title: Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries.
abstract: OBJECTIVE
  To retrospectively evaluate safety and efficacy of pelvic artery embolisation (PAE) in post-partum haemorrhage (PPH) in abnormal placental implantation (API) deliveries.
  
  
  METHODS
  From January 2009 to November 2013, 12 patients with API and intractable intraoperative PPH underwent PAE after caesarean delivery to control a haemorrhage (in four of these cases after hysterectomy). Arterial access was obtained prior to the delivery; PAE was performed in the obstetrics operating room by an interventional radiologist that was present with an interventional radiology (IR) team during the delivery.
  
  
  RESULTS
  PAE was successful in preventing bleeding and avoid hysterectomy in four cases (group A). Uterine atony and disseminated intravascular coagulation caused failure of PAE requiring hysterectomy in four patients (group B). PAE prevented bleeding post-hysterectomy in the remaining four cases (group C). Technical success (cessation of contrast extravasation on angiography or occlusion of the selected artery) was 100 %. Maternal and foetal mortality and morbidity were 0 %.
  
  
  CONCLUSIONS
  PAE is a minimal invasive technique that may help to prevent hysterectomy and control PPH in API pregnancies without complications. Embolisation should be performed on an emergency basis. For such cases, an IR team on standby in the obstetrics theatre may be useful to prevent hysterectomy, blood loss and limit morbidity.
  
  
  CONCLUSIONS
  • Endovascular treatment is a validated technique in post-partum haemorrhage. • Abnormal placental implantation is a risk factor for post-partum haemorrhage. • We propose an interventional radiologist standby in the delivery room.
authors.affiliation: Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, Perugia, 06132, Italy. rebonatoalberto@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rebonato
authors.affiliation: Radiology Unit, Santa Maria della Misericordia University Hospital, Sant'Andrea delle Fratte, Perugia, 06132, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Mosca
authors.affiliation: Radiology Unit, Santa Maria della Misericordia University Hospital, Sant'Andrea delle Fratte, Perugia, 06132, Italy.
authors.forename: Matthias
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, Perugia, 06132, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gerli
authors.affiliation: St. Andrea Hospital, Radiology Department, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Via di Grottarossa, 1035-39, 00189, Rome, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Orgera
authors.affiliation: Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, Perugia, 06132, Italy.
authors.forename: Luigina
authors.initials: L
authors.lastname: Graziosi
authors.affiliation: Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, Perugia, 06132, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Maiettini
authors.affiliation: Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, Perugia, 06132, Italy.
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Di Renzo
authors.affiliation: Obsterics and Ginecology Unit, Santa Maria della Misericordia University Hospital, Sant'Andrea delle Fratte, Perugia, 06132, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Epicoco
authors.affiliation: Department of Radiology, "Guy's and St Thomas' NHS Foundation Trust", 1st Floor Lambeth Wing, St Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK.
authors.forename: Miltiadis
authors.initials: M
authors.lastname: Krokidis
authors.affiliation: Radiology Department, St. Andrea Hospital, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Rossi
authors.affiliation: Department of Surgical and Biomedical Science, Santa Maria della Misericordia University Hospital, Perugia University, Sant'Andrea delle Fratte, Perugia, 06132, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Scialpi
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010921:Placenta Accreta / Q000628:therapy*; D010923:Placenta Previa / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055988:Uterine Artery
keywords: Intraoperative procedures; Placenta accreta; Placenta previa; Post-partum haemorrhage; Uterine Artery Embolisation