DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20202274

Management of obstetric hemorrhage; an observational study highlighting the efficacy of uterine artery ligation

Ambreen Ghouri, Bushra Mushtaq, Azra Ahmed, Najma Dalwani, Padma Bai, Anas Bin Tariq

Abstract


Background: Obstetrical hemorrhage is leading cause of maternal mortality. UAE is termed safe and effective method for resolving hemorrhage. objective of this study was to determine efficacy of uterine artery ligation in management of obstetrical hemorrhage.

Methods: This cross sectional observational using non-probability convenient sampling technique was carried out for six months. After ethical approval, females between 18 to 35 years diagnosed with obstetrical hemorrhage, uterine atony refractory to medical treatment, having active bleeding from placental side or having normal coagulation profile were while females with post-partum hemorrhage because of retained products of conception, due to genital tract trauma or with disseminated intravascular coagulation were excluded. Analysis of data was done using SPSS version 23.0. Quantitative variables were reported as mean and standard deviation and for qualitative variables, frequency and percentages. Chi-square test was applied keeping p-value of <0.05 as statistically significant.

Results: From 109 females with mean age 47±5.25 years. In comparison of parity distribution, 62 (56.88%) were multiparous and 47 (43.12%) were primiparous. Type of bleeding observed was antepartum 36(33.03%), peripartum 39 (35.78%) and postpartum in 34 (31.19%). Efficacy of uterine artery ligation in management of obstetric hemorrhage was observed to be 35 (32.11%). The efficacy of uterine artery ligation in management of obstetric hemorrhage in three categories of age groups reported significant association (p=0.0005) and type of bleeding (p=0.025).

Conclusions: Efficacy of UAE in different types of obstetrical hemorrhage reported in our study was lower than expected in about one-third of females.


Keywords


Uterine artery ligation, obstetric hemorrhage, ante-partum hemorrhage, peri-partum hemorrhage, post-partum hemorrhage

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References


Le Gouez A, Mercier FJ. Major obstetric hemorrhage. Transfusion Clinique etBiologique. 2016;23(4):229-32.

Main EK, Goffman D, Scavone BM, Low LK, Bingham D, Fontaine PL, et al. National partnership for maternal safety consensus bundle on obstetric hemorrhage. Journal Midwifery Women's Health. 2015;60(4):458-64.

Van de Velde M, Diez C, Varon AJ. Obstetric hemorrhage. Curr Opin Anesthesiol. 2015;28(2):186-90.

Baird EJ. Identification and management of obstetric hemorrhage. Anesthesiol Clin. 2017;35(1):15-34.

Saad A, Costantine MM. Obstetric hemorrhage: recent advances. Clin Obstet Gynecol. 2014;57(4):791-6.

Puchol MF, Lanciego C, Esteban E, Ciampi JJ, Edo MA, Ferragud S. Selective embolization to treat obstetric hemorrhage. Radiol. 2014;56(2):148-53.

Dsouza J, Kumar S, Hande PC, Singh SN. Uterine artery embolisation for uterine fibroids: Our experience at a tertiary care service hospital. Med J Armed Forces India. 2015;71(3):233-8.

Torre A, Paillusson B, Fain V, Labauge P, Pelage JP, Fauconnier A. Uterine artery embolization for severe symptomatic fibroids: effects on fertility and symptoms. Human Reprod. 2014;29(8):1833-4.

Sidhu HK, Prasad GR, Jain V, Kalra J, Gupta V, Khandelwal N. Pelvic artery embolization in the management of obstetric hemorrhage. Acta Obstetr Gynecol Scandina. 2010;89(8):1096-9.

Niola R, Giurazza F, Nazzaro G, Silvestre M, Nasti G, Di Pasquale MA, et al. Uterine artery embolization before delivery to prevent postpartum hemorrhage. J Vascular Intervent Radiol. 2016;27(3):376-82.

Martin J, Abraham T. Uterine artery embolization for post-partum hemorrhage. McMaster Univ Med J. 2014;11(1):21-6.

McLucas B, Voorhees III WD. Results of UAE in women under 40 years of age. Minimal Invas Ther Allied Technol. 2014;23(3):179-83.

Resnick NJ, Kim E, Patel RS, Lookstein RA, Nowakowski FS, Fischman AM. Uterine artery embolization using a transradial approach: initial experience and technique. J Vas Intervent Radiol. 2014;25(3):443-7.

Liu Z, Wang Y, Yan J, Li J, Liu X, Zhang L, et al. Uterine artery embolization versus hysterectomy in the treatment of refractory postpartum hemorrhage: a systematic review and meta-analysis. J Maternal-Fetal Neonat Med. 2020;33(4):693-705.

Van Overhagen H, Reekers JA. Uterine artery embolization for symptomatic leiomyomata. Cardiovas Intervent Radiol. 2015;38(3):536-42.

Brown BJ, Heaston DK, Poulson AM, Gabert HA, Mineau DE, Miller JF. Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol. 1979;54(3):361-5.

deBruijn AM, Ankum WM, Reekers JA, Birnie E, van der Kooij SM, Volkers NA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol. 2016;215(6):745-51.

Singhal M, Gupta P, Sikka P, Khandelwal N. Uterine artery embolization following internal iliac arteries ligation in a case of post-partum hemorrhage: a technical challenge. J Obstet Gynecol India. 2015;65(3):202-5.

Myers TT. Uterine artery embolization for postpartum hemorrhage. J Radiol Nurs. 2016;35(2):142-5.

Tandon P, Juneja SK, Mohan B. Angiographic embolization for intractable obstetrical bleeding. Int J Applied Basic Med Res. 2014;4(1):25-7.

Wong TP. Arterial embolisation in intractable primary post-partum haemorrhage: case series. Hong Kong Med J. 2004;10(5):301-6.

Merland JJ, Houdart E, Herbreteau D, Trystram D, Ledref O, Aymard A, et al. Place of emergency arterial embolisation in obstetric haemorrhage about 16 personal cases. Eur J Obstet Gynecol Reprod Biol. 1996;65(1):141-3.

Gilbert WM, Moore TR, Resnik R, Doemeny J, Chin H, Bookstein JJ. Angiographic embolization in the management of hemorrhagic complications of pregnancy. Am J Obstet Gynecol. 1992;166(2):493-7.

Soro MA, Denys A, de Rham M, Baud D. Short and long-term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review. Eur Radiol. 2017;27(2):749-62.

Kirby JM, Kachura JR, Rajan DK, Sniderman KW, Simons ME, Windrim RC, et al. Arterial embolization for primary postpartum hemorrhage. J Vas Intervent Radiol. 2009;20(8):1036-45.

Touboul C, Badiou W, Saada J, Pelage JP, Payen D, Vicaut E, et al. Efficacy of selective arterial embolisation for the treatment of life-threatening post-partum haemorrhage in a large population. PLoS One. 2008;3(11):3819:1-6.

Singhal S, Singh A, Raghunandan C, Gupta U, Dutt S. Uterine artery embolization: exploring new dimensions in obstetric emergencies. Oman Med J. 2014;29(3):217-9.

Keung JJ, Spies JB, Caridi TM. Uterine artery embolization: a review of current concepts. Best Pract Res Clin Obstet Gynaecol. 2018;46:66-73.