Study On Efficacy And Related Risk Factors Of Interventional Therapy For Intractable Postpartum Hemorrhage

Objective:To investigate the efficacyand failure factors of uterine artery embolization(UAE) in treatment of intractable postpartum hemorrhage(PPH). Methods:The clinical data of 64 cases with intractable PPH by interventional therapy in our hospital were analyzed retrospectively. General information, efficacy, angiographic manifestations were analyzed in both recurring and nonrecurrentbleeding groups. Then suspect risk factors of unsuccessful interventional therapy were filtered out by multivariate analysis. Results:1. 57 of the 64 patients(89%) were treated with UAE successfully. In 7 cases, embolization failed, including 4 cases of hysterectomy and 3 cases of a second UAE. Embolization was successfully performed in 2 cases and 1case underwent hysterectomy after failed again.5cases underwent UAE after failed therapy of B-lynch suture of which 4 cases were successful.2 cases of uterine artery pseudoaneurysm(UAP) and 6 cases of DIC were treated with UAE successfully. No patient experienced serious complications and normal menstruation resumed in all patients after followed-up for 3 and 6 month.2.Angiography showed bilateral uterine arteryoriginated from proximal of iliac artery and distal of inferior gluteal artery in one case each; trunk of uterine artery distinctly contracted in 5 cases; Bilateral internal iliac artery branch was orgin of blood supply in 8 cases and external iliac artery branch in 2 cases.3. Each suspicious risk factors of recurrent bleeding were evaluated with univariate analysis and results showed that history of scarred uterus, combined use of oxytocin, uterine atony and placenta factor were quite different in two groups, with statistical significance(P<0.05).After multivariate analysis, two criteria emerged as risk factors of recurrent bleeding: history of scarred uterus(odds ratio [OR] =11.23,P=0.030), combined use of oxytocin(OR=12.83,P=0.045). Conclusions:1. UAE, due to its high success rate, less complications, and retains the uterus and fertility function, is an effective treatment of intractable postpartum hemorrhage.2.History of scarred uterus and combined use of oxytocin increase the risk of recurrent bleeding after UAE for intractable PPH. To further improve the success rate of interventional treatment, placenta factor and anatomic variations in the uterine arteries should be emphasized.