolization for postpartum hemorrhage of >1000 mL between September 2006 and September 2011 were enrolled in this study. The patients were divided into two subgroups according to the blood loss and time from the end of pelvic arterial embolization to complete hemostasis: good-response (16 patients) and poor-response groups (5 patients). The following predictive factors were compared between the groups: (1) patient characteristics; (2) blood loss; (3) time between delivery (or onset of bleeding) and pelvic arterial embolization; (4) obstetrical disseminated intravascular coagulation score comprising clinical background, clinical signs, and laboratory data; (5) individual disseminated intravascular coagulation score; (6) shock index; and (7) laboratory data including platelet count, prothrombin time-international normalized ratio, fibrinogen, fibrin degradation products, and antithrombin-III at the time of pelvic arterial embolization.
  
  
  RESULTS
  In the poor-response group, the obstetrical and individual disseminated intravascular coagulation scores and prothrombin time-international normalized ratio were higher than those in the good-response group (p < 0.05). Platelet count, fibrinogen, and fibrin degradation products were lower than those in the good-response group (p < 0.05). All obstetrical disseminated intravascular coagulation scores in the poor-response group were >9 points.
  
  
  CONCLUSIONS
  The efficacy of pelvic arterial embolization is related to the presence or absence of coagulation disorders. When the obstetrical disseminated intravascular coagulation score is high (>9 points), the efficacy may be poor.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Daichi
authors.initials: D
authors.lastname: Urushiyama
authors.affiliation: Center for Maternal, Fetal, and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, Japan. Electronic address: ty-obgyn@cis.fukuoka-u.ac.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Yoshizato
authors.affiliation: Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kora
authors.affiliation: Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Higashihara
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Anna
authors.initials: A
authors.lastname: Sato
authors.affiliation: Department of Obstetrics and Gynecology, Fukuoka Tokushukai Hospital, Fukuoka, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Kubota
authors.affiliation: Department of Obstetrics and Gynecology, Yamaguchi Red Cross Hospital, Yamaguchi, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Tatsumura
authors.affiliation: Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Yoshimitsu
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D019934:International Normalized Ratio; D007744:Obstetric Labor Complications; D010976:Platelet Count; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011517:Prothrombin Time; D012189:Retrospective Studies; D055357:Uterine Artery Embolization
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D005340:Fibrinogen
keywords: disseminated intravascular coagulation; embolization; forecasting; postpartum hemorrhage; therapeutic