title: Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration.
abstract: OBJECTIVE
  We evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.
  
  
  METHODS
  We reviewed seven cases of patients (mean age 30.9 years; range 27-35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery's architecture, technical and clinical success rates, and complications.
  
  
  RESULTS
  The vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.
  
  
  CONCLUSIONS
  Postpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.
authors.affiliation: Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan. mkoganemaru@med.kurume-u.ac.jp.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Koganemaru
authors.affiliation: Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nonoshita
authors.affiliation: Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Iwamoto
authors.affiliation: Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Asako
authors.initials: A
authors.lastname: Kuhara
authors.affiliation: Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Nabeta
authors.affiliation: Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kusumoto
authors.affiliation: Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kugiyama
authors.affiliation: Department of Obstetrics and Gynecology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kozuma
authors.affiliation: Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Nagata
authors.affiliation: Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Toshi
authors.initials: T
authors.lastname: Abe
mesh_terms: D000328:Adult; D000792:Angiography; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D006801:Humans; D022125:Lacerations / Q000000981:diagnostic imaging / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D011247:Pregnancy; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014621:Vagina / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries; D014623:Vaginal Diseases / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D003287:Contrast Media
keywords: Postpartum hemorrhage; Transcatheter embolization; Vaginal artery; Vaginal laceration