| Objective: To analyze the clinical application value of interventional embolization in the treatment of intractable postpartum hemorrhage,termination of mid trimester of pregnancy with placenta previa,placenta accreta with postpartum hemorrhage and scar pregnancy.Methods: 78 cases of pregnancy related bleeding disorders underwent interventional embolization for the treatment in the Army General Hospital from January 2010 to December 2016 were included,and divided into the following 4 groups.Group A: 22 cases of intractable postpartum hemorrhage,and they were further divided into two subgroups according to the embolic pelvic artery.Group A1(9 cases): embolization of bilateral uterine artery artery combined with other artery;group A2(13 cases): bilateral uterine artery embolism.Group B(8 cases): termination of mid trimester of pregnancy with placenta previa.Group C(3 cases): placenta accreta complicated with postpartum hemorrhage.Group D(45cases): scar pregnancy underwent interventional embolization before curettage.Another 17 scar pregnancy cases without interventional therapy before curettage were collected as the control group.These 78 cases were analyzed retrospectively,including the general situation,the treatment process,as well as the efficacy and complications of interventional embolization.Results:1.To analyze the number of patients with obstetric hemorrhage treated with interventional embolization in our hospital in recent 7 years,There were 5 patients in 2010,7 patients in 2011,12 patients in 2012,15 patients in 2013,15 patients in 2014,12patients in 2015,12 patients in 2016.While to calculate the proportion of patients treated with interventional embolization to the number of pregnant woman with postpartum hemorrhage in the same period,The proportion is 3.35% in 2010(5/149),3.57% in 2011(7/196),4.32% in 2012(12/278),8.98% in 2013(15/167),4.21% in 2014(15/356),7.55% in 2015(12/159),9.68% in 2016(12/124).And there has been a general uptrend in the proportion of patients underwent interventional embolization.2.Of the 22 patients with intractable postpartum hemorrhage in group A,there was no statistically significant difference of baseline condition between group A1(9 cases)and group A2(13 cases),including age,gravidity,parity,gestational age,mode of delivery and the reason of intractable postpartum hemorrhage.However,the amount of bleeding,suspended red blood cell input,hemorrhagic shock and the ratio of DIC in group A1 was much higher than that in group A2.In addition,there was no significant difference in plasma input and related complications after interventional embolization,as well as the success rate following treatment between the two groups(77.8% in group A1 versus 92.3% in group A2,P > 0.05).3.Of the 8 cases with termination of mid trimester of pregnancy with placenta previa,the total bleeding volume was 800 ~ 3000 m L(1725 m L in average)in 4 cases with therapeutic embolization treatment;and that was 100 to 500 m L(225 m L in average)in 4 cases with preventive intervention treatment.The interventional therapy was effective for all without any hysterectomy.4.In group C,3 cases of placenta accreta complicated with postpartum hemorrhage patients were found to have placenta implantation following spontaneous delivery.They were treated with methotrexate(MTX),combined with uterine artery embolization interventional therapy.After blood human chorionic gonadotropin(HCG)was decreased and ultrasound showed safe conditions that permit curettage,uterine curettage was implemented,and the patients got a smooth recovery.5.In group D,45 cases of scar pregnancy undergoing preventive interventionaltreatment before curettage were collected as the observation group,and another 17 cases without interventional treatment before curettage were treated as the control group,the palace before interventional therapy.There was no statistically significance between the two groups in age,gravidity,parity,from the last cesarean section age,menopause duration,gestational sac size,ultrasound visible embryo proportion,as well as operation style(the proportion of laparoscopic surgery).However,HCG level in the observation group was higher than that in the control group,but the thickness of lower thinnest uterine segment was thinner than that in the control group(P < 0.05).In comparison of therapeutic effects,the total amount of bleeding and hospitalization time in the observation group were less than the control group,and HCG lower at discharge were more than that in the control group(P < 0.05).Conclusion: 1.Obstetric hemorrhagic diseases underwent interventional embolization treatment were rising in recent years.2.pelvic artery distributed very complicated.In addition to bilateral uterine artery,internal iliac artery branches and ovarian artery blood supply may make patients with serious postpartum hemorrhage and complications.Hence,it is necessary to implement angiography and embolization for internal iliac artery and ovarian artery during the occurrence of intractable postpartum hemorrhage.3.Interventional embolization combined with intra amniotic injection provides an excellent choice for treatment of induced mid trimester abortion with placenta previa.It is suggested that all placenta previa patients should accept the interventional embolization treatment before induced abortion.4.Interventional embolization therapy combined with methotrexate(MTX)treatment is effective and safe in the treatment of placenta accreta and postpartum hemorrhage.5.Interventional embolization treatment before curettage for patients with scar pregnancy can reduce the intraoperative blood loss,decrease HCG level obviously,andshorten the hospitalization time,which has high safety and good therapeutic effect. |
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