Clinical outcomes and future fertility after uterine artery embolization for postpartum and post-abortion hemorrhage.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-04-07 DOI:10.1177/02841851241244489

Shohei Chatani, Akitoshi Inoue, Tokuko Lee, R. Uemura, Yugo Imai, Kai Takaki, Yuki Tomozawa, Yoko Murakami, A. Sonoda, S. Tsuji, Yoshiyuki Watanabe

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Abstract

BACKGROUND Postpartum hemorrhage (PPH) and post-abortion hemorrhage (PAH) are life-threatening conditions. PURPOSE To evaluate the efficacy and safety of uterine arterial embolization (UAE) for PPH and PAH and to investigate future fertility after UAE. MATERIAL AND METHODS This study included 57 consecutive patients (mean age = 34 years) who underwent UAE for PPH (n = 46) and PAH (n = 11) at our institution between January 2011 and December 2022. Technical success, non-visualization of the peripheral portion of bilateral uterine arteries on angiography, and clinical success, complete hemostasis after UAE, were assessed. UAE-associated complications and factors related to clinical success were analyzed. Pregnancy outcomes after UAE and complications during subsequent pregnancy were investigated in 16 patients who desired fertility and were followed up for >1 year. RESULTS The technical and clinical success rates were 100% and 84.2%, respectively. Sepsis (n = 1) and uterine empyema (n = 1) were observed as severe complications. Placental disorder, bleeding within 24 h after delivery or abortion, ≥1.5 shock index, ≥6 units of transfusion erythrocytes, and ≥8 obstetrical disseminated intravascular coagulation score were significantly associated with unfavorable clinical outcomes. In total, 16 pregnancies were observed in 12 patients after UAE, three of which were miscarriages and 13 were successful live births. During pregnancy, uterine rupture (n = 1) and accreta (n = 1) were observed. CONCLUSION UAE is an effective treatment for PPH and PAH. Although UAE could preserve future fertility, careful attention should be paid to perinatal management for unusual complications.

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子宫动脉栓塞治疗产后和流产后出血后的临床效果和未来生育能力。

目的评估子宫动脉栓塞术（UAE）治疗 PPH 和 PAH 的有效性和安全性，并调查 UAE 术后的生育能力。材料和方法本研究纳入了 2011 年 1 月至 2022 年 12 月期间在我院接受 UAE 治疗 PPH（46 例）和 PAH（11 例）的 57 例连续患者（平均年龄 34 岁）。对技术成功率（血管造影未见双侧子宫动脉外周部分）和临床成功率（UAE术后完全止血）进行了评估。此外，还分析了 UAE 相关并发症以及与临床成功相关的因素。对16名希望生育且随访时间超过1年的患者进行了UAE术后妊娠结局和后续妊娠并发症的调查。结果技术和临床成功率分别为100%和84.2%。脓毒症（1 例）和子宫水肿（1 例）为严重并发症。胎盘障碍、产后或流产后 24 小时内出血、休克指数≥1.5、输血红细胞≥6 个单位、产科弥散性血管内凝血评分≥8 分与不良临床结果显著相关。12名患者在接受超导可视无痛分娩后共妊娠16次，其中3次流产，13次成功活产。妊娠期间，观察到子宫破裂（1 例）和胎盘早剥（1 例）。尽管超导可保留未来的生育能力，但仍需注意围产期管理，以防出现异常并发症。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.