Embolisation in the Therapy of Post-Partum Haemorrhage in a Patient with a Massive MyomaKrzysztof Pyra1*, Slawomir Wozniak2, Lukasz Swiatlowski1, Piotr Czuczwar2, Michal Sojka1 and Tomasz Jargiello1
- *Corresponding Author:
- Krzysztof Pyra
Department of Interventional Radiology
and Neuroradiology Medical University of Lublin
Jaczewskiego 8, 20-810, Poland
Tel: +48 691 507 825
E-mail: [email protected]
Received date December 31, 2015; Accepted date January 18, 2016; Published date January 28, 2016
Citation: Pyra K, Wozniak S, Swiatlowski L, Czuczwar P, Sojka M, et al. (2016) Embolisation in the Therapy of Post-Partum Haemorrhage in a Patient with a Massive Myoma. Gynecol Obstet (Sunnyvale) 6:349. doi:10.4172/2161-0932.1000349
Copyright: © 2016 Pyra K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Study background: The world prevalence of post-partum haemorrhage is approx. 10.5% of pregnancies, and it is the leading mortality cause among young women, accounting for approx. 25% of fatalities. Post-partum haemorrhage is defined as over 500 ml blood loss from genitals, occurring within the first 24 hours post partum. The presented case is an example of efficacy of the embolisation procedure in the management of post-partum haemorrhage. A 29-y.o. female patient was referred to the hospital in her third pregnancy. Because of the presence of a massive myoma the patient was qualified for delivery by Caesarean section. The child was delivered. The uterine muscle was sutured. Haemostasis control - no signs of active bleeding. Three hours after the Caesarean section a massive postpartum haemorrhage developed. Oxytocin and Methylergometrin were administered intravenously, and Mizoprostol per rectum. The bleeding from the uterine cavity was still massive, and a decision was made on embolisation of uterine arteries.
Methods: The procedure was performed with access via the right femoral artery, under local anaesthesia. A selective injection of a contrast medium to the left uterine artery was performed, which allowed visualisation of the uterine vascular bed with the myoma, as well as of the site of the active, massive bleeding. First the left uterine artery was embolised with particles, in order to close the vascular bed of the myoma. Then, a part of the vessel supplying the uterine muscle with the bleeding site, was closed with Spongostan gel.
Results: Control angiography indicated a correctly closed left uterine artery, with no filling of the uterine vascular bed. No other sites of bleeding were detected.
Conclusion: The selective embolisation of vessels in course of a postpartum haemorrhage in that case was a safe, minimally invasive and highly effective therapeutic method, that ensures an option of further pregnancies.