Endovascular Interventions in Obstetric Emergencies: A Game changer

Background: To evaluate role of endovascular IR procedures in obstetric emergencies. Method(s): In this ethically approved study a total of 33 patients presenting with obstetric emergencies were recruited during the period September 2017 to October 2018 after taking informed consent. The clinical success and complications were evaluated. Result(s): The spectrum of obstetric emergencies encountered were uterine arteriovenous malformations in 13 (40%) patients, retained products of conception or retained adherent placenta in 8 (24%), placenta accreta in 8 (24%), retained products of conception with secondary arteriovenous malformations in 3 (9%) patients, and pseudoaneurysm in 1 (3%) patient. A total of 28 uterine artery embolizations (repeat procedure required in 3 patients) were performed with clinical success in all the patients. Prophylactic intraoperative balloon occlusion of bilateral internal iliac arteries was done in 8 patients with suspected placenta accreta. Of these 3 patients (37.5%) had focal placenta accreta which separated after delivery of baby whereas the remaining 5 (62.5%) patients underwent hysterectomy with mean intraoperative blood loss of 3.31 (0.8- 6.8) litres and relative ease of hysterectomy for surgeons. There were no major complications, however minor complications were seen in 10 (30%) patients. These included periprocedural pain in 3 (9%) patients, post embolization syndrome in 5 (15%) patients and puncture site hematoma in 2 (6%) patients. All these resolved on conservative management. Conclusion(s): Interventional radiological procedures are helpful in obstetric emergencies with significant clinical success rate and low complication rate.

 

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Publication History

Article published online:
11 May 2021