| Background and PurposeSevere acute obstetric postpartum hemorrhage, often resulting in massivebleeding due to short maternal hemorrhagic shock occurs rapidly, if rescue is nottimely or improper handling can be life-threatening maternal or lead to seriouscomplications. Currently in China, postpartum hemorrhage is still the primary factorin maternal mortality, the incidence rate is about2.22%-8.21%. With thedevelopment of interventional techniques in the treatment of postpartum hemorrhagetraditional treatment methods gradual transition to surgery, uterine arteryembolization treatment of uterine artery embolization for postpartum hemorrhage itwith less trauma, side effects, and can preserve fertility, is the traditional method oftreatment can not be achieved. Because uterine artery embolization postpartumhemorrhage has unique advantages, in recent years, hospitals have successivelycarried out quickly to treatment of uterine artery embolization treatment ofpostpartum hemorrhage, and achieved better therapeutic effects and social effects,patients are gradually understanding, slowly accepted. After uterine arteryembolization treatment of postpartum hemorrhage and postoperative success ratechosen by human factors, embolism way, the extent of thrombosis, embolismagents continue treatment effects of postpartum hemorrhage in patients with partialthrombosis; However, due to various hospitals mastery of different intervention techniques effective hemostasis can not fail to switch uterine artery resection.Although the incidence is very low, if this technology will inevitably happen toquestion, and even affect the promotion of this technology, hospitals frequentlyreported uterine artery embolization surgery failure rate of3%-5%.Our hospital from2000to carry out the uterine artery embolization postpartumhemorrhage since the uterine artery embolization postpartum hemorrhage1350passengers,97.08%of patients surgery is successful, the patient not only saves livesand preserves the uterus. Now super-selective uterine artery embolization has becomethe preferred method of treatment in our hospital treatment of postpartumhemorrhage. But we have97.08%of the surgical success rate, foreign reports95%-100%, does not meet the3%-5%of surgical failure rate of embolization way weneed to, use and extent of postoperative thrombosis, embolic agents continuetreatment of clinical research. By postpartum hemorrhage patients after external iliacartery angiography and found that62%of postpartum hemorrhage patients there isformed by the external iliac artery collateral arteries that supply blood to the uterus,uterine blood flow accounts for15-40%of total blood supply, this part of thecollateral embolization is not able to effectively stop bleeding, embolism this part ofthe collateral if the blood will not cause other complications, we conducted clinicalstudies with questions.Materials and MethodsGeneral information: By observing the143cases of postpartum hemorrhage casepatients,117cases of early maternal, maternal36cases,19cases of twinpregnancies,124cases of singleton pregnancies, maternal age21-37years, meanage (27.37±4.45) years old.86patients of cesarean deliveries,57patients of vaginaldelivery.70cases of postpartum hemorrhage greater than concurrent varying degreesof shock symptoms1000ml,18cases, all patients were given oxytocin, uterine gauzepacking, poor application of conservative treatment underwent hemostaticintervention.Grouping: A group of ultra-selective group of89cases of uterine arteryembolization. Among patients with an average age of (27.13±4.46) years old;primipara67cases,22cases of maternal; cesarean patients49cases,40cases of patients with vaginal delivery.89patients were treated with conservative therapybefore surgery and life support therapy ineffective career change after super-selectiveuterine artery embolization.Group B super-selective uterine artery embolization plus dual external iliacartery angiography and lateral iliac artery embolization group of54cases. The meanage was (27.77±4.44) years old; primipara40patients,14patients maternal.Cesarean section30cases,24cases of patients with vaginal delivery.54patientsbefore surgery were given conservative treatment and life-support therapy ineffectivecareer change after super-selective uterine artery embolization plus dual external iliacartery angiography and lateral iliac artery embolization.Result1. Effect:143cases of postpartum hemorrhage patients,54routinesuper-selective uterine artery embolization plus dual external iliac artery angiographyand lateral iliac artery embolization, all patients (42-73) to complete the operationwithin minutes, the average operation time58.55±8.19minutes, and postoperativerecovery compared with preoperative systolic blood pressure (118.31±11.37) mmHg,diastolic blood pressure (76.25±5.97) mmHg, slowing of the heart rate (88.38±10.71) beats/min, active vaginal bleeding is less than5ml/after0.5hours, surgicalsuccess rate of100%, only minutes after the patients underwent selective uterineartery embolization, all patients (35-66) to complete the operation within minutes,the mean operative time (46.91±7.86) comparing89cases compared withpreoperative systolic blood pressure rise (116.30±12.75) mmHg, diastolic bloodpressure (72.57±6.19) mmHg, slowing to (90.23±11.65) heart beats/min, activevaginal bleeding is less than5ml/after0.5hours, but two cases after0.5hoursbleeding (325.00±106.06) ml,97.75%success rate.2. Complications:54routine selective uterine artery embolization plus dualexternal iliac artery angiography and lateral iliac artery embolization patients,including13cases of fever, body temperature (38±0.5)℃, continuoussymptomatic treatment temperature for3-5days after recovery normal, lowerabdominal pain in6cases, one case of hip pain, symptomatic treatment after2-4days the pain disappeared,89cases only selective uterine artery embolization in patients with19cases of fever, body temperature (38±0.5)℃, continuous3-5days after symptomatic treatment returned to normal, lower abdominal pain ninecases, two cases of hip pain, symptomatic treatment after2-4days the paindisappeared.ConclusionEmbolization of the uterine artery embolization is the treatment of choice inpatients with treatment of postpartum hemorrhage, uterine artery embolizationshould be routinely done bilateral external iliac artery angiography, if found by theexternal iliac artery collateral arterial blood supply to the uterus, should besuper-selective this part of the blood vessels supplying the embolism. Super-selectiveuterine artery embolization plus dual external iliac artery angiography and lateral iliacartery embolization exact bleeding, surgical success rate than a single line ofsuper-selective uterine artery embolization, surgical complications andlong-term effects with a single line of super-selective uterine arteryembolization is no explicit difference. We postpartum hemorrhagepatients by super-selective uterine artery and external iliac arteryembolization some patients avoid hysterectomy has great clinicalsignificance. Postpartum hemorrhage in patients with routinepostoperative external iliac artery angiography were found in the externaliliac artery collateral arteries that supply blood to the uterus, the studysuggests that the main reason for its existence is the failure of previousembolization. |
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