Purpose: To investigate the efficacy of uterine arterial embolization (UAE)
in patients with post-partum hemorrhage (PPH). Materials and Methods: The subjects were
40 women (mean age, 33 years; age range, 21 - 42
years) who underwent UAE for PPH at two institutes from June 2001 to May 2011.
The rates of clinical success (avoidance of hysterectomy) and complications
were calculated. Differences in related factors between primary PPH and
secondary PPH and between caesarean section and vaginal delivery were examined.
The risk factors associated with hysterectomy were also examined. Results: The overall
clinical success rate was 90% (93% of primary PPH, 77% of secondary PPH, and
87.5% of PPH with cesarean section), and the overall complication rate was 10%.
There were significant differences in time to PPH (P < 0.0001) and in blood
infusion after UAE (P = 0.0158) between subtypes of primary and
secondary PPH and in blood infusion before UAE (P = 0.0052)
between delivery methods. The significant factors associated with hysterectomy
were cesarean section (P = 0.02), severe PPH (>1000 mL bleeding, P = 0.03),
and embolization of non-uterine arteries (P = 0.02).
The aim of this retrospective case series report
is to evaluate systemic methotrexate therapy in conjunction with uterine artery
embolization (UAE) in the conservative management of cervical pregnancy. We
examined clinical presentations, treatments, and therapeutic outcomes in
fifteen patients with a cervical pregnancy who wished for preservation of
fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve
patients received systemic methotrexate including five treated with UAE. One
was treated with UAE alone. Two patients received neither UAE nor methotrexate
because of a low human chorionic gonadotropin (hCG) level and poor blood flow
around the gestational sac (GS). An increased GS size and the elevated hCG
level during methotrexate therapy might be risk factors for emergent UAE. Two
of six patients treated with UAE had subsequent confirmed viable pregnancies.
In patients with a cervical pregnancy, methotrexate therapy in combination with
UAE can be considered as an option before performing a hysterectomy with
suitable counseling about the risk of loss of fertility. Careful observation of
the GS size and hCG level during methotrexate therapy might be important for