PowerPoint Presentation
Endovascular therapy in OB/GYN ESPECIAL IN PPH
DR ramin heidari (cardiologist - interventional cardiology
peripheral interventionalist)
causes
Lieiomyoma
Adenomyosis
AV-M
Fallopian tube recanalization
AV-F
Pelvic congestion syndrome
Uterine bleeding
Retroperitoneal hematoma
Tumor related bleeding ( coriocarcinoma -GTN )
PPH (uterine atony - genital tract trauma Placenta accreta
retained placenta uterine ruptured abnormal placenta site -
retroperitoneal hemorrhage )
Technique
1 Embolization ( hypogasteric . A UAE inf visceral.a internal
pudendal.a inf gluteal .a -other related artery )
2 balloon occlusion technique (Aorta CIA IIA uterine artery
Hypogasteric . A )
Substances for embolization
1 Gel foam ( absorbable after 2 6 WK )
2 PVA 200 to 900
3 coil
4 glue
5 onyx
6 - OTHERS
coil
Embolization
1 Before delivery
2 After delivery
collaterals
1.Cervical .A
2.ovarian.A
3 . Rectal . A
4 . Femoral . A
5 . Lumbar . A
6 . Sacral . A
preparation
1 coordination between OB/GYN & interventionalist - surgeon
internist
2 Lab data include Bun/Cr CBC PT INR electrolyte fibrinogen
FDP
3 Resuscitation of circulation & coagulation before and in
the procedural time in urgent cases
4 Antibiotics prophylaxis ( cazoline coamoxiclave +
metronidazole )
complication
1 fever
2 Buttock ischemia
3 vascular perforation
4 infection
5 Acute limb ischemia
6 uterine ischemia
7 uterine necrosis
8 post embolization syndrome (fever ischemia electrolyte
imbalance - increase CPK due to myolysis nephropathy )
9 Recanalization depending on substances for embolization
10 perforation spasm dissection shock DIC infant death
11 reduce fertility
Success rate
1 95% - 97% in some reports
2 insufficient data
Care after embolization
1 care of sheath insertion (hematoma inspection of distal pulse
electrolyte and Cr measurement Alcalosuria contrast induce
nephropathy CIN )
2 care of fetus viability
3 late care of uterine and underling pathology
Success rate
1 Depending on intervntionalist skill & this team
2 95% to 97% success rate
3 mortality less than 0.5%
4 morbidity (3% - 6%)
5 extract of placenta spontaneous ( 21 wk )
Uterine bleeding due to AV-M
Uterine bleeding
Uterine bleeding due to retained placenta
Placenta accreta
END
