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Uterine necrosis following selective embolization for postpartum hemorrhage using absorbable material

2009; Informa; Volume: 88; Issue: 6 Linguagem: Inglês

10.1080/00016340902934720

1600-0412

Hervé Tixier, Romaric Loffroy, Laurène Coulange, Noémie Butori, Laurence Filipuzzi, Jean–Pierre Cercueil, S. Douvier, D. Krausé, Paul Sagot,

Maternal and fetal healthcare

Acta Obstetricia et Gynecologica ScandinavicaVolume 88, Issue 6 p. 748-748 Free Access Uterine necrosis following selective embolization for postpartum hemorrhage using absorbable material Hervé Tixier, Corresponding Author Hervé Tixier: Hervé Tixier, Department of Gynecology and Obstetrics Bocage Teaching Hospital University of Dijon School of Medicine 2 bd Maréchal de Lattre de Tassigny BP 77908, 21079, Dijon cedex, France. E-mail: herve_tixier@yahoo.frSearch for more papers by this authorRomaric Loffroy, Romaric LoffroySearch for more papers by this authorLaurène Coulange, Laurène CoulangeSearch for more papers by this authorNoémie Butori, Noémie ButoriSearch for more papers by this authorLaurence Filipuzzi, Laurence FilipuzziSearch for more papers by this authorJean Pierre Cercueil, Jean Pierre CercueilSearch for more papers by this authorSerge Douvier, Serge DouvierSearch for more papers by this authorDenis Krause, Denis KrauseSearch for more papers by this authorPaul Sagot, Paul SagotSearch for more papers by this author Hervé Tixier, Corresponding Author Hervé Tixier: Hervé Tixier, Department of Gynecology and Obstetrics Bocage Teaching Hospital University of Dijon School of Medicine 2 bd Maréchal de Lattre de Tassigny BP 77908, 21079, Dijon cedex, France. E-mail: herve_tixier@yahoo.frSearch for more papers by this authorRomaric Loffroy, Romaric LoffroySearch for more papers by this authorLaurène Coulange, Laurène CoulangeSearch for more papers by this authorNoémie Butori, Noémie ButoriSearch for more papers by this authorLaurence Filipuzzi, Laurence FilipuzziSearch for more papers by this authorJean Pierre Cercueil, Jean Pierre CercueilSearch for more papers by this authorSerge Douvier, Serge DouvierSearch for more papers by this authorDenis Krause, Denis KrauseSearch for more papers by this authorPaul Sagot, Paul SagotSearch for more papers by this author First published: 31 December 2010 https://doi.org/10.1080/00016340902934720AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Sir, We read with great interest the letter from Dr. José M. Palacios-Jaraquemada and colleagues concerning ischemic complications following uterine artery embolization (UAE) for postpartum hemorrhage (PPH) using absorbable material 1. First of all, we would like to thank them for their very pertinent comments on cervico-vaginal anastomoses and the need for complete angiographic mapping of the vascular bed before UAE. It must be pointed out, however, that it is sometimes difficult to perform angiography and interpret the images especially because of vasospasm induced by the hemodynamic status of the patient and the possible concomitant use of sulprostone or related prostaglandin medications. We totally agree that the absence of any utero-ovarian anastomoses on the initial angiography does not necessarily constitute a risk factor for necrosis of the uterine adnexa. We would, however, like to underline the risk of uterine necrosis in such cases. Moreover, when utero-ovarian anastomoses are revealed by initial angiography, it is possible to partially reduce blood flow through these anastomoses proximally by using microcoils. This strategy would preclude the risk of overly distal embolization and ovarian necrosis, i.e. protective proximal occlusion. The essence of the problem is the relation between the size of the particles and the degree of selectivity in the site of embolization. The smaller the particles (pumping technique), the more distal the embolization, and the more effective the control of bleeding; the risk of ischemia, however, is greater. Conversely, with larger particles (cutting technique) and more proximal embolization, the lower the risk of ischemia will be; however, in this case the risk of recurrent bleeding will also be higher. Without questioning the obvious interest in UAE, we feel it is necessary to insist on the fact that it should only be used once medical treatment, transfusion of packed red cells and platelets has failed 2, because it is extremely difficult to identify with any certainty the anatomical predictors for the risk of uterine necrosis given the small number of complications reported in the literature. We propose, moreover, that national registries should be set up to record the incidence and nature of complications following UAE in the management of PPH. References 1 Coulange L, Butori N, Loffroy R, Filipuzzi L, Cercueil JP, Douvier S, et al. Uterine necrosis following selective embolization for postpartum hemorrhage using absorbable material. Acta Obstet Gynecol Scand. 2009; 88: 238– 40. Wiley Online LibraryPubMedWeb of Science®Google Scholar 2 Pelage JP, Laissy JP. Management of life-threatening postpartum hemorrhage: indications and technique of arterial embolization. J Radiol. 2006; 87: 533– 40. CrossrefPubMedWeb of Science®Google Scholar Volume88, Issue6June 2009Pages 748-748 ReferencesRelatedInformation