Risk factors for poor hemostasis of prophylactic uterine artery
embolization before curettage in cesarean scar pregnancy

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Abstract

Objective

To observe the hemostatic effect of prophylactic uterine artery embolization (UAE) in patients with cesarean scar pregnancy (CSP) and to examine the risk factors for poor hemostasis.

Methods

Clinical data of 841 patients with CSP who underwent prophylactic UAE and curettage were retrospectively analyzed to evaluate the hemorrhage volume during curettage. A hemorrhage volume ≥200 mL was termed as poor hemostasis. The risk factors of poor hemostasis were analyzed and complications within 60 days postoperation were recorded.

Results

Among the 841 patients, 6.30% (53/841) had poor postoperative hemostasis. The independent risk factors of poor hemostasis were gestational sac size, parity, embolic agent diameter (>1000 μm), multivessel blood supply, and incomplete embolization. The main postoperative complications within 60 days after UAE were abdominal pain, low fever, nausea and vomiting, and buttock pain, with incidence rates of 71.22% (599/841), 47.44% (399/841), 39.12% (329/841), and 36.39% (306/841), respectively.

Conclusions

Prophylactic UAE before curettage in patients with CSP is safe and effective in reducing intraoperative hemorrhage. Gestational sac size, parity, embolic agent diameter, multivessel blood supply, and incomplete embolization of all arteries supplying blood to the uterus are risk factors of poor hemostasis.

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Most cited references 27

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WHO analysis of causes of maternal death: a systematic review.

Khalid Khan, Daniel Wojdyla, Lale Say … (2006)

The reduction of maternal deaths is a key international development goal. Evidence-based health policies and programmes aiming to reduce maternal deaths need reliable and valid information. We undertook a systematic review to determine the distribution of causes of maternal deaths. We selected datasets using prespecified criteria, and recorded dataset characteristics, methodological features, and causes of maternal deaths. All analyses were restricted to datasets representative of populations. We analysed joint causes of maternal deaths from datasets reporting at least four major causes (haemorrhage, hypertensive disorders, sepsis, abortion, obstructed labour, ectopic pregnancy, embolism). We examined datasets reporting individual causes of death to investigate the heterogeneity due to methodological features and geographical region and the contribution of haemorrhage, hypertensive disorders, abortion, and sepsis as causes of maternal death at the country level. 34 datasets (35,197 maternal deaths) were included in the primary analysis. We recorded wide regional variation in the causes of maternal deaths. Haemorrhage was the leading cause of death in Africa (point estimate 33.9%, range 13.3-43.6; eight datasets, 4508 deaths) and in Asia (30.8%, 5.9-48.5; 11,16 089). In Latin America and the Caribbean, hypertensive disorders were responsible for the most deaths (25.7%, 7.9-52.4; ten, 11,777). Abortion deaths were the highest in Latin America and the Caribbean (12%), which can be as high as 30% of all deaths in some countries in this region. Deaths due to sepsis were higher in Africa (odds ratio 2.71), Asia (1.91), and Latin America and the Caribbean (2.06) than in developed countries. Haemorrhage and hypertensive disorders are major contributors to maternal deaths in developing countries. These data should inform evidence-based reproductive health-care policies and programmes at regional and national levels. Capacity-strengthening efforts to improve the quality of burden-of-disease studies will further validate future estimates.

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Cesarean scar pregnancy: a systematic review of treatment studies.

Kathrine Birch Petersen, Elise Hoffmann, Christian Rifbjerg Larsen … (2016)

To study treatment modalities for cesarean scar pregnancies (CSPs), focusing on efficacy and complications in relation to study quality.

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Cesarean Scar Pregnancy: A Systematic Review.

Togas Tulandi, Natalia L Gonzalez (2017)

A relatively new type of ectopic pregnancy is cesarean scar pregnancy (CSP). This is related to the increasing number of cesarean deliveries and the advances in imaging. There are 2 types of CSP: CSP with progression to the cervicoisthmic space or uterine cavity (type I, endogenic type) or with deep invasion of scar defect with progression toward the bladder and abdominal cavity (type II, exogenic type). The endogenic type of CSP could result in a viable pregnancy, yet with a high risk of bleeding at the placental site. The exogenic type could be complicated with uterine rupture and bleeding early in pregnancy. Because early diagnosis and treatment are important for the best outcome, every pregnant woman with a history of cesarean delivery should be screened early in the first trimester of pregnancy. Diagnosis can be achieved with ultrasound and Doppler imaging. To date, there have been only 5 randomized studies on CSP, and evidence-based management remains unclear. Until then, treatment should be individualized according to many factors including clinical presentation, beta-human chorionic gonadotropin levels, imaging features, and the surgeon's skill.

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Author and article information

Journal

Journal ID (nlm-ta): J Int Med Res

Journal ID (iso-abbrev): J Int Med Res

Journal ID (publisher-id): IMR

Journal ID (hwp): spimr

Title: The Journal of International Medical Research

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 0300-0605

ISSN (Electronic): 1473-2300

Publication date (Electronic): 19 January 2021

Publication date Collection: October 2020

Volume: 48

Issue: 10

Electronic Location Identifier: 0300060520964379

Affiliations

[1 ]Department of Radiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, P.R. China

[2 ]Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, P.R. China

Author notes

[*]Guangyao Wu, Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 East Lake Road, Wuchang District, Wuhan 430071, P.R. China. Email: wuguangy2002@ 123456126.com

Author information

Hongan Tian https://orcid.org/0000-0001-6887-8598

Shunzhen Li https://orcid.org/0000-0001-7110-9570

Wanwan Jia https://orcid.org/0000-0002-8395-6459

Kaihu Yu https://orcid.org/0000-0001-5689-8401

Guangyao Wu https://orcid.org/0000-0002-3966-9268

Article

Publisher ID: 10.1177_0300060520964379

DOI: 10.1177/0300060520964379

PMC ID: 7967858

PubMed ID: 33467974

SO-VID: 71993fbe-2c10-43bf-9c75-45f1b153c15a

License:

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 1 April 2020

Date accepted : 14 September 2020

Funding

Funded by: Xianning Science and Technology Bureau;

Award ID: 2018043

Custom metadata

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Keywords: ectopic pregnancy,uterine artery,embolization,multivessel,hemorrhage,cesarean section

Data availability:

Keywords: ectopic pregnancy, uterine artery, embolization, multivessel, hemorrhage, cesarean section

Risk factors for poor hemostasis of prophylactic uterine artery embolization before curettage in cesarean scar pregnancy

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Abstract

Objective

Methods

Results

Conclusions

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International Journal of Medicine and Medical Research

Most cited references 27

WHO analysis of causes of maternal death: a systematic review.

Cesarean scar pregnancy: a systematic review of treatment studies.

Cesarean Scar Pregnancy: A Systematic Review.

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