title: Use of intra-arterial nitroglycerin during uterine artery embolization for severe postpartum hemorrhage with uterine artery vasospasm.
abstract: OBJECTIVE
  Uterine artery embolization (UAE) is a standard method for treating postpartum hemorrhage (PPH), although uterine artery vasospasm during UAE may lead to failure of hemostasis. Here, we report our experience with a case of PPH in which the bleeding was successfully controlled by intra-arterial administration of nitroglycerin during the second UAE.
  
  
  METHODS
  A 30-year-old woman experienced PPH following a successful cesarean section, and a UAE was performed. However, 6 hours later, vaginal bleeding restarted; the reason for unsuccessful embolization during the first UAE was vasoconstriction due to hypovolemic shock. We performed a second UAE, but uterine bleeding continued. After intra-arterial administration of nitroglycerin, hemostasis was confirmed, and there was no reperfusion of the uterine artery. After these two UAE procedures, no recurrence of bleeding was observed.
  
  
  CONCLUSIONS
  Thus, use of intra-arterial nitroglycerin was effective for controlling uterine artery vasospasm during UAE. However, larger studies are required to confirm these findings.
authors.affiliation: Perinatal Center, Division of Maternal and Fetal Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Liangcheng
authors.initials: L
authors.lastname: Wang
authors.affiliation: Perinatal Center, Division of Maternal and Fetal Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Horiuchi
authors.affiliation: Perinatal Center, Division of Maternal and Fetal Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Mikami
authors.affiliation: Perinatal Center, Division of Maternal and Fetal Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan. Electronic address: kenjirotakagi@me.com.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Okochi
authors.affiliation: Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hamamoto
authors.affiliation: Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Emiko
authors.initials: E
authors.lastname: Chiba
authors.affiliation: Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Matsuura
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D005996:Nitroglycerin / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D012008:Recurrence; D055988:Uterine Artery / Q000503:physiopathology*; D055357:Uterine Artery Embolization; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: nitroglycerin; postpartum hemorrhage; uterine artery; uterine artery embolization; vasoconstriction