산과적 출혈의 처치에 있어서 혈관색전술의 적응증과 효과 및 합병증

Abstract

Objective: The object of this study was to evaluate the indications, effectiveness and complications associated with arterial embolization as a safe and effective alternative treatment of obstetrical hemorrhage. Methods: From September 1998 to October 2005, 42 patients who had a pregnancy related hemorrhage which did not respond to treatment using obstetric maneuvers and uterotonic drugs were included in our study. The patients underwent angiographic embolization for the management of intractable obstetrical hemorrhage at Department of Obstetrics and Gynecology, Yonsei University Medical Center. All available medical records and telephone interviews were reviewed and detailed to collect adequate clinical data such as clinical status, underlying conditions, amount of transfusion, embolization sites, materials of embolization, hospital stay, the success rate and the complications. Results: We have experienced clinically successful embolization in 40 (95.2%) of 42 patients of obstetrical hemorrhage resulting from various causes. After embolization, the patient`s vital sign was stabilized. The causes of hemorrhage were atony of uterus (n=17), cervical pregnancy (n=5), abnormal placentation (n=5), laceration of uterine cervix and vagina (n=6). The average amount of blood transfusion was 10.3 unit (range; 0-63 unit). The average duration of hospitalization was 7.4 days (range; 4-18 days). We were able to follow up on 32 patients. The main complications after embolization were hypomenorrhea (n=6), numbness of lower extremities (n=3). In all cases menses resumed spontaneously after procedures. Conclusion: The arterial embolization is one of the safe and the effective procedures and offers patients a fertility-preserving alternative to hysterectomy for treatment of intractable postpartum hemorrhage.