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

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